Shared Flashcard Set

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Test 1
Pharm test 1
39
Nursing
Undergraduate 4
05/23/2010

Additional Nursing Flashcards

 


 

Cards

Term
Amyotrophic Lateral Sclerosis
Definition
progressive weakness & wasting of muscles, destruction of motor neurons
Term
Alzheimer’s disease
Definition
progressive loss of brain function (memory loss, confusion, & dementia)
Term
Huntington’s Chorea
Definition
progressive dementia and involuntary spasmodic movement
Term
Multiple Sclerosis
Definition
progressive weakness, visual disturbances, mood alteration, cognitive deficits
Term
Parkinson’s Disease
Definition
Progressive loss of dopamine causes tremor, muscle rigidity, abnormal movement and posture
Term

Parkinson’s Disease

Definition
  • Degenerative disorder of the CNS – progressive
  • Affects mostly people over 50
  • Lack of the neurotransmitter dopamine Affects more than 1.5 million Americans
  •  Pharmacology only partially relieves symptoms
Term
Parkinson’s Disease Symptoms
Definition
  • Tremors –shakiness, pill rolling
  • Muscle rigidity – have difficulty bending over or moving extremities, face may be rigid
  •  Bradykinesia – difficulty swallowing, chewing, speaking, shuffling feet
  • Postural instability – may be slightly humped over, lose their balance easily, falls.
Term

 

Parkinson’s Disease
Pathophysiology
Definition
—Degeneration and destruction of the dopamine producing neurons in the substantia nigra
—The substantia nigra neurons supply dopamine to the corpus striatum that controls unconscious muscle movement
—Neurotransmitters must be balanced in the corpus striatum (dopamine & acetylcholine)
—Drug therapy focuses on increasing dopamine and blocking the effects of acetylcholine
Term

 

Dopaminergics
What do they do?
Definition
Either restore dopamine function or stimulate dopamine receptors balancing dopamine and acetylcholine
—Drugs of choice
—Levadopa (l-dopa, Laradopa) – prototype
—Carbidopalevadopa (Sinemet)
—Dopamine agonists
—Ropinirole (Requip)
—May be more effective in controlling dyskinesia
Term

 

 

Levodopa (Larodopa)
Definition
  • Actions: Restores neurotransmitter dopamine
  • Administration alerts: Administer as ordered, do not stop taking abruptly (can cause an increase in acetocoline which causes parkinsonism)
  • Pharmacokinetics - Onset 30 min peak 1-3 hrs, half life 1 hr (can take weeks to see change)
  • Adverse effects - Purposeless movement, uncontrolled movement, loss of appetite, N&V, orthostatic hypotension(FALLS)
  • Drug interactions: Tricyclic antidepressants, MAOIs, antihypertensives, anticonvulsants, antacids, pyridoxine (B-6)  + ***Kava
  • Lab tests – liver enzymes  and BUN
Term

Anticholinergics

(Cogentin)

Definition

Block the effects of actylcholine in the corpus striatum  Earliest drugs used to treat Parkinson’s disease.

 Benztropine mesylate (cogentin)  (.5-1 mg/day)  Sedation, nausea, constipation, dry mouth, blurred vision, drowsiness, dizziness, hypotension, tachycardia, nervousness

Nursing Considerations:  Careful monitoring of condition and adverse reactions to medication, Monitor B/P and heart rate, Muscle twitching and mood changes may indicate drug toxicity – report to HCP at once

Client Education

* Increase fiber and fluid intake

*Avoid foods high in pyridoxine (OTC, fortified foods)

*Report muscle spasms, spasmodic winking, and increase in bradykinesia

*Takes up to six months for therapeutic levels to be achieved

*Do not stop taking medicine abruptly

*Change positions slowly

Term

Alzheimer’s Disease

Definition
  • Responsible for 70% of all dementia
  • Progressive memory loss, confusion, inability to think or communicate effectively
  • 4th leading cause of death in the US
  • Etiology unknown
  • Familial form; environmental, immunological, and nutritional factors, Structural damage in the brain- loss in number and function of neurons, Deficit in tasks that require the neurotransmitter acetycholine.

Symptoms

Impaired Memory Loss                                               Confusion and disorientation

Inability to recongnize family and friends                Aggressive Behavior

Depression                 Psychosis             Anxiety

 

Term

 

Donepezil
(Aricept)
Alzheimer's Disease
Definition

—Pharmacokinetics
—<20 minutes, peak 3-4 hrs, half life 70 hours
—Actions/uses
—Enhances the effects of acetylcholine in the neurons that have not been damaged, effects may not be seen for six months, effects modest at best
—Administration
—Give at bedtime
Term

Acetylcholinesterase Inhibitors

 

Donepezil (Aricept)

 

Definition
  • Pharmacokinetics <20 minutes, peak 3-4 hrs, half life 70 hours
  • Actions/uses Enhances the effects of acetylcholine in the neurons that have not been damaged, effects may not be seen for six months, effects modest at best
  • Administration Give at bedtime NEED REGULAR SCHEDULE
  • Adverse effects V&D, dark urine, insomnia, syncope, depression, HA, irritability, muscle cramps, arthritis, bone fractures, fatigue, chest pain, >libido, hot flashes, incontinence, dehydration, blurred vision
  • Interactions- phenobarb, phenytoin, dexamethazone, and rifampin may speed metabolism (speed the metabolism of Aricept)
  • Nursing Considerations Careful monitoring of condition and adverse reactions to medication Monitor B/P and heart rate Monitor for changes in mental status, mood changes, dizziness, confusion, insomnia, anorexia, N&V
  • Client Education Take drug as prescribed Know and report major side effects Report changes in mental status or mood Takes up to six months for therapeutic levels to be achieved Frequent drinks of cool liquid or sugar free hard candy, or sugar free gum for dry mouth Increase fiber and fluid intake
Term

Muscle Spasm

Definition

Associated with excessive use or local injury, antipsychotic drugs, epilepsy, hypocalcemia pain, and neurological disorders

 

Symptoms:

  • Inflammation
  • Edema
  • Pain
  • Loss of mobility/coordination
  • Tonic (tightening of muscles) / Clonic spasms (relaxation)
Term

 

Centrally Acting

 

Skeletal Muscle Relaxants

Definition

 

Probably inhibit upper motor neuron activity

 * CNS depression

 * Alter spinal reflexes

Commonly Used Drugs:

1: Baclofen (Lioresal)

2. Cyclobenzaprine (cycloflex, flexeril)

3. Tizanidine (Zanaflex)

4. Benzodiazepines (Valium, Klonopin, Ativan) (Seizure Control)

Term

 

Cyclobenzaprine

 

(cycloflex, flexeril)

 

Muscle Relaxant

Definition

Actions/Use: Depresses motor activity at the brain stem.

Increases circulating levels of norepinephrine.

Not effective for CP or diseases of the brain or spinal cord.

 

Administration: Not recommended for children

Maximum effects may take up to 2 weeks

 

Pharmacokinetics: Onset 1 hour Peak 3-8 hrs/duration 12-14 hrs Half life 1-3 days

 

Adverse effects: Drowsiness, blurred vision, dizziness, dry mouth, rash, tachycardia

 

Interactions: Alcohol, other CNS depressants, MAOIs

Term

Muscle Spasticity

Definition

Usually secondary to cerebral cortex injury:

(CP, head and spinal cord injury or lesion, stroke.)

  • Symptoms: 1) Involuntary muscle contraction Painful movement or posture
  • Treatment: PT and antispasmodics
Term

 

Antispasmodics

Definition

Centrally acting (CNS)

 

Baclofen (lioresal)

Diazapam (valium)

 

Direct acting (on muscle)

 

Dantrolene Sodium (Dantrium)

Botulinum toxin (botox)

Quinine sulfate

Term

Dantrolene Sodium (Dantrium)

Antispasmodics

Definition

Action/Uses Interferes with the release of calcium ions from inside skeletal muscle cells Spinal cord injury, stroke, CP, MS,

Administration Use oral solution within days (no preservative) IV – high PH, very irritating Dantrolene Sodium (Dantrium) – prototype

Pharmacokinetics Onset 1-2 hours Peak 5 hours/ duration varies Half life 4-8 IV, 8-9 PO

Adverse effects Muscle weakness, dry mouth, drowsiness, dizziness, nausea, diarrhea, tachycardia, erratic B/P, urinary retention, photosensitivity

Interactions Not with OTC cough preparations or antihistamines Alcohol Other CNS depressants

Nursing Considerations Careful monitoring of client conditions  Monitor lab tests when indicated May need assistance in taking meds. (because of spasticity)

Client Education Avoid driving and other potentially hazardous activity Report changes in sensorium, chest pain, palpitations, dyspnea, fatigue, visual disturbances, urine retention Other medications, OTC, herbals DC alcohol ROM exercises Do not DC medicine abruptly – may cause seizures

Term

Endocrine System

Definition
  • Consists of glands that secrete hormones
  • Maintains homeostasis using hormones as chemical messengers   *Secreted in response to changes in internal environment
  • Hormone release commonly controlled by negative feedback    *One hormone may control another
  • Negative Feedback: *Common for last hormone in a pathway to provide feedback * Turns off secretion from first hormone. * Prevents over responses by endocrine system.
  • Hypothalamus and Pituitary Glands: Control many other glands
  • Hypothalamus secretes releasing hormones (Directs anterior pituitary gland as to which hormones should be released)
  • Hypothalamus sends nerve signals (Posterior pituitary releases hormones)
Term

 

 

Hormone Pharmacotherapy

Definition

Hormones used as

  • Replacement therapy
  • Antineoplastics
  • Natural therapeutic effects (Exaggerated response or suppression of body defenses)
  •  Hormone blockers used to inhibit actions of certain hormones
Term

 

 

Pituitary and Hypothalamic Hormones

Definition

Only a few hormones have clinical application

  • Difficult and expensive to obtain
  • Usually more effective to give hormone that directly affects secretion

Commonly used for replacement are

*** Prolactin, oxytocin ** 

 

1) Corticotropin, growth hormone

2) Antidiuretic hormone (ADH)

Term

 

 

Growth Hormone (GH)

Definition

Stimulates growth and metabolism

**Deficiency results in dwarfism

Recombinant DNA technology has produced pharmacotherapy Somatrem (Protropin) and Somatropin (Humatrope) "used most often"

**Recently approved to treat small stature associated with normal levels of growth hormone (GH)

 

Excess secretion results in acromegaly (adults)

Term

 

 

Antidiuretic Hormone (ADH)

Definition

Conserves water in body

    **Diabetes insipidus is caused by deficiency of ADH (uncontrolled diaresis, Major fluid loss.. low ADH)

 

Most common form of ADH: desmopressin (DDAVP)

***Long duration of action (20 hours) *** Forms: nasal spray, oral, intravenous, subcutaneous

 

Other drugs: vasopressin (Pitressin) and lypressin (Diapid)

  • Short duration of action (2–8 hours)
  • Only given via intramuscular or subcutaneous routes
Term

 

 

Anterior Pituitary Hormone

 vasopressin injection (Pitressin)

Definition

Mechanism of action: causes renal collecting tubules to increase their permeability to water. & Enhances water reabsorption

 

Primary use: treatment of diabetes insipidus

 

Adverse effects: hypertension! * Can precipitate angina episodes and myocardial infarction in clients with coronary artery disease.  * Excessive fluid retention can cause water intoxication.

 

Nursing Considerations: Assess for electrolyte imbalances, Assess for changes in specific gravity and fluid intake. Monitor serum sodium and potassium levels. Monitor urinary specific gravity, routine urinalysis. Monitor body weight and fluid intake/output. Assess vital signs, especially blood pressure and pulse

Term

Thyroid Gland

Definition

Secretes thyroxine (T4) and triiodothyronine (T3)

     **Control basal metabolic rate and affect every cell in body

Parafollicular cells in thyroid secrete calcitonin

    **Responsible for calcium homeostasis

Follicular cells secrete thyroid hormone

  ***Thyroxine (T4) and triiodothyronine (T3)

  ***Iodine essential for synthesis of T4 and T3

 

   Negative-feedback loop controls secretion

 ***Low thyroxine levels signal hypothalamus to release thyroid-releasing hormone (TRH)

*** Signals pituitary to release thyroid-stimulating hormone (TSH)

Term

 

 

Hypothyroidism in Adults (Myxedema)

Definition
  • Early symptoms are: general weakness, muscle cramps, and dry skin
  • More severe symptoms include: Slurred speech, bradycardia, weight gain, Decreased sense of taste and smell, Intolerance to cold environments
  • Elevated TSH (thyroid stimulating hormone) with diminished T3 and T4 levels
Term

 

 

Pharmacotherapy for hypothyroidism

 

levothyroxine (Synthroid)

Definition

Mechanisms of action: same as those of thyroid hormone (how T3 T4 acts on the body naturally)

 

Primary use: drug of choice for replacement therapy in clients with low thyroid function

 

Adverse effects: hyperthyroidism, palpitations, dysrhythmias

***(Anxiety, insomnia, weight loss, heat intolerance Menstrual irregularities and osteoporosis in women <- these are signs of hyperthyroidism)

Nursing Considerations: ***(these are assesing for TOO MUCH stynthroid) Assess client’s weight and vital signs Assess tachycardia, irregular heart rate, hypertension Assess nervousness, weight loss, diarrhea, heat intolerance. Monitor clients with impaired renal function closely

***(these are assessing for TOO LITTLE synthroid)Monitor for excess fatigue, slow speech, hoarseness or slow pulse May indicate under dosage

Term

 

 

Hyperthyroidism

Definition

Most common type: is Grave’s disease

Goal: is to lower activity of thyroid

 

Symptoms: Increased body metabolism Tachycardia, weight loss Elevated body temperature, anxiety.

Treatment:

1: Administer thioamides, which decrease activity of thyroid gland: Propylthiouracil(PTU) and methimazole (Tapazole).

 

2: Radioactive iodide that kills overactive thyroid cells.  SUCH AS: Sodium iodide-131, Lugol’s solution

 

Goal is to lower activity of thyroid gland

 

 

Term

 

 

Antithyroid Pharmacotherapy 

 propylthiouracil (PTU)

(for hyperthyroidism)

Definition

Mechanism of action: to interfere with synthesis of T3 and T4 in thyroid gland. Also prevents conversion of T4 to T3 in target tissues

 

Adverse effects: symptoms of hypothyroidism....

***Rash and transient leucopenia are most common side effects

***Small percentage of clients experience agranulocytosis

 

Nursing Considerations:

Monitor vital signs

Monitor thyroid-function tests

Monitor for signs of infection, including CBC and WBC count

Monitor weight at least weekly

Monitor for drowsiness

Term

 

 

Adrenal Cortex

Definition

Secretes glucocorticoids:

1) Mobilize body for long-term stress

2) Influence carbohydrate, lipid, and protein metabolism in most cells

 

Secretes mineralocorticoids:

1)Aldosterone promotes sodium reabsorption and potassium secretion

 

Secretes gonadocorticoids

1)Male sex hormones (androgens)

Term

 

 

Selected Glucocorticoids

Definition
  • Adrenal glands secrete hormones affecting every body tissue
  • Specific pharmacotherapy depends on which portion of adrenal gland is responsible for the abnormal secretion
  • Chronic corticosteroid insufficiency requires replacement with glucocorticoids
  • Goal of replacement therapy is to reach appropriate level of hormones in blood
  • Glucocorticoids also prescribed to suppress inflammatory and immune responses
Term

 

 

Control of Glucocorticoids

Definition

Hypothalamus releases corticotropin-releasing factor (CRF)

  • Causes adrenocorticotropic hormone (ACTH) to be secreted by pituitary

Adrenal cortex releases glucocorticoids

 

**When cortisol level rises, negative-feedback mechanism shuts off further release of glucocorticoids

Term

Adrenocortical Insufficiency

(Addison’s Disease)

Definition

Primary adrenocortical insufficiency

 

It is rare; deficient of both glucocorticoids and mineralocorticoids

 

Symptoms:

*Hypoglycemia, fatigue, hypotension

*Increased skin pigmentation

*GI disturbances: anorexia, vomiting, diarrhea

*Low plasma cortisol, accompanied by high plasma ACTH levels

Term

Adrenal Drugs — Glucocorticoids

 

hydrocortisone

(Aeroseb-HC, Alphaderm)

Definition

Mechanism of action: acts as synthetic corticosteroid

 

Primary use: drug of choice for treating adrenocortical insufficiency

 

Adverse effects: sodium and fluid retention

CNS effects: insomnia, anxiety, headache, vertigo, confusion, depression

***Hypertension, tachycardia, peptic ulcer disease, Cushing’s syndrome (Can occur with long-term therapy)

 

Nursing Considerations: Assess: vital signs for temperature and blood-pressure elevations

Monitor: potassium, T3, T4, glucose levels

***Clients on long-term glucocorticoid therapy Monitor for osteoporosis and elevated serum cholesterol levels

***Assess for signs and symptoms of Cushing’s syndrome

Monitor: skin and mucous membranes for lacerations, abrasions, or break in integrity

Monitor: GI status for peptic ulcer development

Monitor: serum electrolytes

Monitor: changes in musculoskeletal system

Monitor: emotional stability

Term

 

 

Cushing’s Syndrome

Definition

Caused by long-term administration of glucocorticoids

 

Signs and symptoms Moon face, buffalo hump, mood and personality disorders

 

Also:  Hyperglycemia, Na and fluid retention, bruises and petichia, thin skin, osteoporosis, fate deposits on back, thin extremities

Term

 

 

Antiadrenal Drugs

Definition

Used to treat severe Cushing’s syndrome:

  • Occurs with prolonged glucocorticoid therapy 
    • Inhibits corticosteroid synthesis

Antiadrenal drugs NOT curative:

  • Use usually limited to three months of therapy
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