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Exam 2

Class Topic: Neuropharmacology (Autonomic Nervous System [ANS] Drugs)


Objectives: After studying this topic the student should be able to:

1. Define the following terms as relevant to the topic:


a. Sympathetic/adrenergic nervous system
i. Adrenergic receptors: receptors that mediate responses to epinephrine and norepinephrine
1. Alpha1, alpha2, beta1, beta2
b. Parasympathetic/cholinergic nervous system
i. Cholinergic receptors: receptors that mediate responses to acetylcholine
1. Nictoninic and muscarinic receptors
c. Acetylcholine: the transmitter employed at most junctions of the peripheral nervous system
i. All preganglionic neurons of the parasympathetic nervous system
ii. All preganglionic neurons of the sympathetic nervous system
iii. Al postganglionic neurons of the parasympathetic nervous system
iv. All motor neurons to skeletal muscles
v. Most postganglionic neurons that go to the sweat glands
d. Beta receptors
e. Belladonna alkaloids
f. Norepinephrine: transmitter released by practically all postganglionic neurons of the sympathetic
nervous system, except postganglionic sympathetic neurons that go to sweat glands
i. Alpha1, alpha2, beta1, but NOT beta2
g. Neurotransmitters
h. Alpha receptors
i. Epinephrine: the major transmitter released by the adrenal medulla
i. Alpha and beta receptors
2. Identify the major functions of the sympathetic AND parasympathetic branches of the autonomic nervous
system (ANS). (Include bodily/organ processes resulting from stimulation of either branch]
a. Parasympathetic Nervous System – housekeeping, rest and digest
i. Slowing of heart rate
ii. Increased gastric secretion
iii. Emptying of the bladder
iv. Emptying of the bowel
v. Focusing the eye for near vision
vi. Constricting the pupil
vii. Contracting bronchial smooth muscle
b. Sympathetic Nervous System – fight or flight
i. Regulating the cardiovascular system
1. Increases cardiac output
2. Vasoconstriction
ii. Regulating body temperature
1. Regulating blood flow to the skin, sympathetic nerves increase or decrease heat loss
2. Sympathetic nerves to sweat glands promote secretion of sweat
3. By inducing piloerection, sympathetic nerves can promote heat conservation
iii. Implementing the acute stress response (fight or flight)
1. Increasing heart rate and blood pressure
2. Shunting blood away from the skin and viscera and into skeletal muscles
3. Dilating the bronchi to improve oxygenation
4. Dilating the pupils (enhance visual acuity)
5. Mobilizing stored energy, thereby providing glucose for the brain and fatty acids for
muscles.
3. Describe the location and function of the alpha and beta adrenergic receptors.

a.

b.
c.
d. Alpha1 Receptors
i. Eyes: mydriasis (dilation)
ii. Blood vessels: vasoconstriction
iii. Male sex organs: ejaculation
iv. Bladder: contraction
e. Alpha 2 receptors
i. Location: presynaptic nerve terminals
ii. Regulates transmitter release by suppressing further release of norepinephrine or epinephrine.
iii. Helps reduce transmitter release when too much transmitter has accumulated in the synaptic
gap.
f. Beta 1 receptors
i. Heart: increase rate, increased force of contraction, increased AV conduction velocity
ii. Kidney: release of renin to increase blood pressure.
g. Beta 2 receptors
i. Lungs: bronchial dilation
ii. Uterus: relaxation
iii. Heart, lungs, skeletal muscle: vasodilation (opposite of alpha 1 activation)
iv. Liver and skeletal muscle: glycogenolysis, increases blood glucose
4. Identify and compare the actions of four categories of drugs that affect the ANS; (sympathomimetic/adrenergic,
sympatholytic, parasympathomimetic/cholinergics & parasympatholytics)
a. Sympathomimetic/adrenergic agonists
i. Direct receptor binding: bind to adrenergic receptors and mimick the actions of natural
transmitters
ii. Promotion of NE release: indirect activation of adrenergic receptors
iii. Inhibition of NE reuptake
iv. Inhibition of NE inactivation
b. Adrenergic antagonists
i. Reversible direct blockade of adrenergic receptors.
ii. Selective
5. Describe the side effects/adverse reactions of cholinergic, cholinergic blocking, and synthetic antispasmodic
agents.
6. Discuss the nursing management for the care of clients receiving agents affecting the parasympathetic nervous
system and for those receiving adrenergic, and adrenergic-blocking drugs.
7. List common adrenergic drugs and blocking agents, their effects, and side effects/adverse reactions.
8. Obtain/prepare drug references on each of the following drugs: epinephrine, NE, propranolol, prazosin,
acetylcholine, atropine, bethanechol, donepezil

Class Topic: Antihypertensives & Diuretics

Objectives: After studying this topic the student should be able to:

1. Define the following terms as relevant to the topic:


a. Hypertension: elevated blood pressure
b. Primary Hypertension: no identifiable cause, chronic, progressive, most common.
c. Secondary Hypertension: elevation of BP brought on by an identifiable primary cause.
d. Essential Hypertension
e. Hypertensive crisis
f. Stepped Care Approah
g. Edema
h. Ascites
i. Diuresis: loss of water
j. Glomerular Filtration: first step in urine formation. A nonselective process. Virtually all small molecules
that are present in plasma undergo filtration.
k. Hypokalemia: Potassium blood level below 3.5 mEq/L. Causes:
i. Thiazide or loop diuretic
ii. Insufficient potassium intake
iii. Alkalosis and excssive insulin
iv. Increased renal exretion of potassium because of aldosterone
v. Potassium loss from vomiting, diarrhea, or laxatives
l. Hyperkalemia: excessive elevation of serum potassium because of severe tissue trauma, untreated
Addison’s disease, acute acidosis, acute renal failure, misuse of potassium-sparing diuretics, or overdose
with IV potassium.
m. Diuretic: drugs that increase the output of urine

2. Explain the action and uses of diuretics.


a. Diuretics are drugs that increase the output of urine
b. They are used for:
i. Treatment of hypertension
ii. Mobilization of edematous fluid associated with heart failure, cirrhosis, or kidney disease
iii. Prevent renal failure
c. Diuretics block sodium and chloride reabsorption and create an osmotic pressure within the nephron
that prevents the passive reabsorption of water.
d. Diuretics cause water and solutes to be retained within the nephron, and thereby promote the excretion
of both.
e. Drugs that act early in the nephron have the opportunity to block the greatest amount of solute
reabsorption.

3. Identify the various groups of diuretics.


a. Loop diuretics
i. Most effective diuretics
ii. Site of action: loop of Henle
b. Thiazide diuretics
i. Increase renal excretion of sodium, chloride, potassium, and water
ii. Lower maximum diuresis produced than loop diuretics
iii. Dependent kidney function. Doesn’t work on renal impairment
iv. Action: early segment of the distal convoluted tubule
c. Osmotic diuretics
d. Potassium-sparing diuretics
i. Modest increase in urine production
ii. Substantial decrease in potassium excretion
iii. Used to counteract potassium loss caused by thiazide and loop diuretics

4. Describe several side effects and adverse reactions related to thiazide, loop, and potassium-sparing diuretics.
a. Loop diuretics
i. Hyponatremia, hypochloremia, and dehydration
1. Use of furosemide can produce excessive loss of sodium, chloride, and water. Severe
dehydration can result. Dehydration can promote hypotension, thrombosis, and
embolism
ii. Hypotension
1. Loss of volume and relaxation of venous smooth muscle
iii. Hypokalemia
iv. Ototoxicity

5. Explain the nursing interventions, including client teaching, related to diuretics, especially thiazide, loop, and
potassium -sparing diuretics.

6. Identify the categories of antihypertensive drugs, and the stepped-care approach and the modified
pharmacologic approach to antihypertensive drugs.

7. Explain the pharmacologic action of the individual groups of antihypertensive drugs.

8. Describe the side effects and adverse reactions to sympatholytics (beta blockers, centrally acting ad peripherally
acting alpha blockers, alpha and beta blockers), direct-acting vasodilators, and angiotensin antagonists.

9. Explain the nursing interventions, including client teaching, related to antihypertensives.

10. Explain the major nursing diagnoses and goals in caring for hypertensive patients.
Prepare Drug Reference Information for the following drugs.

Drug information to include:

Drug Class Mechanism of Action Indications for use

Contraindications/cautions Side/Adverse effects Teaching

Drug-lab test considerations Nursing Considerations/implications

furosemide hydrochlorothiazide prazosin metoprolol

enalapril maleate clonidine spironolactone

losartan nifedipine
aliskiren

Class Topic: Acute Coronary Syndrome (ACS), Antiaginal and Heart Failure Medications

Objectives: After studying this topic the student should be able to:

1. Define the following terms as relevant to the topic.


a. Inotropic effects
b. chronotropic effects
c. contractility
d. Afterload
e. Preload
f. Arrhythmia
g. Automaticity
h. cardiac output
i. stroke volume
j. Dromotropic effect
k. Systole
l. Diastole
m. Refractory period
n. angina

2. Explain the actions of ACS, antianginal drugs, and antidysrhythmics.

3. Describe the signs and symptoms of digitalis toxicity.

4. Identify the side effects and adverse reactions of nitrates, beta blockers, calcium channel blockers, ACE
inhibitors, and ARB.

5. Explain the nursing process, including client teaching related to ACS, antianginal and heart failure drugs.

Prepare Drug Reference Information for the following drugs. Drug information is to include :

Drug Class Mechanism of Action Indications for Use

Contraindications/cautions Side/Adverse Effects

Drug-lab test considerations Nursing Considerations

Nursing Implications Teaching

digoxin nitroglycerin verapamil metoprolol


Class Topic: Nursing management of the patient taking Anticoagulants

Objectives: After studying this topic the student should be able to:

1. Define the following terms as relevant to the topic.


a. Anticoagulant
b. Thrombus
c. Embolus
d. APTT
e. INR
f. Thrombin
g. Fibrin
h. clotting factors
i. Clotting cascade
j. PT
k. Low molecular weight heparins
l. thrombolytic

2. Apply the nursing process, including client teaching, for the patient receiving anticoagulant therapy

Prepare Drug Reference Information for the following drugs. Drug information to include

heparin

warfarin

enoxaparin

tPA

clopidogrel

aspirin

dabigatran

rivaroxaban
Class 2/21/17

Clopidogrel

Herapin
 WHY; quick onset

Enoxaparin
No labs to monitor
Indication: prevention of DVT, pro pharylxic

T-pa
 Indication: clogged central line
 Arterial clot most common

Someone comes in with DVT and given Heparin 1000/o


Ptt 120. Can’t send home
 Give warfarin 1 dose 5 mg and check INR day 1 is 1
 Day 2: PTT 120 INR 1.5
 Day 3 PT 80 INR 2
 Need progression
 Can stop herapin at any time because it has a short half life