Cholinergics & Electrolytes (2 Questions)
Cholinergic Med:
physostigmine: cholinesterase inhibitor → increased acetylcholine
Anticholinergic Med:
Atropine → blocks acetylcholine
Electrolyte: K+: main ICF cation
Know Potassium Normals:
Excess K+ Antidote:
 sodium polystyrene
 insulin (in DKA)
 Calcium Gluconate
Max IVPB K+ per hour: 10 mEq per hour
Excess K+ noted with renal impairment
hyperkalemia symptoms: paresthesia, heaviness in lower extremities, cold skin,grayish pallor,
cardiac arrhythmia
NEVER give potassium as a slow Intravenous push (will kill a patient)!!. Must be diluted
into an IVPB or IV.
Know Sodium Normals
GI & Psyche Quiz:
LOWER GI (4 questions)


Aluminum and calcium compounds cause constipation.
Magnesium compounds cause diarrhea
Anti Flatulence Med:
Simethicone
Anti-Emetics:
Anticholinergic: (histamine 1 acts on the vomiting center)
o Dimenhydrinate (Dramamine) - OTC
o Diphenhydramine (Benadryl) - OTC
o
o
Hydroxyzine (Vistaril) - prescription
Promethazine (Phenergan) - prescription
Dopamine Antagonist: (refer to acute dystonia in psychiatric terms below: watch video)
o
o
o
Metoclopramide (Reglan) ~ known cases with EPS effects noted
Haloperidol (Haldol) ~ typically psych med, but can be use for GI
Promethazine (Phenergan)
serotonin antagonist

ondansetron
Constipation Treatment:
Contact Laxative: Contact Sensory Irritant ~ 1) Bisacodyl and 2) Milk of Magnesia
Osmotic Laxative: hyperosmolar ~ Lactulose (binds with ammonia in the blood)
Emollient: ~ stool softener: Docusate
Bulk-Forming Meds: psyllium (must be mixed w/ 8 ounces of water)
Diarrhea Treatment:
diphenoxylate with atropine (lomotil)
loperamide (OTC)
Anti Flatulence Med: simethicone
Upper GI
H2 Blockers: Meds generically end with a suffix “tidine”
Proton Pump Inhibitors: Meds generically end with a suffix “prazole”
Meds Used for GI and Psyche (Categorized as Dopamine 2 Blockers)
Dopamine2 Antagonist: (refer to acute dystonia in psychiatric terms below: watch
video)
o
o
o
Metoclopramide (Reglan) ~ known cases with EPS effects noted
Haloperidol (Haldol) ~ typically psych med, but can be use for GI
Promethazine (Phenergan)
Psychiatric Terms (2 questions)
Adverse Effects for psychosis meds: (need to be reported!!! needs to be switched to
atypical group )
1. Akathisia: continuous body movement in which an individual is restless or constantly
paces about.
2. Tardive dyskinesia: drug induced involuntary movements of the lips, jaw, tongue, and
extremities
3. Dystonic reaction: reaction characterized by muscle spasms, twitching, facial
grimacing, torticollis GI Meds related to Dopamine Blockers can cause Acute Dytonia
Video Link:
a.
https://www.youtube.com/watch?v=2krwEbm5hBo : note what is the treatment for acute
onset of dystonia?
b.
https://www.youtube.com/watch?v=O1CnEnhicUo note: what med caused this person
acute dytonia?
4. Parkinsonism: disease or drug-induced condition characterized by muscular rigidity,
tremors, and disturbances of movement.
5. EPS (extrapyramidal syndrome): movement disorders such as akathisia, dystonia, and
parkinsonism caused by antipsychotic drug therapy (dopamine anatagonist)
6. Neuroleptic malignant syndrome (NMS): toxic syndrome associated with the use of
antipsychotic drugs. Symptoms Include:
.
catatonia, rigidity,
a.
stupor,
b.
c.
i.
unstable BP,
hyperthermia (mandatory removal of antipsychotic drug ~ 20% mortality rate)
Antidote:
1. Dantrolene** lowers hyperthermia (Community Hospital Education)
2. Bromocriptine ~ Dopamine Agonist (increase dopamine)
Psychosis
(2 questions ~ 1 fill in question on name of drugs)
Schizophrenia: major form of psychosis, behavior is inappropriate
Cause: excessive activity of dopamine & serotonin
Symptoms: bizarre behavior
Psychotropic Treatment:
Phenothiazines Group: Block Dopamine 2 (1st Generation)
1. Chlorpromazine (low potency)
2. fluphenazine (high potency)
Non-Phenothiazine Group:
1. Haloperidol (high potency)
Atypical (2nd Generation)
1. Aripiprazole (note: end prazole, but not proton pump inhibitor)
Effective Properties:
1. anticholinergic: side effect of blocking the cholinergic system(dry mouth, urinary
retention, tachycardia, constipation, photophobia) ~
2. antihistaminic: describe the effects histamines ~ sedation
3. alpha1-adrenergic blocking effects: describe the effects of blocking alpha 1 receptor ~
Hypotension
Psychotropic Meds:
Anxiety Med:
Lorazepam ~ given for the anxiety
**Watch Video: Neuroleptic Malignant Syndrome (NMS) versus
Malignant Hyperthermia (MH)
Recommended Video: Expect 1 to 2 question from the video
https://www.youtube.com/watch?v=WDioY9LIKq4
This relates to the antiemetics we have discussed for GI; It relates to psychosis meds, and the
video relates to perioperative situations that can happen
1. Which meds cause neuroleptic Malignant Syndrome?
2. Which meds cause Malignant Hyperthermia?
3. In the video, which med is given for the hyperthermia?
4. In the video, NMS is caused by which meds? and what medication was used to counteract
the medication that caused NMS?
DEPRESSION (2 questions)
Cause: decreased amounts of norepinephrine, dopamine, or serotonin
Depression Meds:
1. Monoamine oxidase inhibitors (MAOIs)
a.
phenelzine (Nardil), Parnate, Isocarboxazid (Marplan)
2. Tricyclic antidepressants (TCAs)
.
Amitriptyline
3. Selective serotonin reuptake inhibitors (SSRIs)
.
Fluoxetine , sertraline
4. Atypical antidepressants
.
Bupropion *
a.
Venlafaxine (Effexor)
Mood Stabilizers Med
Med: Lithium ~ Bipolar treatment