benzodiazepine (sleeping pill/treatment of insomnia)
1st generation antihistamine (Benadryl)
benzodiazepine (treatment of long term insomnia)
TCA antidepressant (trycycline antidepresant)
The principal structures affected by muscarinic activation are the
heart, exocrine gland, smooth muscle
the primary indication for the use of bethanechol is
the best-known muscarinic antagonist is
blockage of muscarinic receptors on salivary glands can ______ thereby causing ___ also known as ___-
inhibiti salivation, dry mouth, zero stomia
___ and ____ are the two drugs most often used for urge incontinence
oxybutin and troterodine
the principal indication for ___ is the treatment of myasthenia gravis
overdose with cholinesterase inhibitors causes ___ and ___
excessive muscarinic stimulation and respiratory depression
____ is the drug of choice for treating poisoning by atropine and other drugs that cause muscarinic blockade
the only clinical indication for the irreversible cholinesterase inhibitors is ___
___ is the only depolarizing neuromuscular blocker in clinical use in the US
paralysis with succinylcholine peaks about __ minute after administration and fades completely __ to __ minutes later
1, 4, 10
treatment of malignant hyperthermia consists of ____ ____ and _____
stop druc (d/c), ice pack -cool them, dantrolone-antidote
use of succinylcholine promotes which electrolyte disturbance?
the two therapeutic responses to activation of alphaz receptors are ___ and ___
vasoconstriction and mydriasis
therapeutic applicaiton of beta1 activation include __ __ __ __
cardiac arrest, heart failure, shock, and atrioventricular heart block
therapeutic applicaitons of beta2 activation include _ and ___
asthma and delayed preterm laybor
the most important adverse response to beta activation is ___-
dopamine is used in schock because it can ___ thereby ___ . Success is evaluted by monitoring __
dilate renal blood vessels, increase renal profussion, increase urine output
alpha antagonist lower blood pressue by ___
alpha-adrenergic blocking agents are effective in treating which peripheral vascular disease?
the most serious response to alpha-adrenergic blockade is ____
a relatively new use for beta blockers is its role as a standard treatment for ___
adverse effects of beta2 blockers include ___ and ___
bronchoconstriction and inhibition of glycogendysis
the primary indication for reserpine is ___ and the side effect of greatest concern is ___
adverse effects of reserpine on the cardiovascular system include ___ ___ and ___
bradycardia, orthostatic hypotension, and nasal congestion
the only indication for the use of methyldopa is ___-
two potentially severe side effects of methyldopa are ___ and ___
hemolytic anemia and hepatotoxicity
neuroleptic-induced parkinsonism is treated with some of the drugs used for parkinson's disease. However, ___ and ___ must not be used, because the will counteract the beneficial effects of the antipsychotic treatment
levodopa, and direct dopamine agonist
___ is characterized by pacing and squirming borught on by an uncontrollable need to be in motion. The three drugs used to suppress symptoms include ____ _____ and ___-
betablockers, benzodiazepines, and antichilinergics
___ is characterized by involuntary choreoathetoid movements of the tongue and face.
neuroleptic malignant syndrome is characterized by _____ _____ _____and ____.
lead pipe rigidity ,sudden high vever, sweating, and autonomic stability
___ is the prototype of the high-potency first generation antipsychotics
____ are the most widely prescribed antidepressants
What is the mechanism of action of fluoxetine?
inhibition of serotonin reuptake
initial responses to antidepressants develop in _____weeks and maximal resposes develop over _____
1-3 weeks, 12 weeks
MAOIs can cause severe hypertension if the patient eats food rich in ____
the most serious adverse effect of bupropion therapy is ____
although the exact causes of bipolar disorder is unknown, it is clear that symptoms are caused by ____
the principal mood stabilizers for bipolar disorder are ___ ___ and ___
carbamazepine, lithium, and valprolic acid
the two drugs used for acute management of manic episode are __ and __-
lithium an dvalproic acid
patients receiving lithium therapy are advised to maintain a normal intake of foods containing which electrolyte?
Maintenance levels of lithium should be kept between___ and ___
For therapeutic doses of benzodiazepine therapy can result in __ __ __ __ __ and __
anxiety, insomnia, seizure disorders, muscle spasm, panic disorder, and perioperative applicaiton
3 adverse effects for a patient who overdoses on oral benzodiazepines are
CNS depression, anterograde amnesia, and cannot use w/pregnancy
Barbiturates reduce ventilation through ___ and ___
respiratory drive chemoreceptive mechinism
Acute barbiturate overdose produces a classic triad of symptoms __ __ and __
respiratory depression, coma, and pinpoint pupils (myosis)
___ are drugs of first choice for the short-term treatment of insomnia
The 2 classes of drugs used most commonly for anxiety disorders are ___ and ___
Benzos, and SSRI
____ are the first-choice drugs for anxiety
Only three antidepressants __ __ and __ are approved for general anxiety disorder
venlafaxine-SNRI, paroxietine-SSRI, and escitalopram-SSRI
Panic disorders respond well to all three major classes of antidepressants
SSRI, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOI)
The amphetamines work primarily to ___ and partly to ___
release norepinephrine (NE) , release dopamine (DA) & prevent reuptake of NE & DA
Adverse effects of amphetamine include __ __ __ and __
CNS stimulation, weight loss, cardiovascular effects, and psychosis
Methyphenidate has two indications __ and __
Caffeine is thought to relieve headaches because of it's ability to ___
constrict cerebral blood vessels
the first nonstimulant approved for ADHD is
Symptoms of Parkinsions disease include __ __ __ and __
tremor @ rest, rigidity, postural instability, and brady kinesia
What is the neurochemical basis of parkinsonism
imbalance of dopamine & ACH
___ is the most effective treatment for Parkinsions
why is Parkinsions treated with levodopa and not wth dopamine?
Dopamine cannot cross the blood-brain barrior
The anticholinergic agents used most often in the treatment of Parkinsions are ___ and _-
Benztroine, Artane (trihexyphenidyl)
In patients with Alzheimer's disease, levels of acetylcholine are __ below normal
___ are the first drugs approved by the US food and Drug administration for the treatment of Alzheimer
The three cholinesterase inhibitors recommended for the treatment of Alzheimer are
Donepezil, Galantamine, Rivastigmine
___ carries a significant risk of liver damage and should be avoided
___ was able to stabilize or improve cognitive performance and social behavior for 6-12 months in patients with uncomplicated Alzheimer's disease
Multiple sclerosis is a __ __ __ disorder that damages the __ of neurons in the CNS, causing a wide variety of sensory and motor deficits
chronic, inflammatory, autoimmune, myelin sheath
Initially, most patients experience periods of ___ alternating with periods of ___
The two main groups of disease-modifying drugs are __ and __
A short course of ___ is the preferred treatment for an acute relapse
At this time, only one immunosuppressant __ has been approved for the treatment of MS
___ is a general term that applies to all types of epileptic evens; in contrast, __- has a more limited meaning, applying only to abnormal motor phenomena
Status epilepticus is defined as ___ min or longer
30 min or longer
The drug most widely use to treat epilepsy is ____
___ juice can cause the plasma levels of carbamazepine to rise
The three traditional drugs for epilepsy are? ; the three new are ?
traditional- phenytonin, carbamazepine, valproic acid
new- oxcarbazepine, gabapentin, zonisamide
how do local anesthetics work?
by blocking sodium channels - blocking impuses conduction along axon
The two major groups of local anesthetics are __ and __
In what orders is sensation lost when a local anesthetic is used?
1st- pain perception, 2nd- cold, 3rd-warmth, 4th-touch, 5th-deep pressure
Local anesthetics are frequently administered in combination with a vasoconstrictor, usually __. The benefits of the vasoconstrictor include __ and __
epinephron, reduce toxicity, prolong anesthesia
___ refers specifically to loss of sensibility to pain, and ___ refers to the loss not only of pain, but also of all other sensation
The risk of malignant hyperthermia, is greatest when an inhalation anesthetic is used in combination with ____
Preanesthetic medications are administered to __ __ and __-
Benzodiazepines-reduce anxiety, may produce amnesia
Opiods-pain, suppress cough
Clonidine-allow to give lower dose
Anticholinergic druugs are given with general anesthesia to ___
Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would you use to evaluate a successful response?
increase urine output
A patient brought to the emergency department requires sutures. the prescriber orders a local anesthetic with epinephrine. Epinephrine is orders to:
prolong absorption of anestesia
A patient with asthma uses albuuterol (Ventolin) for wheezing. You assess the patient and notes vital signs of HR, 96 beats per minute; RR 18 breaths per minute; and BP 116/78 mm Hg. The patient has clear breath sounds and hand tremors. What will you do?
ask how often pt use inhaler
You are teaching parents how to use an Epi-Pen for their child, who has a peanut allergy. Which statement by the parents indicates understanding of the teaching regarding their need for emergent care after the shot is injected?
The child still needs to go to the hospital
Because they cause vasoconstriction, alpha1-adrenergic agonist are especially useful for
prolong duration of anestetic
A student ask why albuterol, which is selective for beta2 receptors, causes an increased heart rate in some patients. How should you respond? (Think about what happens at higher doses)
Lose selectivity (think about the heart)
A patient with pheochromocytoma is admited for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. Why?
tumor releases catacholamin- we give them epinephren to allow vasoconstriction to happen. All in all we are preventing a preoperative crisis
A patient with type I diabetes is taking NPH insulin, 30 units every day. The patient is also taking metoprolol (Lopressor) what education should you provide to the patient?
beta blockers will mask tachycardia
You are discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching regarding the appropriate time of day for the mediation?
orthostatic hypotension, take it @ bedtime
You prepare to administer propranolol (inderal) to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should you take next?
Hold dose- contact physician
A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. you auscultate crackles in all lung fields. You understands that these assessments are consistent with what cardiac condition: left side heart failure
left side heart failure (CHF)
A male patient is being treated for benign prostatic hyperlasia and has stopped taking his alpha-adrenergic antagonist medication because of ejaculatory difficulties. Which medicaiton is available in its stead?
How would a person take a Beta Blocker for migranous attacks?
take profalacticly- low dose
A patient has taken levodoopa (dopar) for parkinson's disease for 2 weeks but reports no improvement in the symptoms. What will you tell the patient about their progression?
takes several months
You are discussing motor symptoms with ap atient with parkinson's disease who has been taking levodopa/carbidopa (sinemet) and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?
lower the dose of levodopa
A patient who has begun taking levodopa/carbidopa (Sinemet) reports feeling lightheaded and dizzy, especially when standing up from a sitting position. what will you recommend?
Increase fluid & salt intake
A patient with schizophrenia has been taking an antipsychotic drug for several days. You enter the patient's room to administer a dose of haloperidol (Haldol) and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What medication might you give?
Didrohydromine - anticolonergic antihistamine
A patient taking a first-generation antipsychotic (FGA) medication develops severe parkinsonism and is treated with amantadine (symmetrel) the amantadine is withdrawn 2 months later, and the parkinsonism returns. You expect the provider to: give
2nd generation antispsychotics
A patient is taking an FGA for schizophrenia. You note that the patient has trouble speaking and chewing and observe slow, wormlike movements of the patient's tongue. You recognize which adverse effect in this patient?
You provide teaching for a patient about to begin taking a first-generation antipsychotic drug for schizophrenia. which statement indicates a need for further teaching about side effects of these drugs?
anticholenergic effects, sedation, extra peramidol
A patient has been taking fluoxetine (Prozac) for 11 months and reports feeling cured of depression. the patient is sleeping well, participates in usual activities, and feels up beat and energetic most of the time. the patient's weight has returned to normal. What will you tell this patient?
can switch to delayed release weekly dosing or withdraw
A patient who has been taking a monoamine oxidase inhibitor for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. You will teach this patient to :
It will take at least 14 days to be effective
a patient taking fluoxetine (Prozac) complains of decreased sexual interest. A prescriber orders a "drug holidy." what teaching by the nurse would best describe a drug holiday?
Don't take on Friday and Saturday. This is a discontinuation of the drug to have the body not desensitize the drug. To keep the receptors open for the drug to stay effective.
a patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, you learn that the patient has quit participating in curch and social activities, has diffficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What do you suspect?
Patient shows symptoms of major depression
A neonate is born to a patient who reports taking venlafaxine (Effexor XR). The nurse caring for the infant will observe the infant for:
irritability, tremor, and respiratory distress
A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching?
"TCAs have many side effects, but none of them are serious."
An older adult patient who is to begin taking imipramine (Tofranil) asks the nurse when the drug should be taken. The nurse will instruct the patient to
divide the daily dose into two equal doses 12 hours apart
A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug?
A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone (Risperdal) in addition to the lithium (Lithobid) that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to:
help control symptoms during manic episodes
A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium (Lithobid), which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching?
"I can continue to use ibuprofen as needed for muscle pain."
Because nonsteroidal anti-inflammatory drugs (NSAIDs) can increase lithium levels as much as 60%, they should not be used by patients taking lithium.Antihistamines have anticholinergic effects, which cause urinary hesitancy; this can be uncomfortable when patients experience the polyuria associated with lithium use. Muscle weakness and tremors can occur with lithium; tremors can be treated with beta blockers or by altering the lithium regimen.