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A: a chemical substance that is released at the end of a nerve fiber by the arrival of a nerve impulse and, by diffusing across the synapse or junction, causes the transfer of the impulse to another nerve fiber, a muscle fiber, or some other structure.

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Q: Classification/mechanism of action. Why are they ordered when the patient is already on morphine?

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Q: Classification/mechanism of action. Why are they ordered when the patient is already on morphine?

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A: All of the additional medications ordered vary in their mechanism of action and receptor activity causing additive therapeutic effects. Naloxone and Nalbuphine are PRN, only administered for pruritis and respiratory depression to reverse the effects of opioids.
Mechanism of action for Tylenol: Inhibition of cyclooxygenase (COX) in only the CNS, minimal effects at peripheral sites. By decreasing prostaglandin synthesis in the CNS, it will reduce fever and pain
Mechanism of action for Meloxicam: A non steroidal anti-inflammatory drug (NSAID) that inhibits both COX-1 and COX-2.
Mechanism of action for Naloxone: A potent narcotic antagonist essentially free of agonistic (morphine-like) properties, blocks both Kappa and Mu receptors.
Mechanism of action for Nalbuphine: Agonist at kappa receptors and an antagonist at mu receptors. Has analgesic effect for mild to moderate pain, sedation and respiratory depression.

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A: Past medical Hx. , current meds, base line information regarding sleep.

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1. Discuss the difference between meloxicam and celebrex.

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1. Discuss the difference between meloxicam and celebrex.

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Meloxicam - COX-1 and COX-2 . Nonsteroidal anti-inflammatory drug used to treat pain and inflammation in rheumatic diseases and osteoarthritis. It is taken by mouth. It is recommended that it be used for as short a period as possible and at a low dose

Celebrex -  is a COX-2 selective nonsteroidal anti-inflammatory drug (blocks COX-2) . It is used to treat the pain and inflammation in osteoarthritis, acute pain in adults, rheumatoid arthritis, ankylosing spondylitis, painful menstruation, and juvenile rheumatoid arthritis.

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Q: identify the major adverse effect of acetaminophen.
A: hepatotoxicity (increase doses), agitation (increase in children) (IV), anxiety (IV), headache, fatigue, insomnia, atelectasis (increase in children), dyspnea, hypertension, hypotension, acute generalized exanthemata’s pustulosis, Stevens-Johnson syndrome, toxic epidermal necrolysis

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4.What are the important nursing considerations and teaching needs for patients when taking an over the counter salicylate?

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4.What are the important nursing considerations and teaching needs for patients when taking an over the counter salicylate?

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Nursing Considerations - For assessment and drug effects system relief is gradual and may require 3 to 4 days for a steady state. Monitor for adverse GI effects especially for patients with peptic ulcer disease.
Teaching - Do not take other salicylates while on salsalate therapy. Monitor blood glucose for loss of glycemic control and diabetes. Drug may induce hypoglycaemia when used with sulfonylureas. Report tinnitus, hearing loss, vertigo, rash, nausea.

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Q: Why is it imperative that patients on benzodiazepines be cautioned against combining them with alcohol?

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Q: Why is it imperative that patients on benzodiazepines be cautioned against combining them with alcohol?

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A:  Enhanced effects (alcohol and benzodiazepines can enhance eachothers effects) The main concern here being the increased respiratory depression effect.

Increased Risk of Overdose

Increased Reduction of Cognition (Impaired judgement, significant loss of inhibitions)

Decreased Physical Reactions (Diminished reflexes, motor functions, etc.)

Increased Side Effect Potential

Increased Potential for Unpredictable Effects

Increased potential of Acute Condition Development

Increased Risk of Long-Term physical conditions

Increased risk of developing a mental health disorder

Increased risk of developing a dependence on both or either drug

Increased risk of developing a substance use disorder

Increased Risk of issues with relationships, professional goals, educational goals, finances, etc.

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Q: Identify the most prevalent 5 adverse effects that can be experienced by a patient receiving an opioid drug and indicate what assessments and nursing interventions you, the nurse, might use to prevent and address these adverse effects.
A: Respiratory depression; monitor resp. rate and notify if at 12 or below, and have naloxone available
- Sedation; try smaller doses more frequently, use drugs with shorter half-life, give small doses of CNS stimulant in am and pm
- Orthostatic hypotension; monitor BP and pulse, help patient ambulate
- Constipation; promote physical activity, fluids, fiber, and stool softener/laxative if needed
- Urinary retention; monitor I&O, palpate for bladder distention q4-6h, promote voiding q4h, catheterization if needed
- N&V; give antiemetic

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is the transmitter released by practically all postganglionic neurons of the sympathetic nervous system. the only exceptions are the postganglionic sympathetic neurons that go to sweat glands, which employ acetylcholine as their transmitter
- predominantly from the ends of sympathetic nerve fibres and that acts to increase the force of skeletal muscle contraction and the rate and force of contraction of the heart.
-Norepinephrine exerts its effects by binding to α- and β-adrenergic receptors
-In the blood vessels, it triggers vasoconstriction (narrowing of blood vessels), which increases blood pressure
-Norepinephrine is used clinically as a means of maintaining blood pressure in certain types of shock (e.g., septic shock).

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2.What are the most common adverse reactions of non steroidal anti-inflammatory agents?

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2.What are the most common adverse reactions of non steroidal anti-inflammatory agents?

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Renal impairment, gastric erosion, ulceration, occult GI bleeding, nausea, constipation, diarrhea, stomach pain, stomach ulcers, anemia, dizziness, swelling in the legs.

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Q: how does physical dependence on opioid analgesics differ from abuse and addiction.
A:
Physical: "state which abstinence syndrome occurs if drug is withdrawn"
Abuse: "drug use that is inconsistent with medical or social norms, used to produce euphoria"
Addiction: "pattern of compulsive drug use, individual pathologically pursuing towards and/or relief by substance use & other behaviors"

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Found in the SNS and secreted by the medulla. Epinephrine has a specificity for the following receptors: alpha1, alpha2, beta1, beta2. Its classified as a catecholamine and the therapeutic uses are:
- Delay absorption of local anesthetic
- Control superficial bleeding
- Elevate blood pressure
- Overcome AV heart blockage
- Restore cardiac function post cardiac arrest
-Promotes bronchodilation, useful in asthma
- Treatment of choice for anaphylactic shock.

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(ACh) Is a neurotransmitter that binds to its receptor with a "lock and key" analogy. ACh binds to its receptors (NicotinicN and NicotinicM or Muscarinic) located on the postjunctional cell. Upon dissociating from its receptors, ACh is destroyed immediately by acetylcholinesterase (AChE). ACh causes muscles to contract, activates pain responses and regulates endocrine and REM sleep functions.

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Main functions of the parasympathetic NS:

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Main functions of the parasympathetic NS:

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A: Constricts pupil, stimulates salvation, inhibits heart, constricts bronchi, stimulates digestive activity, stimulates gall bladder, contracts bladder, relaxes rectum

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3. What are the key considerations in using anti-inflammatory agents with older adults?

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3. What are the key considerations in using anti-inflammatory agents with older adults?

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Lead to high blood pressure.

Make symptoms of heart failure worse.

Raise the risk of heart attack, stroke, kidney damage, and skin reactions.

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Dopamine is an organic chemical of the catecholamine and phenethylamine families. Dopamine functions as a neurotransmitter in the brain.

Dopamine plays a part in controlling the movements a person makes, as well as their emotional responses. The right balance of dopamine is vital for both physical and mental well being.
Vital brain functions that affect mood, sleep, memory, learning, concentration, and motor control are influenced by the levels of dopamine in a person's body

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5. Discuss the components of the drug Percocet.

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5. Discuss the components of the drug Percocet.

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- combination of oxycodone and acetaminophen.
- oxycodone: opioid pain medication (narcotic)
- acetaminophen: less potent pain reliever. Increases the effects of oxycodone.

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Found in CNS.  Promotes motivation helps with depression. They are produced by the central nervous system and the pituitary gland. The principal function of endorphins is to inhibit the communication of pain signals; they may also produce a feeling of euphoria very similar to that produced by other opioids.

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Actions of muscarinic and nicotonic receptors

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Actions of muscarinic and nicotonic receptors

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Muscarinic receptors: located in the heart, act to slow the heart rate down to normal sinus rhythm.
Nicotonic receptors: to trigger rapid neural and neuromuscular transmission.

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Serotonin is a chemical that has a wide variety of functions in the human body. It is sometimes called the happy chemical, because it contributes to well being and happiness.

The scientific name for serotonin is 5-hydroxytryptamine, or 5-HT. It is mainly found in the brain, bowels, and blood platelets.

Serotonin is used to transmit messages between nerve cells, it is thought to be active in constricting smooth muscles, and it contributes to well being and happiness, among other things. As the precursor for melotonin, it helps regulate the body's sleep-wake cycles and the internal clock.

It is thought to play a role in appetite, the emotions, and motor, cognitive, and autonomic functions. However, it is not known exactly if serotonin affects these directly, or if it has an overall role in coordinating the nervous system.

It appears to play a key role in maintaining mood balance. Low serotonin levels have been linked to depression

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GABA is considered an inhibitory neurotransmitter because it blocks, or inhibits, certain brain signals and decreases activity in your nervous system.

produces a calming effect. This can help with feelings of anxiety, stress, and fear. It may also help to prevent seizures.

Researchers suspect that GABA may boost mood or have a calming, relaxing effect on the nervous system.

Anxiety or mood disorders

Epilepsy

Chronic pain

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6. What should be included in the discharge teaching for this pt?

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6. What should be included in the discharge teaching for this pt?

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- Highlight the possibility of withdrawal syndrome; physical dependence on drugs
- Do not alter dosage regimen
- Avoid potential hazardous activities ex driving
- Do not drink large amounts of alcohol ( risk of liver damage)
- Check w/ prescriber before taking OTC drugs for colds, stomach distress, allergies, insomnia,  or pain
- Inform dentist of oxycodone usage

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Eye: Contraction of muscle focuses the lens for near vision, decrease pupil diameter.
Heart: Decrease heart
Lungs: Constriction of bronchi, promotion of secretions.
Bladder: Contraction of detrusor muscle which increases bladder pressure. Relaxation of sphincter to allow urine flow. Allows voiding to happen.
GI tract: Salvation, increase gastric secretions, increase intestinal tone and allows for deification.
Sweat glands: Generalized sweating
Sex Organ: Erection
Blood vessels: vasodilation

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Eye: Pupil dilation, blurred vision
Heart: Tachycardia, AV-node conduction
Lungs: Bronchodilation, decreases secretion
Bladder: urinary retention
GI Tract: constipation, dry mouth
Sweat glands: anhidrosis (no sweat)
Sex organ: no effect
Blood vessels: no effect

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Mechanism of Action & Why it's preferred - Benzodiazepine

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Mechanism of Action & Why it's preferred - Benzodiazepine

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Acts on the limbic, thalamic and hypothalamic areas of the CNS. Has long acting hypnotic properties. Mild suppression of REM. Increases the total sleep time

Safer alternative while extending stage 4 of the REM Cycle

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Therapeutic uses and potential adverse effects:

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Therapeutic uses and potential adverse effects:

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Cholinergic (muscarinic) agonist drugs
Uses: Increases smooth muscle tone, especially in GI tract, urinary bladder and the eye. May also be used to reduce heart rate.
Adverse: Bronchospasm, eye pain due to ciliary spasm, nausea, vomiting, cramps, diarrhea

Cholinergic antagonist drugs (anticholinergics)
Uses: Increase actions of parasympathetic nervous system and used to treat glaucoma.
Adverse effects: dry mouth, blurred vision, hyperpyrexia

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Take drug exactly as prescribed; do not skip, increase/decrease doses, change intervals or discontinue therapy without physician's advice. Do not offer to any other person

-Do not take any other OTC drugs unless prescribed

-Oral hygiene can alleviate discomfort

-Avoid excessive sunlight (r/t photophobia)

-Do not breastfeed

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Ach binds to nicotinicN or NicotinicM,

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parkinsons - lower levels of dopamine as part of disease process
Schizophrenia - also lower level of dopamine

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Signs and symptoms of cholinergic crisis

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Signs and symptoms of cholinergic crisis

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Sweating, salivation, bronchial secretions along with meiosis (constricted pupils)

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Effects of sympathetic (ADRENERGIC) receptor stimulation and blocking

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Effects of sympathetic (ADRENERGIC) receptor stimulation and blocking