exam 2

• Cholinergic drugs are contraindicated for patients with:

  Asthma, COPD, bradycardia, arrhythmias, intestinal obstruction, urinary tract obstruction
• Anticholinergic drug side effects


  CBUDD: constipation, blurred vision, urinary retention, dry mouth, drowsiness
• Nursing interventions for anticholinergics

  Monitor pulse and BP, monitor urine output, promote hydration
• Signs of cholinergic overdose 


  Bronchospasm, miosis, bradycardia, hypotension, excessive sweating, hypersalivation, muscle weakness/ paralysis
• Scopolamine


  Anticholinergic

  Indications: prevent postop nausea and vomiting and motion sickness

  Contraindications: angle- closure glaucoma

  Side effects: Hallucination, confusion, blurred vision

  Adverse effects: coma, lethargy, convulsion, dry mouth, urinary retention, HTN, tachycardia
• Treatment for acute asthma attack- epinephrine, albuterol, metaproterenol, methylxanthines
• Side effects of asthma treatment-

  TICK=tremor, increased blood glucose, cough, K increase
• Diphenhydramine


  Uses: allergic rhinitis, pruritis, urticria, common cold, sneezing, cough, motion sickness prophylaxis

  Contraindications: closed-angle glaucoma, urinary retention, severe liver disease

  Education: do not take with alcohol or other depressants
• Digoxin


  Secondary drug of choice for heart failure

  Has long half life (toxicity)

  Therapeutic range= 0.2-8.0

  Thyroid disease- leads to altered metabolism, dose must be increased for hyperthyroidism and decreased for hypothyroidism

  Monitor serum potassium
• Digitalis toxicity- caused by overdose/ accumulation of digitalis (digoxin).

  Hypokalemia can increase chance of digoxin toxicity.
• Digitalis antidote- Digoxin immune Fab
• Digitalis toxicity symptoms- loss of appetite, N/V/D, bradycardia, dysrhythmias, blurred vision, halos around objects
• Nitrates- cause vascular and coronary vasodilation which increases blood flow through arteries to myocardial cells.

  Monitor blood pressure
• Nitroglycerin routes of administration

  Sublingual tablet (faster onset), transdermal patch, topical ointment
• Antidysrhythmic side effects- headache, nausea, thirst, dizziness, constipation
• Thiazides and thiazide-like diuretics: treat HTN and edema in those with normal renal function

  Monitor calcium, glucose, uric acid, lipids, and electrolytes
• Loop diuretics (furosemide and bumetanide)- Act on ascending loop of Henle to inhibit passive reabsorption of sodium.

  Monitor blood glucose, potassium, sodium, uric acid, cardiac output, and blood pressure
• Potassium sparing diuretics (spironolactone)- block action of aldosterone to promote sodium and water excretion and potassium retention.

  Monitor potassium (If K>5.0, discontinue drug)
• Beta adrenergic blockers (beta blockers; propranolol, metoprolol, acebutolol)- reduce cardiac output by reducing the sympathetic nervous system response. Vascular resistance is diminished which leads to decreased blood pressure.

  Side effects: Decreased pulse, decreased blood pressure, bronchospasm, dizziness, erectile dysfunction, hypoglycemia
• Alpha adrenergic blockers (doxazosin, prazosin)- blocks alpha1 adrenergic receptors which results in vasodilation and decreased blood pressure.

  Side effects- orthostatic hypotension, nausea, HA, drowsiness

  Education- do not drive, monitor blood pressure
• ACE inhibitors (fosinopril, benazepril)- inhibits formation of angiotensin II which blocks release of aldosterone. Increases sodium excretion and retains potassium.

  Side effects- dry irritating cough, N/V/D, angioedema

  Monitor potassium and blood pressure
• Thrombolytics- bind to fibrin, promoting conversion of plasminogen to plasmin. Disintegrates clot

  Side effects: anaphylaxis, dysrhythmias, hemorrhage, dehydration

  Monitor skin and vitals
• Warfarin- inhibits hepatic synthesis of vit k, thus affecting clotting factors to prolong clotting time

  Side effects: excessive bleeding, dehydration, bruising, blurred vision, headache, confusion, internal/ external bleeding

  Monitor PTT (partial thromboplastin time) and INR

  Antidote: Vit K
• Heparin- bind with antithrombin III to inhibit action of thrombin, inhibit conversion to fibrin, and inhibit clot formation.

  Side effect: bleeding, bruising, weakness, dizziness

  Antidote: Protamine sulfate

  monitor PTT and INR
• Aspirin- Effective and inexpensive treatment for suppressing platelet aggregation

  Prevent stroke, myocardial infarction, and thromboembolism
• HMG CoA reductase inhibitors (statins)- inhibit HMG CoA reductase in cholesterol biosynthesis to decrease LDLs and increase HDLs

  Side effects: GI disturbances, headache, muscle cramps, fatigue, serum liver enzymes (damage to liver cells), cataracts

  Monitor homocysteine (4-17 mmol/L)- high levels indicate CV disease, stroke, etc

  Monitor high sensitivity CRP (high risk= >3)- detects plaque build up in coronary arteries
• Niacin (nicotinic acid)- reduced VLDL and LDL.

  Side effects= dizziness, headache, edema, weakness, GI distress, flushing, liver damage, hyperglycemia, hyperuricemia
• Bile acid sequestrants- reduce LDL cholesterol by binding with bile acids in the intestine

  Side effects: anorexia, cramping, N/V, constipation, flatulence, steatorrhea, GI bleeding, peptic ulcer, folate deficiency
• Osmotic diuretics- decrease intracranial pressure, decrease intraocular pressure, promote excretion of toxic substances
• statin- HMG CoA
• pril- ACE inhibitor
• artan- ARBs
• olol- Beta blockers
• Diuretics- decrease blood pressure and edema
• Anticholinergics- inhibit sympathetic response (stops rest and digest)
• Cholinergic drugs- promote sympathetic response (rest and digest)