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1) Identify the 7 main functions of the parasympathetic nervous system.

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1) Identify the 7 main functions of the parasympathetic nervous system.

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(Rest & Digest)
- slowing of the heart rate
- increase gastric secretion
- emptying of the bladder
- emptying of the bowel
- focusing the eye for near vision
- constricting the pupil
- contracting bronchial smooth muscle

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2) Explain the actions of muscarinic receptors and nicotine receptors.

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2) Explain the actions of muscarinic receptors and nicotine receptors.

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Both are cholinergic receptors mediated by acetylcholine.

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Effects of parasympathetic muscarinic receptor stimulation and blocking:

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4) Based on the chart what would be logical therapeutic uses for and potential adverse effects of:

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4) Based on the chart what would be logical therapeutic uses for and potential adverse effects of:

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(A): Cholinergic (muscarinic) agonist drug:
Uses: decreases heart rate, hypotension, reverses erectile dysfunction and reduces fever
Adverse Effects: salivation, lacrimation, urination, diaphoresis, diarrhea, emesis
(B): Cholinergic antagonist drugs (anticholinergics)
Uses: Increases heart rate, decrease secretion from salivary & sweat glands, decreases tone of urinary bladder, detrusor, and decrease tone in urinary tract
Adverse Effects: Dry mouth, blurred vision, urinary retention, constipation, asthma,

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Chemicals released by the neuron when stimulated. Reacts with a specific receptor site to cause a reaction. Excitatory or Inhibitory effects.

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a) What additional data should the nurse collect about the patient's symptoms?

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a) What additional data should the nurse collect about the patient's symptoms?

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Nurse should collect:
- Baseline vitals such as: blood pressure, respirations, heart rate, SpO2.
- Mental Health Assessment
- Drug history (home medications or recreational use)
- Sleep patterns
- Amount of caffeine or stimulants taken during average day

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1) Discuss the differences between meloxicam and celebrex

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1) Discuss the differences between meloxicam and celebrex

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Celebrex: only inhibits Cox 2
Meloxicam: inhibits cox 1 and 2 blocks arachidonate
-Medications are cox inhibitors: some medication will inhibit both and some will only inhibit one of them

-Meloxicam: ibuprofen is also cox 1 and 2 inhibitor is anti-pyretic (first generation cox inhibitor)

-Celebrex: Second generation cox inhibitor: anti-inflammatory does not have anti-pyretic properties

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2) what are the most common adverse reactions of non-steroidal anti-inflammatory agents?
-toxicity is common when treating inflammatory disorders, which require long-term high-dose treatment
-The most common side effects are gastric distress, heartburn, and nausea. These can be reduced by taking  with food or a full glass of water (for ex aspirin).

-Occult GI bleeding occurs often. In most cases, the amount of blood lost each day is insignificant. However, with chronic use, cumulative blood loss can produce anemia.

-frequently cause mild GI reactions (dyspepsia, abdominal pain, nausea).

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1. Indicate classification and mechanisms of action of each medication and discuss why they would be ordered when the patient is already on Morphine.

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1. Indicate classification and mechanisms of action of each medication and discuss why they would be ordered when the patient is already on Morphine.

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a) Meloxicam: blocks enzymes that produce prostaglandin (anti-inflammatory) - it is an antagonist
b) Tylenol: non-opioid analgesic/antipyretic, elevates pain threshold & inhibits endogenous pyrogens
c) Nalbuphine: opioid analgesic, agonist-antagonist, relieves moderate/severe pain
d) Naloxone: blocks the effects of opioids, narcotic opiate antagonist
e) Morphine: analgesic narcotic opiate agonist - binds to same receptors as endogenous opioid peptides

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3) What are key considerations in using anti-inflamttories agents with older adults

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3) What are key considerations in using anti-inflamttories agents with older adults

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low body water content: effects pharmacokinetics: reduced protein binding, can result in acute kidney injury. Can effect blood pressure and in turn can cause congestive heart failure or hypertension

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Found in all motor neurons. Clinical use of acetylcholine is limited primarily to producing rapid miosis (pupil constriction) following lens delivery in cataract surgery. Not used often as it lacks selectivity (activates both muscarinic cholinergic & nicotinic cholinergic receptors), and due to destruction by cholinesterase it has an extremely short half-life.

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b) Briefly describe the mechanism of action of benzodiazepines and barbiturates and explain why benzodiazepines are preferred over barbiturates and other general CNS depressants for anxiety and insomia.

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b) Briefly describe the mechanism of action of benzodiazepines and barbiturates and explain why benzodiazepines are preferred over barbiturates and other general CNS depressants for anxiety and insomia.

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Benzodiazepines- enhance the actions of GABA by binding to specific receptors in a supramolecular structure known as the GABA receptor- chloride channel complex. They do not act as direct GABA agonists, however intensify the effects.
Barbiturates-  binds to the GABA receptor-chloride channel complex. The drugs can enhance the inhibitory actions of GABA and directly mimic the actions of GABA.
- Benzodiazepines are preferred because they amplify the actions of endogenous GABA, rather than directly mimicking GABA, therefore there is limit to how much CNS depression can be produced.

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6) What should be included in the discharge teaching of this patient.

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6) What should be included in the discharge teaching of this patient.

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Celebrex/Celecoxib:
- Seek immediate medical attention for any of the following: Chest pain, SOB, sudden weakness, slurring of speech, or other S&S of Stroke.
- Promptly report any of the following: Unexplained weight gain, edema, skin rash.
-Stop taking celecoxib and promptly report to prescriber if any of the following occurs: S&S of liver dysfunction including nausea, fatigue, lethargy, itching, jaundice, abdominal pain, and flu-like symptoms; S&S of GI ulceration including black, tarry stools and upper GI distress.
- Avoid using celecoxib during the third trimester of pregnancy

Aspirin:
- Should not take on an empty stomach
-Enteric coated tablets dissolve too quickly if administered with milk and should not be crushed or chewed.
- D/C Aspirin with onset of ringing or bussing ears, impaired hearing, dizziness, GI discomfort or bleeding and report to prescriber.
- Avoid alcohol when taking large doses of Aspirin.
- Maintain adequate intake of fluids when taking Aspirin.

Percocet:
- Avoid alcohol and other CNS depressants.
- Do not use OTC drugs unless approved by physician.
- Do not ambulate without assistance after receiving drug.
- Use caution or avoid tasks requiring alertness (Driving) until response to drug is known.

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5. Percocet is composed of Oxycodone and acetaminophen 325 mg. The dose of Oxycodone depends on the strength of Percocet prescribed. It can be between 2.5 mg - 10 mg. The amount of acetaminophen should not exceed 4 g/day. It is prescribed for moderate to severe pain. 

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5. Percocet is composed of Oxycodone and acetaminophen 325 mg. The dose of Oxycodone depends on the strength of Percocet prescribed. It can be between 2.5 mg - 10 mg. The amount of acetaminophen should not exceed 4 g/day. It is prescribed for moderate to severe pain. 

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5) Identify the signs & symptoms of cholinergic crisis: 

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5) Identify the signs & symptoms of cholinergic crisis: 

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- excessive salivation
- cramps
- diarrhea
- blurred vision
- sweating
- constricted pupils
- muscle weakness

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2. Identify most prevalent 5 adverse effects that can be experienced by a patient receiving an opioid drug and what assessments/nursing interventions a nurse might use to prevent & address the adverse effects.

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2. Identify most prevalent 5 adverse effects that can be experienced by a patient receiving an opioid drug and what assessments/nursing interventions a nurse might use to prevent & address the adverse effects.

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- 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
- Others: biliary colic, cough suppression, miosis, neurotoxicity, birth defects, dependence in neonate, dysrhythmias

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4) What are the important nursing considerations and teaching needs for this patient when taking and over-the-counter salicylate 

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4) What are the important nursing considerations and teaching needs for this patient when taking and over-the-counter salicylate 

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Potential for abuse/over dose use because of wide spread over-the-counter use, may block signals for signs and symptoms of present illness leading to misdiagnosis,
In children: susceptible to GI and CNS side effects therefore correct dosage is important
In adults: should notify HCP when taking OTC salicylate because if on other drugs can have adverse drug-drug reactions
Pregnant: should not be taken unless the severity of the benefit outweighs the severity of the risks
Older adults: susceptible to CNS and GI side effects important to discuss dosage and minimize the amount taken
Be cautious of dizziness, ringing in the ears, nausea, vomiting, mental confusion, diarrhea,
Toxicity can cause: hypernea, tachypnea, hemorrhage, pulmonary edema, fever, respiratory collapse
Assess for contraindications of use
Establish baseline physical assessment
Assess for skin lesions/dermatological effects
Monitor for low temperature
Monitor LOC and CNS for effects
Monitor pulse, BP, perfusion, bleeding effects
Evaluate respirations for respiratory depression/distress
Monitor bowel sounds, hypersensitivity
Monitor clotting time for adverse bleeding effects

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3. Identify the major adverse effect of acetaminophen.

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3. Identify the major adverse effect of acetaminophen.

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Hepatotoxicity

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4. How does physical dependence on opioid analgesics differ from abuse and addiction?

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4. How does physical dependence on opioid analgesics differ from abuse and addiction?

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- 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 PNS, stored in small amounts in adrenal tissue. Norepinephrine (NE) has specificity for the following receptors: alpha1, alpha2, beta1. NE is a catecholamine, cannot be given orally, by IV infusion only. NE has limited clinical applications: hypotensive states & cardiac arrest.

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

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

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- Will feel the effects of alcohol faster
- Not safe to consume alcohol or take other drugs that have similar effects on the CNS since it cause additional depression of the brain and respiratory system.

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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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d) What information should be included in the nurse's health teaching plan for this patient?

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d) What information should be included in the nurse's health teaching plan for this patient?

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Side effects: confusion, drowsiness, sedation, memory impairment, improper balance, N&V, reduced libido, respiratory depression, suicidal thoughts, withdrawal, low BP and low HR.
Patient Teaching:
- Do not drive or participate in other hazardous activities until you know how these drugs affect you.
- Do not consume alcohol or other drugs that have similar effects on the CNS since it causes additional depression of brain and respiratory system.
- Notify HCP if psychomotor function change is experienced
-  Reduce gradually to stop over a period of several days (to prevent withdrawal)
- Discuss D/C with HCP if you wish to become pregnant

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Found in CNS. Dose-dependent receptor specificity therefore in small doses it acts on the dopamine receptor, in moderate doses it acts on the beta1 receptor, and in high doses it acts on the alpha1 receptor. Therapeutic uses include: shock and heart failure. It is a catecholamine and it must be given by IV for continuous infusion.

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Found in the CNS, serves as an inhibitory transmitter. Prevents over excitability or over stimulation, typically used for seizure activity.

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2) Based on the chart, what would be logical therapeutic uses for and possible adverse effects of:

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2) Based on the chart, what would be logical therapeutic uses for and possible adverse effects of:

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(a) Alpha 1 adrenergic agonist drugs?
Uses: Stimulates eye dilation, arteriole & vessel constriction, ejaculation, bladder contractions
Effects: Headaches, reflex bradycardia

(b) Alpha 1 adrenergic antagonist drugs
Uses: stimulated eye constriction, arteriole & vessel dilation, bladder relaxation
Effects: Dizziness, orthostatic hypotension, nasal congestion, headaches, reflex tachycardia

(c) Alpha 2 adrenergic agonist drugs
Uses: Help treat hypertension
Effects: sedation, dry mouth, bradycardia, orthostatic hypotension, impotence

(d) Alpha 2 antagonist drugs
Uses: treat depression
Effects: Dizziness, orthostatic hypotension, nasal congestion

(e) Beta 1 adrenergic agonist drugs
Uses: increase HR, Increase heart strength of contraction
Effects: Tachycardia, palpitations, hypertension

(f) Beta 1 adrenergic antagonist drugs
Uses: treat high BP
Effects: bradycardia, hypotension, heart failure

(g) Beta 2 adrenergic agonist drugs
Uses: dilation of bronchial passages, vasodilation in liver & muscles, relaxation of uterine muscles, release of insulin, treat asthma and other pulmonary disorders
Effects: restlessness, anxiety tremor, headaches, tachycardia, angina

(h) Beta 2 adrenergic antagonist drugs
Uses:

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Effects of Sympathetic (ANDRENERGIC) receptor stimulation and blocking:

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Found in CNS. Effects are inhibitory. Vasoconstrictor in vascular system. Chemical messages can be sent from receptor to receptor.

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Found in CNS.  Promotes motivation helps with depression.