Muscarinic Receptors aka cholinergic

PNS → Rest + Digest

Agonist → PiloBeth Antagonists → ADIOS

↳ can pee → ↑ voiding, no urinary retention ↳ can't pee → ↓ voiding, urinary retention
↓ OP

↳ can see-miosis ⇔,see near, for blurry ↳ Can't see → mydriasis ( I see far, near blurry, photophobia,POP
↳ can spit → I sweating, salivation, secretions. ↳ can't spit → ↓ sweating, salivation

↳ can shit → ↑ GI motility ↳ Can't shit → ↓ GI motility, constipation

↳ ❤→ ↓HR, NBP ↳ ❤→ ↑ HR,/BP
↳ → ↑ secretions, bronchi constriction ↳ → thickening of secretions (mucus plugs), bronchi dilation
↳ erection ↳ ∅ erection
Antagonists toxicology

Pilocarpine Sx → dry mouth

↳ glaucoma → r

miosis, ↓ OP, near vision Atropine → blurred vision

↳ edu→ eye drops 5 mins apart ↳ reversal of muscarinic agonists, ↓ HR, eye exams → photophobia
↳ adv FX (TAX) → CNS effects (hallucinations + delirium)
Bethanechal ↳ THR tacky
* → activated charcoal
↳Trinary retention, ↑ voiding ↳ asthma
→ physostigmine * most effective antidote *
↳ adv FX ⇒ ↓ BP, ICO, diarrhea, exacerbation of asthma, COPD ↳ Xerostomia-dry mouth
dysrythmias in pts w/ hyperthyroidism ↳ lozenge
↳ edu ⇒ bathroom available
Dicyclomine
⇒ fall risk (LBP)
↳ IBS
⇒ assess BP, urinary + GI blockages
↳ adv FX ⇒ tachyal, drowsiness

Ipratropium bromide (inhaler)

↳ asthma, COPD, rhinitis
↳ prevents bronchoconstriction
↳ adv FX → dry mouth + irritation of pharynx

Oxybutynin
↳ overactive bladder
↳ adv FX
↳ dry mouth
↳ tacks
↳ urinary hesitance + retention
↳ confusion, hallucinations, insomnia, nervousness
↳ combo w/ other anticholinergic can alter Fxs

Scopolamine
↳ motion sickness, eye procedures, sedation + obstetric amnesia
↳ adv FX → unique to med
↳ dry mouth, drowsiness, blurred vision

↳ urinary retention, constipation, disorientation

 Adrenergic Receptors Fight or Flight

Agonists Antagonists

As → can't see = mydriasis As → can see = miosis

can't pee = urinary retention can pee = ^ voiding
no blue = ejaculation, I prostate contraction blue = ∅ ejaculation, ↓ prostate contractility
no flu = nasal decongestion flu = nasal congestion
❤ = ∅ bleeding, TBP, vasoconstriction ❤ = ↓ BP, vasodilation

As → no significance As → promote neurotransmitter release

inhibit neurotransmitter release reflex tachycardia

Bs → HR Bs → ↓HR
force of contraction ↓ force of contraction
AV conduction velocity ✓ AV conduction velocity
kidney = ↑ renin (TBP) kidney = ↓ renin (IBP)

B2 → bronchodilation Ba → bronchi constriction

glycogenolysis = ↑ BGL (diabetic pts) ↓ glycogenolysis = ↓ BGL (diabetic pts)
skeletal tremors
Dopamine → in CNS
uterus relaxation = delays preterm labor
meds for schizophrenia + bipolar
Dopamine → kidney dilation = ↑ urination

Alpha-Adrenergic Antagonists Beta-Adrenergic Antagonists Indirect-Acting Antiadrenergic Agents

Catecholamine = not oral Non catecholamine = can be given oral ↳ tx ⇒ ↓ BP to treat HTN ↳ B, ⇒ ↓ HR ↓ CO ↳ Aa agonist ⇒ reduce impulses along sympathetic nerves
CDEND = brief NAP = long ↳ adv Fx → orthostatic HTN ⇒ ↓ force of contraction
= doesn't cross BBB = crosses BBB ⇒ reflex tachycardia (LBP leads to THR) ⇒ ↓ AV conduction velocity • Clonidine

Albuteral ⇒ nasal congestion ↳ Ba → bronchoconstriction ↳ activates A receptors in CNS ⇒ ↓ CO ↓HR(brady

Dopamine
⇒ ∅ ejaculation (pt edu) → hypotension → vasodilation
↳ low dose activates dopamine ↳ activates B2
→ Nat retention + ↑ blood volume → bradycardia ↳ adv FX ⇒ rebound HTN = withdraw slowly over 2-4 days
↳ as dose ↑ = ↓ selectivity (activates B. + Ai) ↳ tx ⇒ asthma (inhaler)
(↓ BP = ↓ renal perfusion = urine retention) ⇒ worsening heart failure sx
↳ tx → shock (TBP, no,↑ renal perfusion) ↳ adv Fx ⇒ ↑ doses ↓ selectivity
↳ usually combined w/diuretic ⇒ hypoglycemia • Guanfacine
❤ failure ❤contractility) ↳ B, + Be
action similar to clonidine
↳ adv FX → necrosis w/ extravasation ↳ tremors
- Zosins (for HN + prostate sometimes) Propranolol
↳ tachycardia ↳ blocks B, ✗ By bad ✗ asthma
Epinephrine ↳ Ai antagonist Machethyldopa + Methyldopate
↳ non-selective → activates A, + Az + B, + Be ↳ 1st dose effect ⇒ take 1ˢᵗ dose@bedtime ↳ check pulse when taking beta-blocker ⇒ causes ↓HR ↳ activates As → vasodilation
Phenylephrine
↳ tx for anaphylactic shock ↳ risk of severe postural hypotension (fall risk) ↳ check insulin → causes ↓BGL (hypoglycemia) → WBP
↳ activates Ai
↳ pt edu ⇒ carry 2 epi pens
↳ tx → nasal decongestion (nasal spray) Tamsulosin (for prostate) Metoprolal Common side effects
→ after admin, go to ER
↳ Ai antagonist ↳ blocks B, ↳ drowsiness/sedation
⇒ "blue to the sky, orange to the thigh"
↳ combo w/ other hypotensive drugs (i.e.Viagra) = significant
in BPreductions ↳ contraindicated for pts w/ → sinus bradycardia + AV block > 1° ↳ dry mouth * → sugar-free lozenge
Norepinephrine * primary receptor *
↳ caution pts w/heart failure ↳ rebound HTN
↳ activate A, + Az + B, ↳ safer than propranolol ✗ pts w/ asthma or hx of severe allergic rins ↳ CNS FXs
↳ tx ⇒ low BP, cardiac arrest (THR, ↑ BP) ↳ used more safely than propranolol by pts w/ diabetes ↳ hepatotoxicity
↳ adv Fx ⇒ necrosis w/extravasation ↳ masks common s&sx of hypoglycemia
↳ nursing intx ⇒ ❤monitor + frequent vs

Dobutamine
↳ activates B,
↳ to → CHF
↳ goal ⇒ set❤to work as hard as it can
↳ edu ⇒ need to live w/someone
↳ continuous IV (Walkman)
Blood Brain Barrier

↳ only lipid-soluble drugs can cross

Adaptation of CNS to Prolonged Drug Exposure

↳ ↑ therapeutic effects → over time, usually several weeks before full effects develop

↳ ↓ side effects ⇒ see right away, but go with time

↳ tolerance ⇒ ↓ response over prolonged drug use

↳ physical dependence ⇒ abrupt discontinuation of drug use will cause withdrawal syndrome

→ meds need to be tapered off

Antiepileptic Drugs Antipsychotic Agents Bipolar Disorder

goal ⇒ reduce seizures promoting adherence ⇒ education for pt + family
1st generation antipsychotics (FGAs)
⇒ balance seizure control w/ acceptable side effects (balance of most benefit for least harm) ⇒ pt adherence can be difficult due to manic episodes
↳ adv Fx ⇒ acute dystonia = requires rapid response, tx w/ anticholinergic med
↳ if no change in seizure frequency ⇒ RN contact provider to request serum drug level order + many pts don't see benefits of prophylactic meds
= severe spasm of muscles of tongue, face, neck, or back
↳ withdrawing tx ⇒ withdraw slowly over 6 wks-months
⇒ parkinsonism = bradykinesia, drooling, tremor, rigidity, etc. Lithium
⇒ 1+ seizure med, taper off 1 at a time (NEVER at same time)
→ akathisia = pacing + squirming brought on by uncontrollable need to be in motion ↳ administration ⇒ take w/food to reduce GI upset
⇒ if meds stopped abruptly, seizures can return or pts can experience suicidal ideation
⇒ tardive dyskinesia = choreoathetoid movements of tongue + face ↳ pharmacokinetics ⇒ ↓ Nat = ↓ lithium excretion
↳ Sx to report ⇒ skin rash = Steven Johnsons Syndrome (SSS)
= lip-smacking movements ⇒ plasma levels = 0.8-1.4 MEall
→ ↑ seizure activity
= tongue flicks out in "fly-catching" motion ↳ pt edu ⇒ avoid high intensity exercise = dehydration = lithium toxicity
⇒ SX of infx = leukopenia, anemia, thrombocytopenia
↓ WBCs WRBCs ↓ platelets = slow, worm-like movement of tongue ⇒ drink 2-3L of liquid daily = promotes normal lithium excretion in body
↳ requires CBC ASAP
= involuntary movements of limb + toes + fingers + trunk ↳ adv. FX ⇒ at therapeutic levels (below 1.5)
Phenytoin ⇒ neuroleptic malignant syndrome = "lead pipe" rigidity, sudden high fever, sweating, dysrrhythmias, etc. ⇒ medical emergency ↳ GI FX ↳ polyuria (output > 3L)
stop med + supportive measures
↳ effect of of oral contraceptives ⇒ anticholinergic FX = dry mouth, blurred vision, photophobia ↳ tremors ↳ renal toxicity (liver fin tests)
↳ adv FX ⇒ gingival hyperplasia = swelling + bleeding of gums ⇒ orthostatic hypotension ↳ goiter (enlarged thyroid gland) + hypothyroidism
⇒ skin rash (8) ↳ tx/preventions ⇒ be observant for sesx of EPs ⇒ at toxic levels (above 1.5)
⇒ teratogenic ⇒ EPS can be IRREVERSIBLE if not treated early ↳ confusion ↳ ECG changes
* soft §:&#city
→ dysrrhythmias + hypotension (IV) → cardiac monitor ⇒ stop or reduce dose of med ↳ tinnitus blurred vision
⇒ switch to 2nd gen med ↳ seizures ↳ coma + death
Carbamazepine

↳ adv Fx ⇒ neurologic = nystagmus (involuntary eye movement) + ataxia (if Fit:&.mn") Haloperidol (high potency = movement disorders)
Levodopa/Carbidopa (Parkinson's)
⇒ hematologic = leukopenia, anemia, thrombocytopenia (CBC ASAP) ↳ block receptors for dopamine in CNS
↳ goal ⇒ improve motor fxn
↳ drug intx ⇒ grapefruit juice ↳ cause extrapyramidal symptoms (EPs)
↳ pharmacokinetics ⇒ give on empty stomach + avoid foods high in fat + protein
↳ adv Fx ⇒ can prolong QT interval + cause dysrrhythmias
Valproic Acid ↳ side FX ⇒ dyskinesia (movement disorder)
↳ adv FX ⇒ teratogenic effects ⇒ postural hypotension, arrythmias
Antidepressants
⇒ hepatotoxicity ⇒ headache, dizziness, dry mouth
↳ SSRIs + MAOIS
⇒ pancreatitis ⇒ darkened urine
↳ may increase suicidal tendencies during early tx ⇒ requires close monitoring
↳ drug intx ⇒ topiramate = leads to hyperammonemia ↳ tx w/levodopa alone is no longer recommended due to its Fx alone not being
selective Serotonin Reuptake Inhibitors (SSRIs) long lasting + dyskinesia are more likely to occur
Ethosuximide
↳ 1st line ⇒ most commonly prescribed
↳ therapeutic use ⇒ absence seizures * slow memory + cognition loss
↳ main adv FX ⇒ serotonin syndrome, mild, weight gain, neonatal abstinence syndrome, sexual dysfunction Cholinesterase Inhibitors (Alzheimer's) but not guaranteed
↳ nursing cons.. ⇒ important to record #of seizures each day
action ⇒ prevent breakdown of acetylcholine + may help slow progression of disease
Serotonin Syndrome
Phenobarbital
↳ begins 2-72 hrs after tx Donepezil/Rivastigmine
↳ adv FX ⇒ drowsiness in adults
↳ AMS ↳ adv. FX ⇒ bradycardia → fainting
⇒ hyperactive in children
↳ artificial ventilation may be required ⇒ falls ⇒ fall-related fractures
↳ drug into ⇒ CNS depressants = alcohol, benzos, opioids
↳ resolves spontaneously after discontinuing drug
⇒ ↓ effect of oral contraceptives + warfarin Memantine
↳ risk increased by concurrent use of MAOIs + other drugs
↳ therapeutic uses → only for moderate or severe AD
Lamotrigine
Fluoxetine ↳ action ⇒ modulates FX of glutamate (major excitatory neurotransmitter in CNS) at NMDA receptors, which
↳ new (AED)
↳ adv FX ⇒ insomnia = take in AM, notPM are believed to play a critical role in learning + memory
↳ nursing cons.. ⇒ monitor for rash due to possible Sss
↳ drug intx ⇒ when taken w/MAOI = risk of serotonin syndrome ↳ adv. FX ⇒ dizziness (causes falls)
⇒ monitor for suicidal ideation
⇒ watch out for pts w/ renal failure
Sertraline
Oxcarbazepine
↳ adv FX ⇒ diarrhea
↳ adv FX ⇒ clinically significant hyponatremia Sedative-Hypnotic Drugs
⇒ neonatal abstinence syndrome
⇒ Sss depress CNS fan
⇒ persistent pulmonary HTN of newborn when used during late pregnancy
⇒ toxic epidermal necrolysis ↳ relieve anxiety in low doses + induce sleep in higher doses

Paroxetine
Pregabalin Benzodiazepines
↳ adv. FX ⇒ abnormal liver function tests
↳ no precise mechanism of action ↳ have lower tendency to cause a potentially fatal CNS depression compared to other drugs like barbiturates
(monitor liver levels + sesx of liver failure)
↳ adv FX ⇒ hypersensitivity runs = life-threatening angioedema ↳ can be used to treath both insomnia + anxiety effectively

⇒ rhabdomyolysis Citalopram ↳ potentiate the effects of GABA (but not GABA agonists)

↳ major depression ↳ pharmacologic FX ⇒ tendency to accumulate w/ repeated dosing (high-risk for older pts → bad kidneys)
Levetiracetam
↳ adv. FX ⇒ nausea, somnolence, dry mouth, sexual dysfunction ↳ drug intx → other CNS depressants (pinpoint pupils + decreased respirations)
↳ for epilepsy
⇒ can cause neonatal abstinence syndrome ⇒ priority of RN to maintain 02 to brain (supplemental 02)
↳ friendly w/ pregnancy
↳ isomer = Escitalopram better tolerated ↳ acute toxicity ⇒ tx w/ flumazenil

Topiramate ↳ competitive benzo receptor antagonist

↳ many therapeutic uses + many side effects ↳ reverses sedative Fxs of benzos but may not reverse resp. depression
Monoamine Oxidase Inhibitors (MAOIs)
↳ approved for benzo overdose + for reversing Fxs of benzos after general anesthesia
↳ atypical depression + Parkinson's
↳ adverse FX ⇒ CNS depression = avoid activities that require alertness like driving
↳ adv. FX ⇒ orthostatic hypotension
⇒ anterograde amnesia
⇒ HTN crisis from eating tyramine
⇒ sleep driving
↳ all cheese + beer + wine + avocados + figs + sausage +
⇒ paradoxical Fxs = insomnia, excitation, heightened anxiety
foods containing yeast + shrimp paste + soy sauce
= if pt stops taking their benzos + reports having feelings of panic + paranoia,
↳ headache + tachycardia + HTN+ MN + confusion + perfuse
RN would ask if it was stopped abruptly
sweating = possibly leading to stroke + death
⇒ respiratory depression
↳ pt edu = while on med, don't consume cold cuts (bologna)
⇒ abuse
↳ many drug-drug intx ⇒ serotonin syndrome
⇒ use in pregnancy + lactation = highly lipid soluble + can readily cross the placental barrier

↳ withdrawal Sx ⇒ agoraphobia = fear of situations which feel difficult to escape

⇒ anxiety,etc.

⇒ * if pt stops taking their benzo + reports having feelings of panic/paranoia, RN would ask to

stop med ASAP *

↳ use benzos for short term treatment of anxiety while waiting for SSRI/SNRIs to reach full effectiveness

THEN taper off benzos