Explain this question. Local anesthesia. Lidocaine is the prototype
- How does it work?
- What is it used for?
- What are the major adverse effects—remember, it is usually injected into the skin around the area for stitches, etc, but will eventually enter the bloodstream, so how can it affect the body once it moves to the bloodstream?
Why and when would epinephrine be added to the use of lidocaine?
- What are the concerns about the effects of epinephrine when it enters the bloodstream?
Topical lidocaine—patient teaching. Just a general reminder—topical is meant to stay “topical” (versus transdermal, which is applied to the skin to intentionally enter the body)
- What teaching should be done about using topical lidocaine to reduce systemic effects?
- Lidocaine is also often applied in the mouth for dental work and to the throat topically for invasive procedures like endoscopy and bronchoscopy…If part of the mouth is numb or the back of the throat is numb, what are the safety concerns?
Local anesthetics are what are used in spinal and epidural anesthesia. Review concerns for patients receiving the medications via this route.
General Anesthesia
What is balanced anesthesia?
- The agents added to obtain the ideal anesthesia for the patient/procedure are all drugs you have already learned and so you should have a basic understanding of these drugs, too.
- Opioids/NSAID’s would be given to?
- Antiemetics would be given to?
- Benzodiazepines/Barbiturates would be given to?
- Anticholinergic (prototype atropine) would be given to?
Inhaled anesthesia is the main focus of the chapter, but again, it is rarely the only substance used because there is no “ideal” agent, so some of the above listed drugs are added to improve the experience
How do they work?
What are the major adverse effects? You need to know what to be concerned about when the post-op patient returns to their room after receiving an inhaled anesthetic.
Neuromuscular blocking agents
- What are they and why are they used?
- What are the side effects?
- What do they do and not do?
Many students believe this is also an anesthetic-it is NOT
Acetylcholine has to attach to the nicotinic m receptor on skeletal muscle to cause muscle contraction. If it does not, then the muscle becomes flaccid (paralyzed)
These drugs do NOT cross into the brain and have no effect on the level of consciousness—if this is the only drug on board, the patient can hear everything, but cannot move, speak, blink, because the person is paralyzed.
Review both depolarizing and non-depolarizing neuromuscular blocking agents to understand the differences. End result is flaccid paralysis.
Your patient has received a neuromuscular blocking agent during surgery and is now post-operative. What are the nurse’s priority concerns?
What is malignant hyperthermia?
What are the risk factors for developing it?
What are the symptoms?
What is the treatment?
What are the concerns with the use of ketamine?
What is nitrous oxide used for?
What makes propofol so dangerous?
CNS Stimulants
Amphetamines in general are used therapeutically for?
- What are the most common adverse effects?
What are the effects of caffeine?
- What is it used for therapeutically?
All CNS stimulants in excess amounts can cause?
Endocrine System
Growth Hormone (Somatropin)
- What is it used for therapeutically?
- How is its effectiveness measured?
- What are its major adverse effects?
- How is it usually administered?
Somatostatin can be used to treat acromegaly—how does it work?
- Why is it not the preferred treatment for acromegaly?
What is Diabetes Insipidus?
ADH is produced in the hypothalamus and stored in the posterior pituitary gland
Its release is affected by serum osmolarity (you should know what that is—it is the amount of solute in relation to the fluid in the blood stream)
When serum osmolarity is high (there is a lot of solute in relation to the water—imagine ingesting a very salty meal), ADH is released and causes the kidneys to reabsorb water (to dilute that excess solute) and restore the serum osmolarity to normal. This results in decreased urine output (because more water is being retained) and the urine is more concentrated and has a higher specific gravity/urine osmolarity
Some people do not make ADH or it does not work.
This causes DI/Diabetes insipidus, which means excessive urine output.
- If the cause is lack of ADH, it can be replaced with ADH replacement known as desmopressin. Review how it is used and major adverse effects/teaching
Thyroid gland
- Please review the actions and effects of thyroid hormone on the body—you must understand what this hormone made by the body does to understand the effect of too much or too little on the body
- What labwork is done to diagnose problems with the thyroid gland?
Review how and when the following drugs are used in thyroid disorders? (Hyperthyroidism, hypothyroidism, thyroid storm, myxedema)
Review the major side effects and nursing interventions
- Synthroid (include how and when it should be taken/given)
- Methimazole
- Potassium Iodide
- Beta blockers
- Radioactive Iodine
Adrenal Gland
Glucocorticosteroids (Cortisol)
- How do they work in the body?
- What are they used for?
- These drugs are great, BUT have tremendous adverse effects when used long term/high doses—what are those?
Hydrocortisone is the prototype and has BOTH glucocorticoid and mineralocorticoid functions
Mineralocorticosteroids (Aldosterone)
- What controls its release?
- What is its function in the body?
Fluticasone is the prototype for this drug
What drug would be used if there was excess mineralocorticoids?
Something you would have covered in pharm 1 is the difference between physiologic and pharmacologic dosing of these substances.
Glucocorticosteroids are frequently used to treat inflammatory conditions because they block the production of a number of the inflammatory mediators. The dose will be bigger than a replacement dose and is called a pharmacologic dose. When given this way, they produce more adverse effects because of the size of the dose—what are those adverse effects and what teaching should be done to deal with them? (Think “Cushing’s)
On the other hand, if the adrenal gland does make the hormones, the replacement dose will be small (similar to what the body would make on its own). But, because the body would increase it if the person was experiencing stress, the patient will need to be taught to do that too.
Female Reproductive drugs
What are estrogen and progesterone?
- Where do they come from and how are they produced?
- What is the function of each?
What are the reasons for giving a woman hormone replacement? What increases the risk of adverse effects? What are the most concerning adverse effects?
How do oral contraceptives work to prevent pregnancy? (As I write “oral” I imagine that descriptor will change as these drugs can be delivered in a great many different ways, including via rings, transdermal patches, BUT, the mechanism of action is the same.
- What teaching should be done?
- What can interfere with effectiveness?
- Review the adverse effects and how they would present and how to reduce them
Clomiphene is the prototype for fertility drugs
- How does it work?
- What are the adverse effects?
Drugs used in Pregnancy—focus here is on how they work, major adverse effects and not on how to fine tune dosing (that is for maternity)
Tocolytics?
- What is their purpose
- Terbutaline is the prototype—how does it work and what are the adverse effects
I will remind you here that, glucocorticoids are used in preterm labor—why????
What is the purpose of the prostaglandin dinoprostone?
Oxytocics?
- Oxytocin is the prototype here
- How does it work?
- What are the major adverse effects and what should be monitored?
Male Reproductive Drugs
What is testosterone?
- Why would it be used?
- What are major concerns to teach the patient using it?
- Often it is applied topically-what is essential to teach about this route?
Sildenafil is the prototype for ED drugs
- How does it work?
- Major adverse effects
- Because of the potential for serious consequences, be sure to review who should and should not take it and why
BPH
What is BPH?
Review the 2 types of drugs to treat it and adverse effects and precautions with each
