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NUR 909 Midterm Exam With Questions And Correct Answers
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NUR 909 Midterm Exam With Questions And Correct AnswersANS & CNS - Answer
What are the two main neurotransmitters in the ANS and to what receptors do they
bind? - Answer Norepinephrine (sympathetic) & acetylcholine (parasympathetic); NE =
alpha & beta receptors, ACh = muscarinic & nicotinic
Agonist-A drug or chemical that binds to a receptor inside the cell or on its surface &
causes the same action as the thing that normally binds to the receptor; causes a
response
Antagonist- An antagonist is a drug that prevents the action or effect of another
substance.
Ex med & its MOA: alpha-1 agonist - Ans midodrine (indicated for orthostatic
hypotension); stimulate vascular smooth muscle & pupillary dilator muscle to cause
contraction
Ex med & its MOA: alpha-2 agonist - Ans methyldopa (primarily indicated for HTN);
stimulation assoc w/relaxation or inhibition of norepinephrine release
Ex med & its MOA: alpha-1 antagonist - Ans tamsulosin (BPH); block alpha-receptors in
bladder neck & prostate gland resulting in relaxation
Ex med & its MOA: beta-2 agonist - Answer albuterol; promotes smooth muscle
relaxation in respiratory tract
Ex med & its MOA: beta-3 agonist - Answer mirabegron (overactive bladder); by the
action of stimulating beta-3 receptors on the bladder, it allows the detrusor smooth
muscles to relax during the storage phase of urination, hence preventing contraction
,Ex med & its MOA: beta-1 antagonist - Answer atenolol (selective) & propranolol
(non-selective); decrease force & rate of contraction in the heart
Ex med & its MOA: muscarinic agonist (acetylcholinesterase inhibitors) - Answer
donepizil (Alzheimer's); inhibit the cholinesterase enzyme from breaking down ACh
Ex med & its MOA: muscarinic antagonist - Answer scopolamine (N/V); block action of
ACh in smooth muscle, secretory glands & CNS
If initiating a client on an alpha blocker antagonist, at what time of day should the
medication be taken, and for what reason? Bedtime, to avoid orthostatic hypotension.
What is the difference between the terms "selective" and "non-selective"
beta-blockers? -Answer Selectivity refers to medications that some BBs act only on
specific beta receptors; cardioselective refers to medications that have an effect on
heart rate because the BB just blocks the beta-1 receptors, which are found primarily in
the heart; the nonselective BBs inhibit both receptors
3 examples of selective BBs - Answer atenolol, acebutolol, metoprolol; remember
cardioselective
3 examples of nonselective BBs - Answer nadolol, propranolol, timolol
Which beta-blockers inhibit both alpha and beta receptors (nonselective)? - Answer
carvedilol, labetalol
Possible advantage/disadvantage of BBs that inhibit both alpha & beta receptors? -
Answer Alpha blockade predominates so the BB is less likely to produce significant
reductions in HR or CO; could be an advantage or disadvantage depending on pt's
condition
, What is the concern in a patient with diabetes being treated with a beta-blocker? Which
symptom of hypoglycemia would still be noticeable? -Answer BBs may precipitate
(cause) or exacerbate DM; b/c of their effects on carbohydrate metabolism & their ability
to mask the common sx of hypoglycemia (except sweating), BBs must be used
cautiously in pts w/DM
What are the four major anticholinergic/antimuscarinic side effects? - Answer Urinary
retention, constipation, xerostomia, blurred vision
Why are elderly pts susceptible to anticholinergic/antimuscarinic side effects? - Answer
Susceptible due to increased risk for cognitive impairment/falls
List two reasons why TCAs have fallen out of favor and are no longer considered
first-line for the treatment of depression. ANSWER TCAs are lethal in OD & lower
seizure threshold; MAOIs also have gone out of favor d/t potentially fatal drug-drug &
drug-food interactions, they also can't be used w/other antidepressants
MOA: TCAs - Answr act on neurotransmitters serotonin & NE; also act on histamine &
acetylcholine
What monitoring is recommended for patients being prescribed TCAs? - Answr Annual
ECG d/t potential to cause cardiac arrhythmias; also watch for seizures d/t lower seizure
threshold
MOA: SSRIs - Answr inhibit reuptake of serotonin in synapse, increasing lvls of serotonin
in the brain
Common ADEs of SSRI medications, including 1 potentially life-threatening- Answer
Common ADEs: anx, irritability, insomnia, sedation, sexual dysfxn, GI issues (nausea,
diarrhea, stomach upset); lifethreatening: serotonin syndrome (start as
diarrhea/sweating -> mental status change -> ANS dysfxn/neuromuscular abnorms ->
death)
How would you counsel a patient that is newly started on an SSRI (specifically, r/t
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