motion Study Guide for Exam 1
Nutrition
Carbs – Principles of nutrition
Types of Carbs and their sources:
 Digestion
o Digestion starts in the mouth
 Simple carbs digest in the mouth
o Mostly the rest of carb digestion happens in the SMALL intestines
 Dissaccharides and starches are digested into monosacerides
o Monosaccersides go to the liver > (In Liver) fructose + galactose =
glucose > Glucose goes into bloodstream > Glucose blood goes to CNS
for fuel
 function of Carbs
 RDA (recommended daily allowance) for Carbs
o 45%-65% of total calories a day should be from Carbs
o 25-38g of fiber should be taken daily
o Limit added sugar to 6-10%
 Kcal calculation, Carbs
o Each gram of carbohydrates provides 4 kcal
Fiber:
 Function of Fiber: proposed by the food and nutrition board, fictional fiber
consists of extracted or isolated non digestible carbohydrates that have beneficial
physiological effects in humans. It lowers blood glucose levels, could prevent
colon cancer, helps prevent constipation and hemorrhoid, and diverticular disease
by softening stool
 Fiber daily requirements
o 5 servings of fruit and vegetables daily
o Verity of plant food daily
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Sources of fiber.
o Replace refined grain (white) with whole grain (brown)
o Ready to eat cereal with 5 grams of fiber or more
o Dried peas and beans (2-3 X week)
o 5 servings of fruit and vegetables daily
o Verity of plant food daily
Proteins:
 Protein digestion,
 Protein its types
o Protein are made up of amino acids which consist of
 carbon
 hydrogen
 oxygen
 nitrogen
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Protein function
mProtein sources.
RDA for proteins,
Protein calculation,
proteins and bodybuilding
Protein recommendation for vegans.
Lipids:
 Types of lipids,
 lipids digestion
 lipid function
 lipids sources
 LDL vs HDL cholesterol
 Saturated vs Unsaturated fat
 Hydrogenation
 Fatty acids
 RDA for lipids
 Lipids Kcal calculation
Water, Vitamins and Minerals:
Vitamins: water vs fat soluble vitamins
vitamins their functions and sources
Vitamin deficiencies and supplements
Water and minerals: their functions and sources;
Water and minerals deficiencies
Water and minerals supplements
Diet and Different Types of Feeding
Diet and Different Types of Feeding
Types of different diets and their indication;
 Oral diet
o Depending on the needs of the individual patient, oral diets may be
modified in their:
o consistency
o concentration of certain nutrients
o dietary components
 Clear Liquid:
o Diet composed of only clear liquids or foods that becomes fluid at body
temperature. It requires minimal digestion and leaves a minimum residue
o Indicated in preparation for bowel surgery or colonoscopy, acute GI
disorders, first feeding after surgeries. Contraindicated for long term use.
o Example:
o Clear broth or bullions, juices-clear like apple, cranberry, grape, gelatin,
honey, hard candy
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Full Liquid :
o Foods that are liquids at body temperature, don’t have to be clear.
o Indicated as a transition between a clear liq. Diet and a soft diet. For
clients who have difficulty chewing and swallowing
o Examples:
o All items on clear liq. Diet plus all milk products in liquid form, puddings,
yogurt, custards, all juices, butter and cream
Pureed diet:
o Composed of liquids and solid foods blended to liquid form.
o Used after oral or facial surgery, for wired jaws, chewing and swallowing
problems
o Examples: All foods allowed but consistency is changed to liquids
Soft Mechanical:
o A regular diet modified in texture only. Excludes most foods containing
seeds, nuts, and dried fruits.
o Used for patients who have limited chewing ability, such as patients who
have ill-fitting dentures, no dentures, or have undergone facial surgery.
o Examples:
o Chopped, ground and pureed foods, mashed soft ripened fruits, cooked
soft mashed vegetables.
Bland:
o Foods mild in flavor and easy to digest; omits spicy foods
o Avoids irritation of GI tract as with ulcer and colitis patients
High calorie:
o Foods high in protein, carbs, minerals, and vitamins
o Given to underweight and malnourished patients
Low calorie:
o Low in cream, butter, cereal, deserts and fats
o For clients who need to lose weight
Low fat:
o Limited amounts of butter, cream, fats and eggs
o For patients who have difficulty digesting fats, as in gallbladder,
cardiovascular and liver diseases
Low cholesterol:
o Low in eggs, whole milk and meats
o Helps to regulate the amount of cholesterol in the blood
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Nutritional supplements;
 Dietary supplements for patients
o Patients with altered appetites or increased needs may benefit from
supplements given with or between meals
o A variety of supplements are available (clear liquid, milk-based, routine,
modified routine, puddings, and bars)
o Supplements vary in nutritional composition, cost, and taste( Ensure,
Glucerna, Nepro, Javity)
Enteral nutrition-tube feeding, types of formula, indications and side effects
 Enteral nutrition = tube feedings
o preferred to parenteral nutrition whenever the gastrointestinal tract is at
least partially functional, accessible, and safe to use
o may be delivered to the gastrointestinal tract through
o transnasal tubes (NGT)
o ostomy sites (PEG)
o Nasogastric tube-NGT- inserted through the nose and into the stomach or
small intestine
o Used for periods of 6 weeks and less.
o Gastrostomy (opening into the stomach) or Jejunostomy ( opening in to
the jejunum) may be done surgically if feeding is needed for longer than 6
weeks
o SIDE EFFECTS
o TYPES OF FORMULA
Nursing care of patient with tube-feeding, complications, medications administration and
tube feeding
 Giving Medications by Tube
o Drugs should be given orally whenever possible
o Stop the feeding before administering drugs
o Make sure tube is flushed with 15-30 mL of water before and after the
drug is given
o If more than one drug is given, flush the tube between doses with 5 mL of
water
o Drugs absorbed from the stomach should never be given through a
nasointestinal tube
o Liquid form of a medication diluted with 30 mL of water should be used
for feeding tube administration
o If there is no alternative, a drug can be crushed to a fine powder and mixed
with water before it is administered
o Slow-release drugs should never be crushed
o Dilute highly viscous and hyperosmolar liquid medications with 10-30 mL
of water before administering
o Tube feeding may need to be temporarily stopped to permit drug
administration on an empty stomach or to avoid drug-nutrient interaction
o Some experts recommend stopping a continuous feeding for 15 minutes
before and after the delivery of the medication
Complications
Side Effects
- Dehydration
- Diarrhea due to hyperosmolarity (the pull of H2O into the GI tract)
- Aspiration pneumonitis
Types of fluids used for hydration
• Isotonic Fluids
o Fluids that are classified as isotonic have total osmolality close to that of
extra cellular fluid and do not cause red blood cells to shrink or swell
• Hypotonic Fluids
o Are used to replace cellular fluid and to provide free water for excretion of
body wastes. Hypotonic solutions are used to treat Hypernatremia and
other hyperosmolar conditions
PPN vs. TPN
Parenteral nutrition
• delivers nutrients by vein when
gastrointestinal tract is nonfunctional
oral or enteral intake is inadequate to meet the patient’s needs
• Amino acids, dextrose, lipid emulsions, electrolytes, multivitamins, and trace
elements may be given by vein
• Peripheral vein used for nutrient solution for 2 weeks or less
• PPN (Partial Parenteral Nutrition)- must be near-isotonic to avoid collapsing
small-diameter veins
• For patients who do not require more than 2000 to 2500 cal/day
• Concentration can’t exceed 10% dextrose and 5% amino acids, also vitamins,
electrolytes and trace elements are added
• Parenteral nutrition- TPN
o Total parenteral nutrition (TPN) or hyperalimentation is given when
parenteral nutrition is used to provide total nutrition
o Central vein access used for TPN needed for an extended period of time
o TPN infusions are hypertonic (highly concentrated) and are quickly
diluted by the rapid blood flow. Reduces risk of phlebitis and thrombosis
• Complications of TPN
• Infection at site of the catheter can cause infection of blood called sepsis
• Bacterial or fungal infections can develop in the solution if unrefrigerated for over
24 hours
• Abnormal electrolyte levels, phlebitis, or blood clots can occur.
• Hypergylcemia due to TPN’s high glucose quantity (20%)
• Hypoglycemia w/ abrupt stop of TPN
Care of patients with TPN/PPN infusion
• Caring for a patient with parenteral nutrition:
o Read doctor’s recent order for infusion, note the type of fluid, amounts,
medications
o Calculate how much to be administered-each hour drops to be given each
minute
o Go to the bedside to assess the client and note the following:
o Infusion site for infiltration and irritation; kinking or leakage, accuracy of
infusion rate( count drops per minute) and adjust as indicated
o Determine how much is left in the bottle
o Determine how much is absorbed out of the bottle
o Calculate the expected level at each hour while caring for the patient and
note this on your care plan
o Determine when the I.V. will be finished
o Have the next bottle prepared and ready at bedside to be hung before I.V.
runs dry
o Changes tubing daily; w/in 24 hrs. For the first 10 days; q 48 hrs thereafter
o Never turn off I.V. unless it is intended to be taken out
o Never let I.V. run dry; Hang Dextrose 10% in emergencies
Side Effects
PHARM
Drug Action:
Pharmaceutic
 Pharmacokinetic - is the process of drug movement to achieve drug action. The
four processes are:
Absorption
Distribution
metabolism (or biotransformation)
Excretion (or elimination)
 Pharmacodynamics - the study of the way biochemical and physiologic effects
of drugs and their mechanisms of action on the body AKA the study of the way drugs
affect the body.
 Disintegration - the breakdown of a tablet into smaller particles. This process
follows dissolution.
 Dissolution - the breakdown of a tablet into smaller particles in the GI fluid
before the process of absorption.
 Rate limiting - the time it take the drug to disintegrate and dissolve to become
available for the body to absorb it.
 First-pass effect - When a drug passes through the liver first. In the liver the drug
may be metabolized to an inactive form, which may than be excreted, thus reducing the
amount of active drug. Side note - this is b/c some drugs do not get metabolized in the
liver.
 Bioavailability - the % of the administered drug dose that reaches the systemic
circulation.
 Creatinine clearance - rate at which the drug is eliminated from circulation.
This can vary by age and gender. When Creatine clearance is decreased, drug dosage
needs to be decreased also
 Half-life (elimination) - time required for the plasma drug concentration or the
amount of drug in the body to decrease by50%. Exceptions are: phenytoin, theophylline
and heparin.
Potency - Dose necessary to achieve one half of the desired effect.
 Efficacy - Maximal response a drug can produce.
 Therapeutic Index - Ratio of dose causing toxicity to dose causing therapeutic
effects. Side note - The ratio of the drug dose which produces an undesired effect to the
dose which causes the desired effects. (See PPT’s and text for more info)
Through levels - the rate of eliminating a drug from the body. Toxicity can occur if
through levels are too high (same w/ peak) It is the lowest plasma concentration of a
drug.
 Effective - Single amount of medication administered to achieve a therapeutic
effect.
 Maximal - Largest amount that can be given safely w/o causing an adverse or
toxic effect.
 Loading - When immediate drug response is desired, a large initial dose, known
as the loading dose, of drug is given to achieve a rapid minimum effective concentration
in the plasma.
 Lethal doses - Amount of medication that will cause death.
 Therapeutic Window - The range of plasma drug concentrations with a high
probability of therapeutic success. Side Note - The therapeutic window for a typical
population is sometimes inappropriate for an individual patient. (See PPT’s and text for
more info)
 Onset - the time it takes to reach the minimum effective concentration (MEC)
after a drug is administered.
 Peak - occurs when the drug reaches its highest blood or plasma concentration
 Duration of action - the length of time the drug has a pharmacologic effect
 Dose response and maximal efficacy - See slide on Drug Action (Chapter 1)
 Drug Allergies - not dose related, common cause of serious toxicity, s/s
determined by antigen-antibody interactions, largely independent of the
pharmacologic properties of the drug, Allergic reactions are not completely
unpredictable
 Drug to drug and drug to food interactions - unsure where to find
 Trough level - the lowest plasma concentration of a drug and it measures the rate
at which the drug is eliminated
 Dose response and maximal efficacy - unsure where to find
Trans-cultural and Genetic Considerations/ Geriatric Pharmacology
Nursing Process:
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Transcultural Considerations - page 53 9th edition and page 89-91 8th edition
Culturally sensitive nursing care - pg. 89 8 edition and pg. 54 9 edition
Physiologic changes; see Tables: Polypharmacy and Pharmacokinetics
Pharmacodynamics - Due to a lack of affinity to receptor sites throughout the body
in the older adult, the pharmacodynamic response may be altered. As a result, the
patient is less sensitive to drug action. This almost always causes drug dosages to be
lowered. (I.e. A regular dose of an antihypertensive may cause orthostatic
hypotension)
 Health Teaching: Special Considerations Review medications with patient and family, including reason for medication,
route of administration, frequency, common side effects, and when to notify health care
provider.
Explain to patient and family the importance of adherence to the drug regimen.
Emphasize taking drug as prescribed, discarding unused or old drugs, and keeping a
record of medication taken. Remember: Drugs are the property of the patient and may not
be disposed of without his or her permission.
Be available to answer patient’s questions. Be supportive of the older adult and
the family. Discuss problems related to the medications.
Advise patient to use one pharmacy to fill prescriptions. Tell patient to inform
pharmacist of all OTC and herbal drugs taken.
Advise patient and family to request a non–childproof cap from the pharmacy if
patient has arthritis in the hand joint or difficulty opening childproof bottle caps. Patient
may need to sign for this at the pharmacy; safety of children or pets in the environment
must be ensured.
Counsel patient not to share prescribed medications with others or to take
medications prescribed for another person.
Nursing Process and Client Teaching
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Subjective data - Current health hx., Client symptoms, Current medications, Past
health history, Client’s environment, Primary language and communication needs.
Objective data - Physical assessment, Laboratory tests, Diagnostic studies
nursing diagnoses relevant to pharmacology
planning and characteristics of a correct goal/outcome
Nursing actions necessary to accomplish the goals
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Client teaching in Drug Therapy and Evaluation
Principles of Drug Administration
Functions of a Registered pharmacist - Healthcare professional who is licensed to
prepare and dispense medications on the order of a licensed practitioner of medicine
Legal Aspects/FDA - U.S. FDA
- Operates under U.S. DOH and Human Services
- Medications and therapeutic agents safe and effective for public use
- Standards of strength and purity
“Five Plus Five Rights” of Drug Administration - Right patient, right drug, right dose,
right time, right route; “Plus Five Rights” - Right documentation, right assessment, right
to education, right evaluation, right to refuse
Drug orders:
Standing- daily doses
One –time single dose
PRN- as needed
STAT – at once
QD- every day, BID-twice/day; TID- 3 times/day; QID- 4x day;
Q 4, 6, 8, 12 hours;
QOD- every other day, TIW- 3 times /week
Safety in Medication Administration - (See PPT slides in Principles of Drug Safety and
Administration)
Medication Forms - Oral (tablets, capsules) administered PO, Topical (gels, ointments)
applied to the skin or mucous membranes, Inhalants (Albuterol Sulfate) inhaled or
breathed in, Injectable (PPD, Vitamin K) given via a needle, Transdermal (Fentanyl)
applied and aborbed through the skin, etc.
Route of Administration- how to administer different types of medications correctly
- (See PPT slides b/c they have pictures in Principles of Drug Safety and Administration)
Medications and Calculations
Methods for Calculation, Calculations of Oral Dosages, Calculations of Injectable
Dosages, Calculations of Intravenous Fluids, Pediatric Drug Calculations NO BSA
Adrenergic and Adrenergic Blockers
Effects of adrenergic/sympathomimetic drugs. Figure 18-1, understand the effects of
adrenergic drugs on different body systems.
 WAIT!! WTF is adrenergic/sympathomimetic first?
o Adrenergic SYSTEM (AKA the sympathetic nervous system) – is the
FIGHT AND Flight responce
1. Know the difference between selective adrenergic drugs and nonselective drugs.
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Epinephrine (Adrenalin) – Nonselective
o In anaphylactic shock, epinephrine is useful because it increases BP, HR,
and airflow through the lungs. Because epinephrine affect different
adrenergic receptors, its non-selective.
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Albuterol – Selective
o Albuterol is a beta 2 adrenergic agonist, so it relaxes the bronchial
smooth muscles and promotes bronchodilation.
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Isoproterenol (Isuprel) – nonselective
o It increases HR and contractility, stimulates bronchial dilation and
vasodilates mesenteric and renal vessels and skeletal muscle. Isoproterenol
is also a fairly effective vasodilator of the pulmonary circulation.
o Its all over the place.. so its NON-selective
2. List major side effects of adrenergic drugs.
 Undesired side effects frequently occur when the adrenergic drug dose is
increased or when the drug is NONSELECTIVE
 Side effects of alpha1, beta 1, and beta 2
o Hypertension
o Tacycardia
o Palpitations
o Restlessness
o Tremors
o Dysrhythmia
o Dizziness
o Urinary retention
o Nausea
o Vomiting
o Dyspnea
o Pulmonary edema
o Flushing of the Skin
 Reflex Tachycardia
o Decreased renal perfusion
3. Explain nursing interventions, including client teaching, associated with adrenergic
drugs.
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Nursing interventions
o Monitor BP, heart rate, urine output.
o Report tachycardia, palpitations, tremors, dizziness, hypertension.
o Monitor IV site for infiltration.
o Antidote: phentolamine mesylate (Regitine)
o Avoid cold medicines and diet pills if hypertensive, diabetic, CAD, or
dysrhythmic.
client teaching, associated with adrenergic drugs.
o Avoid adrenergics when breastfeeding.
o Avoid continuous use of adrenergic nasal sprays. No more after 3 days.
Teaching
Adrenergic blockers: Pay attention to the tables in this chapter:
 Adrenergic means “ working on adrenaline, epinepherine and norepinephrine”
 Adrenergic blockers: were blocking adrenaline, so we are slowing everything
down
4. the uses of alpha blockers and beta blockers.
 1 drugs (Alpha 1 and Beta 1, some of Beta 2 ) make your vitals go out UP
 2 drugs (most of Beta 2 ) relaxes vitals so blood goes to GI
 Alpha blockers (aka Alpha antagonists) - Stimulation adrenergic nerves
results in vasoconstriction. If stimulation of α-adrenergic nerves is interrupted
or blocked by Alpha blockers, the result is vasodilation.
 Alpha-blockers—used for vasodilation do drop BP so HR goes
up to compensate
 decrease symptoms of Benign prostatic hyperplasia (BPH)
and Peripheral vascular disease PVD such as Raynauds disease
o Selective-Dapipraso l(Rev-Eyes), used during eye examination,
reverses mydriasis
o Nonselective- Carteolol HCL (Cartrol), used to treat HTN,
contraindicated in a client with Glaucoma
 beta blockers (aka Beta-adrenergic Antagonists) slow down the heart and
decrease Blood pressure. causes bronchoconstriction; ex. (Inderal); used to
treat angina, high BP , decrease HR, decrease cardiac workload and oxygen
consumption, and provide membrane-stabilizing effects that contribute to the
antiarrhythmic activity of the beta-adrenergic blocking drugs.
o Nonselective beta blockers-affect all beta sites (cardiac and
respiratory)
 Propranolol HCl (Inderal)
 Contraindication-COPD, will constrict respiratory muscles, and
exacerbate COPD
o Selective beta blockers affect specific beta sites
 Metoprolol tartrate (Lopressor), Atenolol (Tenormin)
o ends in LOL ( 2 L’s) EX Atenolol, esmolol (Brevibloc) and
propranolol (Inderal)
 Think Lower HR
 Low BP
o Beta 1
 Slows the heart ( think you have 1 Heart)
o Beta 2
 Slow down breathing (Think Beta 2 , you have 2 lungs)
o Non selective beta blockers (1 & 2) should be used with extreme
caution with COPD and asthma Patients
5. List the general side effects of adrenergic blockers.
 Alpha-adrenergic blockers Side effects
o Cardiac dysrhythmias, flushing, hypotension, reflex tachycardia
o Orthostatic hypertension
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o Reflex tacycardia
o Bradycardia
 Do not give if PT RR is under 60
 Don’t give if BP if systolic less than 100
o Do not stop beta blockers immediately, taper off in 1-2 weeks to avoid
tacycardia
Beta-Adrenergic Blockers Side effects
o Side effects/adverse reactions
o Bradycardia, hypotension, headaches, hyperglycemia/hypoglycemia,
agranulocytosis
o As well as dizziness, cold extremities, hypoglycemia, and
bronchospasm. General side effects of beta-adrenergic blockers
include cardiac dysrhythmias, flushing, hypotension, weakness,
impotence or decreased libido, depression, and pulmonary edema.
6. Describe nursing interventions, including client teaching, associated with
adrenergic blockers.
Nursing interventions for adrenergic blockers
 nursing interventions
o Notify the primary health care provider promptly if adverse drug reactions
occur.
o Monitor for adverse reactions weakness, orthostatic hypotension, cardiac
arrhythmias, hypotension, and tachycardia.
o Another bodily system reaction is bronchospasm (especially in those with
a history of asthma with Beta Blockers)
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client teaching
o Do not stop taking the drug abruptly, except on the advice of the primary
health care provider. Most of these drugs require that the dosage be
gradually decreased to prevent precipitation or worsening of adverse
effects.
o Observe caution while driving or performing other hazardous tasks
because these drugs (β-adrenergic blockers) may cause drowsiness,
dizziness, or lightheadedness.
o Immediately report any signs of HF (weight gain, difficulty breathing, or
edema of the extremities).
Do not use any nonprescription drug (e.g., cold or flu preparations or nasal
decongestants) unless you have discussed use of a specific drug with the
primary health care provider.
o Inform dentists and other primary health care providers of therapy with
this drug.
o Keep all primary health care provider appointments because close
monitoring of therapy is essential.
Cholinergic and Anticholinergic Meds
Effects of cholinergic and anticholinergic drugs, adverse reactions, side effects, and
routes.
Pay attention on the effects of the medications on the body systems:
1. Compare the two Cholinergic receptors.
Cholinergic - activate rest and digest The major response of the cholinergic drug is to
stimulate bladder and GI tone, constrict pupils of the eye, and increase neuromuscular
transmission rest and digest
Acetylcholine Ach is the chief
neurotransmitter of the parasympathetic
nervous system, the part of the autonomic
nervous system (a branch of the peripheral
nervous system) that contracts smooth
muscles, dilates blood vessels, increases
bodily secretions, and slows heart rate Rest
and digest
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Cholinergic drugs that act like the
neurotransmitter ACh are called directacting cholinergics. cholinergic drugs
causes contraction of the bladder
smooth muscles and passage of urine.
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Cholinergic drugs that prolong the activity
of ACh by inhibiting the release of AChE
are called indirect-acting cholinergics or
anticholinesterase muscle stimulants.
More ACH is produced so you have a
greater chance for toxicity
Effects
Stimulate skeletal muscles, increase tone
Greater GI motility, bradycardia, miosis
Bronchial constriction, promote urination
Side effects: bradycardia, asthma, peptic ulcers
2. Know the responses of cholinergic drugs and anticholinergic drugs.
3. Differentiate between direct-acting and indirect-acting cholinergic drugs.
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Cholinergic drugs that act like the neurotransmitter ACh are called direct-acting
cholinergics. cholinergic drugs causes contraction of the bladder smooth muscles and
passage of urine.
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Cholinergic drugs that prolong the activity of ACh by inhibiting the release of AChE
are called indirect-acting cholinergics or anticholinesterase muscle stimulants.
4. Compare the major side effects of cholinergic and anticholinergic drugs.
5. Differentiate the uses of cholinergic and anticholinergics.
6. Explain the nursing process, including client teaching, associated with cholinergic
and anticholinergics.
Stimulants
Categories  Amphetamines
 Amphetamine - Like Drugs
 Caffeine
 Anorexiants
 Analeptics - (respiratory drugs)
 Most common: tx for ADHD and Narcolepsy
 Medically approved uses - The above categories are medically approved with the
exception of Amphetamines vs. Amphetamine - Like Drugs b/c Amphetamines have
more adverse reactions (Double check this info)
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Actions Side effects/adverse reactions:
 restlessness
 insomnia
 tachycardia
 hypertension
 heart palpitations
 dry mouth, anorexia
 weight loss, diarrhea
 constipation
 impotence
Interactions Describe:
Nursing interventions ■ Monitor vital signs. Report irregularities.
■ Evaluate height, weight, and growth of children.
■ Observe patient for withdrawal symptoms (e.g., nausea, vomiting, weakness, headache).
■ Monitor patient for side effects (e.g., insomnia, restlessness, nervousness, tremors,
irritability, tachycardia, elevated blood pressure). Report findings.
Client teaching - associated with stimulants
 Teach patient to take drug before meals.
 Advise patient to avoid alcohol consumption.
 Encourage use of sugarless gum to relieve dry mouth.
 Teach patient to monitor weight twice a week and report weight loss.
 Advise patient to avoid driving and using hazardous equipment when experiencing
tremors, nervousness, or increased heart rate.
 Teach patient not to abruptly discontinue the drug; dose must be tapered off to avoid
withdrawal symptoms. Consult health care provider before modifying dose.
 Encourage patient to read labels on over-the-counter (OTC) products, because many
contain caffeine. A high plasma caffeine level could be fatal.
 Teach nursing mothers to avoid taking all CNS stimulants (e.g., caffeine). These
drugs are excreted in breast milk and can cause hyperactivity or restlessness in
infants.
 Direct family to seek counseling for children with attention deficit/hyperactivity
disorder. Drug therapy alone is not an appropriate therapy program. Notify school
nurse of drug therapy regimen.
 Explain to patient and family that long-term use may lead to drug abuse.