By L. Wenzel. South Carolina State University. 2017.

Drugs that decrease effects of neuromuscular blocking agents: (1) Anticholinesterase drugs (eg buy generic malegra fxt 140mg, neostigmine) These drugs often are used to reverse the effects of the non- depolarizing agents purchase malegra fxt 140 mg online. They do not reverse the effects of succinyl- choline and may potentiate them instead. What interventions are needed to ensure client safety during Answer: The risk of administering a drug to the wrong patient is in- recovery from local or regional anesthesia? Other factors that could have contributed ing agent is used in critical care settings? Journal of the American Medical Association, 286(2), Review and Application Exercises 208–216. When assessing a client before, during, or after local or re- Kowalski, S. A post hoc descriptive study of pa- gional anesthesia, what are important factors to consider? Identify risk factors for development of drug drugs and the circumstances indicating dependence. Outline major elements of treatment for over- juana, and nicotine on selected body organs. Describe specific antidotes for overdoses of rates, benzodiazepines, cocaine and other central nervous system (CNS) depressant CNS stimulants, ethanol, and opiates. Critical Thinking Scenario You are a school nurse working in a middle school. Just after lunch, an 8th grader approaches you saying he is very worried about his friend.

Levodopa is contraindicated in clients with narrow-angle glaucoma discount malegra fxt 140mg fast delivery, hemolytic anemia discount 140 mg malegra fxt, severe angina pectoris, transient ischemic attacks, or a history of melanoma or undiagnosed Anticholinergic Drugs skin disorders, and in clients taking MAO inhibitor drugs. In addition, levodopa must be used with caution in clients with Anticholinergic drugs are discussed in Chapter 21 and are de- severe cardiovascular, pulmonary, renal, hepatic, or endocrine scribed here only in relation to their use in the treatment of disorders. Only anticholinergic drugs that are cen- and therefore are contraindicated in people hypersensitive trally active (ie, those that penetrate the blood–brain barrier) to ergot alkaloids or those with uncontrolled hypertension. Atropine and scopolamine Selegiline, entacapone, and tolcapone are contraindicated in are centrally active but are not used because of a high incidence people with hypersensitivity reactions to the drugs. In addition to the primary anticholinergic is contraindicated in people with impaired liver function. The drugs must be used cautiously in clients with cardiovascular Mechanisms of Action disorders (eg, tachycardia, dysrhythmias, hypertension) and liver or kidney disease. Dopaminergic drugs increase the amount of dopamine in the brain by various mechanisms. Amantadine increases dopamine release and decreases dopamine reuptake by presynaptic INDIVIDUAL ANTIPARKINSON DRUGS nerve fibers. Bromocriptine, pergolide, pramipexole, and ropinirole are dopamine agonists that directly stimulate post- Dopaminergic antiparkinson drugs are described in this sec- synaptic dopamine receptors. Levodopa is a precursor sub- tion; names, routes, and dosage ranges are listed in Drugs at stance that is converted to dopamine. Anticholinergic all major symptoms, especially bradykinesia and rigidity. Dopamine cannot be used for replacement therapy because it does not penetrate the blood–brain barrier. Levodopa Indications for Use readily penetrates the CNS and is converted to dopamine by the enzyme amino acid decarboxylase (AADC). The dopamine is Entacapone, levodopa, pergolide, pramipexole, ropinirole, stored in presynaptic dopaminergic neurons and functions like selegiline, and tolcapone are indicated for the treatment of endogenous dopamine.

The or other antiplatelet agents are thought to outweigh the risks of drugs are indicated for acute coronary syndrome (eg cheap 140mg malegra fxt with visa, unsta- hemorrhagic strokes (approximately 15%) discount malegra fxt 140 mg mastercard. Their antiplatelet effects subside and 2 hours for tirofiban; the drugs are cleared mainly by when the drugs are eliminated from the circulation and the renal excretion. With tirofiban, plasma clearance is approxi- 840 SECTION 9 DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM mately 25% lower in older adults and approximately 50% boembolism after cardiac valve replacement and is given lower in clients with severe renal impairment (creatinine with warfarin. The drugs are contraindicated in clients with hypersen- sitivity to any component of the products; current or previ- Thrombolytic Agents ous bleeding (within the previous 30 days); a history of thrombocytopenia after previous exposure to tirofiban; a Thrombolytic agents are given to dissolve thrombi. They history of stroke within 30 days or any history of hemor- stimulate conversion of plasminogen to plasmin (also called rhagic stroke; major surgery or severe physical trauma fibrinolysin), a proteolytic enzyme that breaks down fibrin, within the previous month; severe hypertension (systolic the framework of a thrombus. The main use of thrombolytic blood pressure >180 mm Hg with tirofiban or >200 mm Hg agents is for management of acute, severe thromboembolic with eptifibatide, or diastolic blood pressure >110 mm Hg disease, such as myocardial infarction, pulmonary embolism, with either drug); a history of intracranial hemorrhage, neo- and iliofemoral thrombosis. Heparin and warfarin above (for the 180 mcg/kg bolus and the 2 mcg/kg/min in- are given after completion of thrombolytic therapy. Throm- fusion) or 4 mg/dL or above (for the 135 mcg/kg bolus and bolytic drugs are also used to dissolve clots in arterial or the 0. Alteplase, reteplase, and tenecteplase are tissue plas- Bleeding is the most common adverse effect, with most minogen activators used mainly in acute myocardial infarction major bleeding occurring at the arterial access site for car- to dissolve clots obstructing coronary arteries and re-establish diac catheterization. If bleeding occurs and cannot be con- perfusion of tissues beyond the thrombotic area. The drugs trolled with pressure, the drug infusion and heparin should bind to fibrin in a clot and act locally to dissolve the clot. Phosphodiesterase Inhibitor Streptokinase and urokinase are enzymes that break down Cilostazol inhibits phosphodiesterase, an enzyme that me- fibrin. They are used mainly to lyse coronary artery clots in tabolizes cyclic adenosine monophosphate (cAMP). Streptokinase may also be used to hibition increases intracellular cAMP, which then inhibits dissolve clots in vascular catheters and to treat acute, severe, platelet aggregation and produces vasodilation.