All Flashcards

Question

Ondansetron mechanism of action?

Answer 1

- blocks serotonin receptors in chemoreceptor trigger zone

Answer 2

pulls water into stool (sennosides) - implies accelerated, stronger, and more complete bowel empyting through osmosis

Answer 3

- promotes defecation - prevents and treats constipation - Metamucil + surfactnat type (docusate sodium)

Answer 4

monitor for retrosternal pain (bulking from behind) + possible bowel perforation

Answer 5

- simple, chroni constipation - accelerate removal of ingested toxic substances - accelerate removal of dead parasites - cleanse bowel prior to diagnostic or surgical procedures

Answer 6

- know PMHx - assess BMs + GI functioning - mix power + granules w/ at least 8 ounces of pleasant-tasting liquid immediately before use, drinks lots of h2o - **immediately report complaints of retrosternal pain after taking drug to prescriber** - smaller, more frequent doses spaced throughout day to relieve discomfort - monitor warfarin + digoxin levels closely

Answer 7

- opioids = most effective for controlling severe diarrhea - common opioids: codeine + diphenoxylate with atropine (Lomotil)

Answer 8

- antidiarrheal - P = opioid

Answer 9

- moderate to severe diarrhea - not recommended for infants - low-maintenance dose can by continued for up to 10 days - approved for children 2yr+

Answer 10

acts on smooth muscle cells of intestine to slow peristalsis

Answer 11

- dizziness - lethargy, drowsiness, - anticholinergic effects of atropine

Answer 12

- know PMHx + Sx - complete assessment of BM + GI function (freq + consistency of stools) - report abdo distension + s/s decr peristalsis - want to find SNTnoD --> softness, non-tender, no distension - monitor s/s dehyration, esp young children - maintain safe env't bc **can cause drowsiness/dizziness**

Answer 13

- 5-ASA agents - immunosuppressants - biologic therapies - anti-inflammatory drugs

Answer 14

- reduce symptoms - keep in remission (immunosuppressive agents) - alter progression of disease

Answer 15

**- 5-aminosalicylic acid (5-ASA) agents** - sulfasalazine, olsalazine, balsalazide, mesalamine severe: corticosteroids maintenance: immunosuppresive agents

Answer 16

- sulfonylureas - sulfonamide antibiotics - loop + thiazide diuretics

Answer 17

**- sulfonamide / salicylate** hypersensitivity - urinary obstruction - can worsen blood dyscrasias - hepatic impairment - dehydration - diabetes/ hypoglycemia

Answer 18

- affect target organism's structure, metabolism, or life cycle - goal = eliminate pathogen - may be used for prophylactic treatment of people with suppressed or compromised immune systems

Answer 19

Bactericidal = kill bacteria bacteriostatic = slow growth of bacteria

Answer 20

- make sure pt finishes all abx - don't share - keep away from children (safety lid + lock) - educate about abx decreasing effects of oral contraceptives and use back up BC -- will decr efficacy of hormone-based BC - teach pts to wear medic-alert bracelets if allergic

Answer 21

observe for 30 mins, esp after first dose - monitor for hypersensitivity - make sure pt knows s/s of allergic rxn

Answer 22

- teach when to take w/ food & when to avoid certain foods (i.e., Ca/iron - tetras) - take probiotics (1-2x/day) to counter antibiotic - replacement of normal colon flora w/ probiotic supplements or cultured dairy products - most best taken on empty stomach

Answer 23

- skin, teeth, tendons, ears, kidneys - assess renal + hepatic function (esp in elderly) = 2.2lb or 1kg/day

Answer 24

look @ location + shape - bony locations = harder for abx to get to, e.g., sinus infection = 10-14 days; ear infections ~5 days

Answer 25

- assess previous drug rxn to penicilin (animal products exposed to abx) - avoid cephalosporins if pt has severe penicilin allergy - monitor for hyperkalemia + hypernatremia (incr risk in pt w/ DM/ on dialysis) - monitor cardiac status, including ECG changes

Answer 26

- assess presence/hx of bleeding disorders - assess renal + hepatic function (esp in elderly) - assess for persistent diarrhea in children - avoid alcohol

Answer 27

- can reduce prothrombin levels through interference w/ vitamin K metabolism

Answer 28

some cephalosporins cause disulfiram (Antabuse)-like reaction with alcohol -- will start to severely vomit

Answer 29

- **decr **effectiveness of OCP - should use alt BC - incr potential for yeast infection while taking OCP + tetracyclines - caution w/ impaired liver/kidney function - take on empty stomach to incr absorption - may result in **photosensitivity** - watch for supra infection, e.g., pseudomembranous colitis - don't take w/ **milk products, iron supplements, magnesium**-containing laxatives, or antacids (fluoros)

Answer 30

- watch liver (EES) erythromycin estolate - multiple drug-drug interactions w/ macrolides (CYP) - examine pt for hx of cardiac disorders - may exacerbate existing heart disease - cause **metallic taste** in mouth

Answer 31

- more toxic than most abxs - have potential for serious AEs - last names don't work with this family and macrolides

Answer 32

- ototoxicity, worse if given with lasix - nephrotoxicity, worse if given with Zovirax (acyclovir) - neuromuscular blockage, including resp paralysis

Answer 33

- initially for UTIs - bacteriocidal, affect DNA synthesis by inhibting 2 bacterial enzymes - activity against gram-neg pathogens, newer drugs have activity against gram-positive microbes - for infections of GI, GU, resp, skin + soft tissues - "-oxain's"

Answer 34

- decr 90% if taken with multivitamins or minerals such as Ca, Mag, Fe, Zinc ions (Tetras 50%) - IV = PO, easy transition to home - can cause C. Diff, dysrhythmias + liver failure (QT prolongation + arrythmias) - CNS disturbances affect 1-8% of pts

Answer 35

- Cipro, teenagers or atheletes, will cause tendon rupture - children + lactacting or pregnant women - crosses into breast milk

Answer 36

norfloxacin -- sensitivity to lights

Answer 37

- bacteriostatic, inhibit folic acid - broad spectrum, but widespread use has led to incr resistance - used in combination to treat UTIs - anti-inflammatory properties can help w/ RA + UC - teratogenic - cause birth defects - don't take when breastfeeding or pregnant

Answer 38

Rxn to sulfonamide abx could mean allergy to other sulfonamide meds - DM sulfonylyreas (glyburide + glimepiride), NSAIDs (celecoxib), certain "h2o pills" (furosemide, chlorothiazide), IBD (sulfasalazine) - allergy to those meds may cause sensitivity to abx, caution w/ 1st dose

Answer 39

trimethoprim-sulfamethoxazole = tmp/smz - bactrim, septra, cotrimoxazole - potential for allergic rxn

Answer 40

to kill bacteria by inhibiting metabolism of folic acid

Answer 41

- skin rashes - N/V - agranulocytosis or thrombocytopenia (caution w/ pernicious anemia) - photosensitivity

Answer 42

- broad spectrum (TMP/SMX) for UTIs - pneumocystis carinii pneumonia - shigella of small bowel - acute episodes of chronic bronchitis

Answer 43

- assess for anemia/ other hematological disorders (HgB & platelets) - can incr risk for hemolytic anemia + bld dyscrasias - assess renal function; sulfonamides may incr risk for crystalluria - use alt BC if on OCP - contraindicated w/ hx of hypersensitivity to sulfonamides (SJS) - teach how to decr effects of photosensitivity

Answer 44

mechanism of action: bactericidal, inhbits cell wall synthesis primary use: reserved for severe/resistant gram-positive infection; effective for MRSA infections, used to treat for C. Diff **AES: ototoxicity (balance + dizziness), nephrotoxicity, red man syndrome, confusion/hallucinations, anaphylaxis**

Answer 45

- abx destroy sensitive bac, only insensitive (mutated) bac remain - free from competition from bac that were sensitive to drug, mutated bacteria thrives - client now develops infection that is resistant to conventional therapy - resistant bacteria can be transmitted to others - aka **SUPERBUGS**

Answer 46

- **methicillin-resistant staphylococcus-aureus (MRSA) --> won't respond to fluoroquinolones, macrolides, aminoglycosdies, tetrocyclines** - VRE - CBO/CBE - ESBL - PCNs & Cephalosporins rendered useless - VRSA or VISA

Answer 47

when organism is resistant to more than 1 drug

Answer 48

- pts take full course of abx - don't save abx or share with others - abx don't treat viral infections - overprescribing has led to ARO d/t loss of effectiveness - C&S prior to treatment preferable

Answer 49

reduces antagonism +** reduces resistance **

Answer 50

- diarrhea (c. diff or pseudomembranous colitis) - bladder pain + painful urination (e. coli / UTI) - abnormal vaginal discharge (yeast - candida) - red rash w/ satellite lesion (yeast - candida)

Answer 51

- secondary infections that occur when too many host flora are killed by abx - host flora stop pathogenic organisms - host flora killed by abx, microorganisms multiply - super opportunistic

Answer 52

- not easily transmitted thru casual contact - serious fungal infections uncommon w/ healthy immune defense - more common in immunocompromised pts - treatment may req weeks to months of therapy due to resistance

Answer 53

dark, moist environments with lots of sugar

Answer 54

- DM, HIV, Cancer - systemic fungal infection may be rapidly fatal - may experience freq fungal infections and require aggressive pharmacotherapy

Answer 55

unknown drug interactions + symptomatic overdose treatment

Answer 56

- Hx + assessment - observe for improvement & report persistent infections - avoid occlusive dressings / ointment on moist, dark areas of body - teach pt to avoid sharing shoes, towels, or personal objects (esp w/ candida)

Answer 57

- orally only (ineffective topically) - used to treat skin infections, e.g., jock itch, athlete's foot, ringworm; fungal infections of scalp, fingernails, toenails - reserved for cases w/ nail, hair, or large body surface involvement

Answer 58

- phototoxicity - SJS - urticaria - dizziness - really decr effectiveness of OCP - alcohol = disulfiram-like reaction

Answer 59

**Check blood glucose** - if pt isn't feeling well - went for exam, didn't get breakfast - sweating, confused

Answer 60

it masks s/s of hypoglycemia

Answer 61

regular insulin: Humulin R or Novolin R onset: 0.5-1h (30 min before meal) peak: 2-3 h duration: 8h

Answer 62

Lispro (Humalog), Aspart (Novorapid), Glulisine (Apidra) onset: 0-15 min before meal peak: 0.5-1hr (**best to be eating)** duration: 3-4h

Answer 63

regular insulin - for gestation diabetes

Answer 64

AEs: - irritation at injection site - lipodystrophy - weight gain SAEs: - hypoglycemia - rebound hyperglycemia - hypokalemia - always watch K+ levels, goes up in DKA

Answer 65

- adminster only regular insulin via IV - assess alc intake & BG -- will make them go up and down - medicine hx - herbs + dietary supplements, note meds that can alter effects of insulin - ensure pt has consumed or is capable of consuming adequate food to prevent hypoglycemmia rxn - assess K of insulin therapy, diet, and exercise, and how these affect serum glucose levels

Answer 66

- don't admin if BG < 4 mmol, or if exhibting signs of hypoglycemia - rotate injection sites weekly to prevent lipodystrophy - check periodic hemoglobin A1C levels - assess s/s LT DM complications: eyes, heart, kidneys, feet

Answer 67

- be familiar w/ **onset, peak, duration of action** of prescribed insulin - be aware of i**mportant aspects** of each specific insulin - not all insulin types compatible - know s**/s hypoglycemia + hyperglycemia**

Answer 68

- some may not be mixed tgt in single syringe, e.g., Lantus - **clear insulin always drawn into syringe first**

Answer 69

- monitor BG (hypo- & hyperglycemia) - check s/s illness or infection - watch liver function - assess for adherence to therapy + ability for self-care - sulfonylureas contraindicated in women who are pregnant/breast-feeding, or persons w/ renal/liver disease - 2nd gen sulfonylureas have fewer drug-drug interactions

Answer 70

- stimulates insulin release from pancreas - incr sensitivity to insulin receptors - decr chance of prolonged hypoglycemia - 10% experience decr effectiveness after prolonged use - most SEs = minor + GI related

Answer 71

- glipizide (Glucotrol) - glyburide (Diabeta, Micronase) - glimepiride (Amaryl)

Answer 72

- sensitivity to sulfa drugs or thiazide diuretics - renal or hepatic disease - if used during pregnancy, discontinue at least 1 month b4 delivery

Answer 73

- alcohol - oral anticoagulants, MAOIs, probenecid, sulfonamides - chloramphenicol, salicylates, clofibrate - rifampin - thiazides / sulfonamide-based drugs - ginseng, garlic, black cohosh, juniper berries, fenugreek, coriander, dandelion root

Answer 74

6-12 weeks

Answer 75

- decr glucose production by liver - incr insulin sensitivity at tissues - improve glucose transport into cells - don't promote weight gain - usually first line of treatment ## Footnote T2D

Answer 76

48h before and 48h after to prevent lactic acid buildup

Answer 77

- impaired renal function - HF, liver failure, hx of lactic acidosis - concurrent serious infection, e.g., septicemia - any condition that predisposes pt to hypoxemia - anemia, diarrhea, vomiting, fever, dehydration, gastroparesis, GI obstruction - hyperthyroidism, pituitary insufficiency, trauma - pregnancy + lactation

Answer 78

- short duration of action - destroyed rapidly by monoamine oxidase (MAO) - COMT (catechol-O-methyltransferase) is one of several enzymes that degrade catecholamines, such as dopamine, epinephrine, norepinephrine - no PO - must be parenteral or inhalation d/t COMT in intestinal tract - doesn't cross BBB

Answer 79

"eats" cates b4 enter bldstream & to target tissue - broken down before it is absorbed

Answer 80

- may be taken PO - not destroyed as rapidly - better able to enter brain + affect CNS

Answer 81

- assess underlying problem + preexisting conditions - hx / px (VS) - closely monitor resp status - use cardiac monitor/resuscitation equipment - monitor BP closely - inform prescriber of changes in I&O - monitor for hyperglycemia - insulin gtt - examine ocular + nasal mucosa - protect from light (brown bag/IV)

Answer 82

- severe HTN - pre-existing bradycardia - advanced CAD - nitroglycerin - narrow-angle glaucoma - hyperthyroidism - diabetes

Answer 83

- phentolamine - anti-dysrhythmic drugs

Answer 84

- examine IV site frequently - advise pt to remove contact lenses - dark eye protection after ophthalmic admin (dry out eyes + nasal airways) - avoid caffeine (w/ all adrenergic agonists) - contact HCP if palpitations or jittery/nervousness

Answer 85

belladonna - natural source of alkaloids w/ anticholinergic activity

Answer 86

- GI disorders such as IBS - opthalmic procedures - cardiac rhythm disorders - chemotherapy induced diarrhea - adjuncts to anesthesia (decr secretions) - asthma + COPD (bronchodilation effects) - antidotes for poisoning or overdose - urge incontinence (overactive bladder), helps w/ spasms - watch BPH - Parkinson disease

Answer 87

relatively high incidence of AEs - why it is rarely the drug of choice - urinary retention - xerostomia (dry mouth) - tachycardia - CNS stimulation - dry eyes - photophobia - urinary retention in BPH

Answer 88

= overdose of muscarinic antagonists - dry mouth, difficulty swallowing - visual changes, blurred vision, photophobia - agitation + hallucinations antidote = physostigmine - generally only admin to pts showing severe symptoms

Answer 89

work on muscle, NOT CNS or motor/sensory perceptions

Answer 90

motor end plate of muscle: causes relase of Ach to travel to receptors on skeletal muscle = muscle contraction continuous depolarized state in which Ca doesn't return to its storage depots = - sustained muscle contraction + paralyzed condition necessary for certain surgical procedures

Answer 91

- given to produce muscle paralysis duringn short medical-surgical procedures - watch for contraction to signal access - **preceded by contraction** - initial contraction and then muscle is relaxed --> paralyzed - restlessness = no success

Answer 92

- given to produce muscle paralysis during longer surgical procedures - occupies Ach receptors and causes muscle paralysis w/o depolarization (no contraction - = flaccid paralysis

Answer 93

- complete paralysis of diaphragm/intercostal muscles - watch for resp paralysis - tachycardia - hypotension - urinary retention

Answer 94

- malignant hyperthemia - muscles rigid, skin hot - resp depression - apnea - dysrhythmias

Answer 95

- children w/ congenital musculoskeletal diseases at greater risk for cardiac arrest - no way to predict which pts at risk

Answer 96

- surgical anesthesia - pseudochlinesterase - relaxes abdo muscles, or for relaxation prior to intubation - induces relaxation in less than 1 minute - muscle strength returns quickly after discontinuation of drug - pt can still feel pain, is aware of surroundings (use benzos + opioids)

Answer 97

- nondepolarizing neuromuscular blockers (NDNBs) - tubocurarine = prototype, 9 others in class - used to relax skeletal muscles during surgical procedures - **don't cause sedation, analgesia, or loss of consciousness --> must use benzos, propofol & opioids in conjunction**

Answer 98

- when the SNS is blocked, PNS dominates - hypotension / orthohypotension d/t decr blood flow to brain; syncope - reflex tachycardia and nasal congestion also occur

Answer 99

prevention by initial therapy begun with low doses and usually given at bedtime

Answer 100

- block peripheral catecholamines - used concurrently w/ drugs like diuretics - relax smooth muscle bladder (detrusor) and prostate - incr urine flow

Answer 101

Block vasoconstriction on vascular smooth muscle (afterload) which decr BP directly

Answer 102

Block vasoconstriction which decr venous return (preload) to heart and lowers BP indirectly

Answer 103

1. Benign prostatic hyperplasia 2. Pheochromocytoma 3. HTN

Answer 104

2 selective agents used in BPH 1. Alfuzosin (uroxatral) 2. tamsulosin (Flomax) don't cure condition, need surgery

Answer 105

small tumour of adrenal medulla, causes irregular secretion of Epi & NE - excessive secretion of catecholamine in this condition causes severe HTN

Answer 106

used to treat severe HTN

Answer 107

- block only beta1 receptors - cardioselective - fewer noncardiac SEs - little effect on bronchial smooth muscle - can be safely given to pts w/ asthma and COPD

Answer 108

- block beta1 and beta2 receptors - produce more SEs than selective beta1 antagonists - serious SE = bronchoconstriction (caution in pts w/ COPD + asthma)

Answer 109

- don't stop suddenly, will go into rebound tachycardia / rebound HTN --> can lead to stroke - stay away from grapefruit juice + statins (ARBs)

Answer 110

- hypotension - bradycardia - in 2nd-3rd degree heart block

Answer 111

most therapeutic actions relate to CV system - slow conduction velocity thru AV node - decr HR (chronotropic) - decr force of contractions (inotropic) - during stress/exercise - prevents sympathetic stimulation to heart - caution when admin CCBs concurrently bc may potentiate HF

Answer 112

in about 6 weeks, pts will feel like shit

Answer 113

1. prevents hyperglycemia effect of catecholamines --> dangerous in pts w/ DM b/c can cause hypoglycemia + masks s/s hypoglycemia - decr amount of free fatty acids available during metabolic stress 2. bronchoconstriction - cannot be used in pts w/ COPD, asthma 3. rebound cardiac excitation may occur if beta blockers withdrawn abruptly - never stop w/o talking to HCP first

Answer 114

- monitor VS q15min to q1hr - Hx + Px - assess for asthma + COPD - review lab tests for kidney, liver, hematologic + cardiac functions - watch for ADRs in older adults + in pts w/ impaired renal function - monitor I/O & daily weights (esp in HF) - pt edu: decr salt intake, don't stop drug suddenly - examine for impaired circulation: irregular rhythm, SOB, bilateral lower extremities edema - watch for widening QRS - immediate nursing attention

Answer 115

"-olol" - carvedilol (Coreg) - labetalol (Normodyne, Trandate) - sotalol (Betapace, Sorine): watch for widening QRS complex

Answer 116

- prevents contraction of peripheral arterioles (vasodilation + decr BP) - afterload reduced - decr peripheral resistence + preload = lower myocardial oxygen demand + less workload for heart - dilation of coronary arteries = more bld flow to heart

Answer 117

stop the influx of Ca into vascular smooth muscle

Answer 118

reduces force of myocardial contraction (negative inotropic effect) - reduces inward movement of calcium during plateau phase of action potential

Answer 119

negative chronotropic effect - SA node generates fewer action potentials - slows automaticity - decr hR

Answer 120

- may interact w/ drugs that induce or inhibit CYP 3A4 - additive effect w/ other antiHTN drugs - incr risk of CHF w/ BB - incr serum levels of digoxin - bradycardia - syncope/drop in BP w/ alcohol

Answer 121

- rapid-acting vasopressors such as dopamine, dobutamine - calcium infusions

Answer 122

- incr digoxin levels = incr risk bradycardia - additive hypotension / bradycardia with other antiHTN drugs - 3x plasma concentration of buspirone - risk of myopathy incr significantly w/ statins - verapamil incr carbamazepine (Tegretol) levels = neurotoxicity (ataxia/seizures) - grapefruit juice may incr levels

Answer 123

Diltiazem (Cardizem, Dilacor, Taztia XR, Tiazac) - treatment of atrial dysrhythmias + HTN, stable, and vasospastic angina - same profile as verapamil - migraine prophylaxis off-label

Answer 124

- = first-line agents in treatment of HTN and HF - block conversion of angiotenin I to angiotensin II (occurs in lungs) - results in decr in BP + HR - decrease in aldosterone secretion reduces blood volume - breaks down bradykinin (similar to histamine) ## Footnote Drugs affecting renin-angiotensin-aldosterone system

Answer 125

primary: due to genetics, treatment = hydrochlorothiazide secondary - drug of choice = ACE for kidney protection / heart if CVS problems

Answer 126

- slows progression of HF - lower mortality of recent acute MI - prophylaxis for adverse cardiac events - prevent or delay progression of renal disease and retinopathy of diabetics

Answer 127

- contraindicated in hyperkalemia - caution when using ACEI with K+ sparing diuretics (don't give with spironolactone) - watch K+ levels - angioedema most serious --> rapid swelling of throat, face, larynx, tongue that can lead to airway obstruction - all have black box warning regarding risk for major congenital defects, esp 2nd & 3rd trimester

Answer 128

- HF - HTN - acute MI

Answer 129

lisinopril (Prinivil, Zestril) therapeutic classification: antihypertensive pharmacologic classification: ACEI

Answer 130

- binds to and inhibits action of ACE - decr in serum angiotensin II reduces aldosterone, which results in less sodium and water retetion

Answer 131

- cough - headache - dizziness - orthostatic hypotension

Answer 132

- angioedema - agranulocytosis (abnormal bld levels) - hepatotoxicity

Answer 133

- pregnancy - category D - angioedema - hyperkalemia - serious renal impairment

Answer 134

- check renal labs and K+ levels for hyperkalemia - monitor BP before administration and 30min to 1 hour after

Answer 135

- decreased antiHTN activity and worsened renal disease (NSAIDs --> GI + GFR = kidneys) - synergistic hypotensive action (diuretics + other hypotensives) - hyperkalemia (K+ supplements, potassium-sparing diuretics) - pregnancy category C (1st trimester), category D (2nd & 3rd)

Answer 136

- normal saline or vasopressor - hemodialysis

Answer 137

- act by inhibiting AT1 receptor and are used for HTN + HF - block angiotensin II form activating their target receptors in smooth muscle - cause vasodilation, reduce PR, decr BP - prevent aldosterone secretion - promote excretion of Na+ & h2o by kidneys

Answer 138

- same as ACEI - HTN, HF - some approved to treat MI and prophylaxis of CVA - unlike ARBs, don't cause cough - angioedema less common than ARBs

Answer 139

prototype = losartan (Cozaar) therapeutic classification: antiHTN pharmacologic: angiotensin II receptor blocker

Answer 140

- HTN - CVA prophylaxis - prevention of diabetic neuropathy - off-label use for HF

Answer 141

- selectively blocks angiotensin AT1 receptors, resulting in decreased BP - blockade prevents cardiac remodelling and deterioration of renal function in pts with diabetes (protects heart & kidneys)

Answer 142

- decr antiHTN activity w/ NSAIDs - additive hypotensive action w/ diuretics & other hypotensives - hyperkalemia --> K+ supplements, potassium-sparing diuretics - additive hypotensive effect (alcohol)

Answer 143

heart - hypertrophy, MI, HF (watch for rapid weight gain, 5lbs/2-3 days), SOB, BLE edema eyes: - blindness --> have frequent eye checks brain: - stroke - assess for speech changes, drooping face, one-sided weakness kidneys: - kidney failure - watch for protein in urine (micro/macro-albuminuria)

Answer 144

diurectics = often first choice of drug for treating mild to moderate HTN - thiazide diuretic = first line treatment option for HTN - multi-drug therapy often required

Answer 145

decr blood volume and decr BP AEs: - dehydration - hyponatremia - hypokalemia (less w/ K+ sparing diuretics) - nocturia (if taken too late in day) - orthostatic hypotension

Answer 146

- thiazide + thiazide-like diuretics (most common for HTN): hydrochlorothiazide - potassium-sparing diuretics: triamterene, spironolactone - loop (high-ceiling) diuretics: not usually used for HTN; furosemide, bumetanide (can cause K+ depletion)

Answer 147

- persistent cough - postural hypotension - hyperkalemia - angioedema

Answer 148

nonspecific causes bronchoconstriction - use w/ caution for pts w/ asthma / HF - low doses: AEs uncommon higher doses: - fatigue, activity intolerance - erectile dysfunction - masks symptoms of hypoglycemia - clinical depression

Answer 149

- inhibits effects of angiotensin II - similar effects to ACEI - drug = losartan fewer AEs than ACEI - hypotension - angioedema (more rare) - more expensive - no cough

Answer 150

- relax arterial smooth muscle directly = decr resistance (pressure coming back up) and decr afterload - affects veins and arteries - some drugs also affect veins, such as isosorbide dinitrate (long-acting nitrate) = decr preload ## Footnote relax arteriolar smooth muscle --> decr resistance, and therefore decr afterload

Answer 151

- reflex tachycardia and hypotension - compensatory incr in HR due to suden drop in BP - fluid retention - can be minimized with beta blockers and diuretics

Answer 152

- hydralazine - diazoxide - nitroprusside

Answer 153

therapeutic: antiHTN pharmacologic: direct vasodilator prototype drug = hydralazine (Apresoline)

Answer 154

- moderate to severe HTN - hypertensive emergencies - acute HF

Answer 155

- causes peripheral vasodilation - decr peripheral vascular resistance, HR & CO - decr afterload - selective for arterioles (selective for afterload)

Answer 156

- Hx & Px (esp BP) - monitor lab tests for antinuclear antibody titer before and during therapy - monitor I&O - potential with fluid retention/edema - **watch for adverse effects (i.e., palpitations/CP) - heart!!!** - assess for rapid drop in BP and subsequent tachycardia (can put into shock)

Answer 157

- for reducing blood lipid levels / for dyslipidemias - first-line therapy - can reduce LDL levels by 20-40% - raise HDL levels - primary prevention (no hx of cvs disease) - secondary prevention (slow progression and reduce mortality)

Answer 158

atorvastatin (Lipitor) therapeutic: antihyperlipidemic pharmacologic: HMG-CoA reductase inhibitor

Answer 159

therapeutic uses: - hypercholesterolemia - family hypercholesterolemia mechanism of action: - inhibits HMG-CoA reductase (primary regulatory enzyme in cholesterol biosynthesis) - liver makes less cholesterol and responds by making more LDL receptors to remove cholesterol from blood

Answer 160

- RUQ tenderness - changes in stool - jaundice - bleeding/ bruising - abdominal distention

Answer 161

- often combined w/ statins to reduce LDL cholesterol levels - GI SEs bile breaks down fat --> bile acid sequestrants binds with bile acids so fat doesn't get broken down/reabsorbed

Answer 162

- obtain baseline lipid values - monitor LDL cholesterol values - assess lipid lab tests within 2-4 weeks of initiation of therapy/ change in dose - assess for signs of **rhabdomyolysis or myopathies** (generalized muscle pain/aches all over) - observe for digoxin toxicity - watch for hepatotoxicity - pregnancy - category X **- no grapefruit juice** **- no alcohol (liver)**

Answer 163

cholestyramine (Questran) therapeutic: antihyperlipidemic pharmacologic: bile acid sequestrant

Answer 164

therapeutic use: - hypercholesterolemia (elevated LDL) mechanism of action: - binds to bile acids - forms insoluble compounds containing cholesterol that is excreted in feces - lowers LDL levels by increasing LDL receptors on hepatocytes

Answer 165

- completely dissolve powder before administration - increase fluid intake - assess for early signs of hypoprothrombinemia (watch bld) - monitor lab tests for therapeutic effectiveness - consult prescriber to see if supplemental vit A & D, and folic acid are required in LT care - A & D = fat-soluble vitamins, so can decr absorption, and cholestyramine binds to folic acid --> can lead to deficiencies

Answer 166

- to lower triglyceride levels - have little effect on LDL cholesterol - most often used for elevated triglycerides and other "L"s are within good range

Answer 167

gemfibrozil (Lopid) therapeutic: antihyperlipidemic pharmacologic: fibric acid agent (fibrate)

Answer 168

therapeutic effect/use: - hypertriglyceridemia and VLDL (very low-density lipoprotein) - second-line therapy after statins mechanism of action: - exact mechanism unknown - inhibits breakdown of stored fat

Answer 169

- GI: abdominal cramping, diarrhea, nausea, dyspepsia (indigestion) - headache - dizziness - peripheral neuropathy - diminished libido ## Footnote fibric acid

Answer 170

- cholelithiasis (gallstones) - anemia - eosinophilia (high #) - bleeding

Answer 171

- gallbladder disease - serious liver impairment - renal impairment

Answer 172

- increased risk of myositis (inflammation) and rhabdomyolysis w/ some statins - incr risk of bleeding with anticoagulants: easily bruised, tarry/dark stool, vomit coffee grounds, check hematocrit/labs, hematuria, pain, stroke s/s - enhanced hypoglycemia effects w/ antidiabetic agents

Answer 173

- monitor lab tests - consult prescriber if inadequate response after 3 months - educate pt that drug will cause bloating and gas - watch for bleeding

Answer 174

location: - left-sided: pulmonary edema - right-sided: peripheral edema types of failure: - systolic failure: decr contractility, decr EF - diastolic: decr ventricular filling, normal EF

Answer 175

- used in treating HF before ACEIs (ACEIs now first-line treatment) - incr force of myocardial contraction --> incr contractility - improves symptoms but doesn't improve mortality - **stabilizes cardiac conduction abnormalities** (watch with other antiarrhythmics) - digitalization - incr dose gradually until tissues become saturated with medication and s/s of HF diminish

Answer 176

- ensure pt monitors for dependent BLE edema - worsening SOB or new onset of SOB - evaluate # of pillows needed to sleep at night or if they are sleeping in recliner - weigh themselves everyday - same time, scale, clothes **- call HCP if 2lb weight gain in 1 day, or 5lbs in 2-3 days **

Answer 177

**= ARB + neprolysing agents ** - decrease mortality by 40% --> will see massive improvement

Answer 178

digoxin (Lanoxin, Lanoxicaps) therapeutic: drug for HF pharmacologic: cardiac glycoside, inotropic agent

Answer 179

indications: HF mechanism of action: inhibits sodium-potassium-ATPase - as sodium accumulates in myocytes, calcium ions are released from storage areas to activate contractile elements

Answer 180

- general malaise - dizziness, headaches - N/V, anorexia **- visual disturbances (blurred or yellow vision)**

Answer 181

- ventricular dysrhythmias - AV block (chambers stop talking to other chambers --> heart block) - atrial dysrhythmias - sinus bradycardia

Answer 182

- to termine or prevent angina episodes - short-acting: to stop angina attacks - long-acting: to prevent angina attacks

Answer 183

- nitric oxide = cell-signaling molecule and potent vasodilator - relaxes venous muscles --> redue preload = less work for heart - relaxes arterial muscle --> incr blood flow to myocardium, heart doesn't have to blow so hard = afterload reduced -

Answer 184

- hypotension - headache - tolerance

Answer 185

nitroglycerin (Nitrstat, Nitro-Bid, Nitro-Dur, others) therapeutic: antianginal pharmacologic: organic nitrate, vasodilator indications: - acute angina/MI - acute CHF/pulmonary edema - severe HTN - hypertensive emergency

Answer 186

- forms nitric oxide @ vascular smooth muscle --> triggers cascade resulting in release of calcium ions - relaxes both arterial and venous smooth muscles = less cardiac return (less preload & afterload) -** dilates coronary arteries = incr O2 to myocardium (cardiac muscles)**

Answer 187

- reduce myocardial demand - decr HR (- chronotropic), decr contractility (- inotropic), decr BP - counters effects of sympathetic stimulation - reduce contraction + strength of contractility (prevents dysrhythmias) - therapy usually continued for life

Answer 188

- given within 24h of onset of MI - prevents cardiac remodelling - suppress dysrhythmias - therapy usually continued for life - watch K+ levels and for angioedema - check labs for K+ & renal function

Answer 189

- 160-325 mg initially, and then 81mg daily - lower dose causes less GI bleeding - heparin and low-molecular-weight heparins (enoxaparin) used for acute treatment

Answer 190

- to dissolve active clots - only for use in early MI (best within 30 mins, no benefit after 24h) - severe risk of bleeding - alteplase (Activase)

Answer 191

- clopidogrel (Plavix) and ticlopidine (Ticlid) used to prevent + treat MI & thrombotic stroke - GP IIb/IIa inhibitors used for MI + pts undergoing percutaneous coronary interventions (PCIs) - protease-activated receptor-I-antagonists, such as vorapaxar (Zontivity) = newly approved antiplatelet drugs used to reduce incidence of thrombotic events in pts with MI hx or clotting disorders

Answer 192

aka fibrinolytics - alteplase (tPa), tenecteplase (TNK-tPa) - dissolves bonds that hold existing thrombi together

Answer 193

aminocaproic acid & tranexamic acid - inhibit activation of plasminogen to plasmin, prevent break-up of fibrin & maintain clot stability - used to prevent excessive bleeding - used to stabilize post surgical bleeds

Answer 194

parental: - heparin - low-molecular-weight heparins (only subcu) - fondaprinuxn (chemically r/t LMWH) - direct thrombin inhibitors oral (preferred route): - warfarin - dabigatran

Answer 195

- baseline blood tests - monitor aPTT every 6 hours when adjusting dose (follow PPOs in IHA) - monitor for signs of bleeding - apply firm pressure x5 min venous & x10 mins for arterial needle sticks - reduce risk of trauma -** keep heparin antidote readily available (protamine sulfate)**

Answer 196

1. hemorrhagic stroke 2. GI bleed 3. trauma 4. surgery - heparin stopped 24h before surgery, start again 24h after 5. blood disorders, e.g., hemophilia

Answer 197

- below 1 if not going for surgery/is normal - between 2-3 if at risk for clotting

Answer 198

- no razors, wax instead or use electric razor * soft bristled toothbrush * no high impact activities (will bruise more easily) * if bleeding, e.g., nosebleed or fingercut, > 30 min, go to hospital - if GI bleed (coffee ground emesis or melena), go to hospital

Answer 199

warfarin (Coumadin) therapeutic: anticoagulant pharmacologic: vitamin K antagonist

Answer 200

therapeutic effects/uses: - prophylaxis arterial thromboembolism (prevention of CVA/MI) - DVT/PE - long-term indwelling catheters - prevent thromboembolic events in high-risk patients mechanism of action: - inhibits 2 enzymes involved in formation of activated vit K - inhibits synthesis of new clotting factors

Answer 201

- assess for risk of thromboemboli - monitor PT/INR - monitor urine, stool, liver function, blood - monitor risk groups for nonadherence - teach pts to avoid, or eat sparingly, foods rich in vit K, such as broccoli, leafy greens, etc

Answer 202

- monitor for signs of bleeding - apply firm pressure x 5 min venous & x10 mins for arterial needle sticks - reduce risk of trauma

Answer 203

therapeutic class: anticoagulant pharmacologic: indirect thrombin inhibitor effects/uses: - acute thromboembolic disorders - DVT/PE - unstable angina/evolving MI - prophylaxis mechanism of action: - activates anti-thrombin III, which inhibits thrombin and to a lesser extent, factor Xa (prevents formation of clots)

Answer 204

- baseline blood tests - monitor **aPTT q6h** when adjusting dose (follow PPOs in IHA) - monitor for signs of bleeding - apply firm pressure x 5min venous & x10 mins for arterial needle sticks - reduce risk of trauma - keep **heparin antidote** readily available (**protamine sulfate**)

Answer 205

- aka P2Y12 inhibitors - antiplatelet agents prescribed for prevention & treatment of arterial thrombosis - inhibits aggregation (decr ability to clot, doesn't come to spot of bleeding) - makes blood less "sticky"

Answer 206

reversible: - Ticlopidine (Ticlid) BID - stroke prophylaxis - cangrelor irreversible - MI & stroke - clopidogrel (Plavix) - prasugrel

Answer 207

- bleeding - neutropenia/agranulocytosis - thrombotic thrombocytopenic purpura

Answer 208

clopidogrel (Plavix) therapeutic: antiplatelet agent pharmacologic: ADP receptor blocker 3 new P2Y12 receptor inhibitors: prasugrel, cangrelor, ticagrelor

Answer 209

- **reduce risk** of CVA/MI (doesn't break down clot directly) - more preventative - reducing thrombolytic events post-CVA/MI - prevent DVT - prevent thrombi formation unstable angina / coronary stents

Answer 210

- inhibits ADP receptors on platelets and prolongs bleeding time by irreversibly inhibiting platelet aggregation - CYP450 interaction

Answer 211

- delayed onset of action - large inter-individual variability in platelet response - genetic polymorphism of metabolizing enzyme - drug-drug interactions (DDIs) - 2-step activation process catalyzed by series of ctyochrome P450 (CYP) isoenzymes --> prodrug, requires hepatic conversion to an active metabolite resulting in delayed onset of action and inter-individual variability

Answer 212

"-plase" or "-nase"

Answer 213

streptokinase (SK)/ Urokinase (UK) - older, slower, more side effects, cheap, allergenic - for PE, MI, DVT newer drugs have fewer side effects - tenecteplase (TNK-tPA) - alteplase (tPA)

Answer 214

risk of bleeding may outweight benefits - watch for s/s hemorrhagic stroke (LOC)

Answer 215

- aplastic anemia - hepatic cirrhosis - postop cardiac surgery (@ risk for excessive bleeding - certain carcinomas - hemophilia A - excessive post surgical bleeds

Answer 216

- aka hemostatics/tranexamic acid, to promote formation of clots - more commonly prescribed in surgical pts - occupies binding sites on plasminogen and plasmin - prevents digestion of fibrin clot by plasmin - stabilizes clot

Answer 217

- N/V - **brown stains on teeth from liquid** - darkened stools - constipation

Answer 218

- hemochromatosis - PUD - regional enteritis - ulcerative colitis

Answer 219

- assess VS for cellular hypoxia - give on empty stomach, if possible - if difficulty swallowing tablets or capsules, recommend a liquid formulation or less corrosive form, such as ferrous gluconate - prevent staining of teeth (rinse with h2o) - mix Feosol elixir w/ h2o - continue iron therapy for 2-3 months after normal Hgb - baseline levels for RBCs, hematocrit, hemoglobin, and serum ferritin - monitor BMs

Answer 220

- don't take tablets or capsules within 1 hour of bedtime - don't crush tablets or empty contents of capsule - take ferrous sulfate with full glass of water - rinse mouth with clear h2o immediately after ingestion - consume citrus fruit or tomato juice with iron preparations (except elixir form) - dark green or black stools = harmless SE - report constipation or diarrhea

Answer 221

avoid taking with: - milk - eggs - antacids - caffeine beverages

Answer 222

T: agent for anemia P: vitamin supplement - for vit b12 deficiency anemia

Answer 223

- rashes - itching - other signs of allergy

Answer 224

- sodium retention with possible worsening HF - anaphylaxis - hypokalemia & potential dysrhythmias

Answer 225

- suspected sensitivity to cobalt - severe pulmonary disease - heart disease pregnancy category A, category C when used parenterally

Answer 226

can decrease absorption - ethanol/ alcohol - aminosalicylic acid - omeprazole - neomycin - chloramphenicol

Answer 227

- monitor lab tests; repeat test 5-7 days after start of therapy, and @ regular intervals during - monitor serum K+ levels during first 48h - pts w/ cardiac disease and those on parental cyanocobalamin @ risk for dysrhythmias, palpitations & CP - watch VS - be alert to s/s pulmonary edema - monitor effectiveness of pharmacotherapy - complete diet + drug hx - inquire into alcohol drinking patterns

Answer 228

- apprehension - worry, fear - palpitations - SOB - heartburn - dry mouth - excess sweating

Answer 229

often can be miscontrued as heart attack - always rule out MI first (diagnostic tests & ECG) - obtain hx of recent events that might trigger anxiety or that might indicate drug abuse

Answer 230

nurse needs to take complete hx: - medications that may worsen/cause anxiety symptoms - medical conditions that may be associated with anxiety - consider nonpharmacological interventions that reduce environmental, physical, and emotional stressors prior to pharmacological intervention

Answer 231

- drugs of choice for generalized anxiety disorder and short-term therapy of insomnia - off-label use: seizures, alcohol withdrawal, status epilepticus - metabolized in liver, excreted in kidneys - tolerance develops - potential for dependence - OD with alcohol may be fatal - "-azepam"

Answer 232

- change dose gradually - DONT stop abruptly - watch for suicidal ideation - may cause mania or psychosis - watch in use with dysfunctional kidneys, liver, CV, or pulmonary system - use cautiously with the elderly

Answer 233

1. brain: sleepy, make person relaxed, put into dreamy state 2. blood - cause blood dyscrasias 3. drops BP 4. bile (think liver) 5. bonkers - more likely for elderly (e.g., gets agitated instead of relaxed)

Answer 234

lorazepam (Ativan) therapeutic: antianxiety agent, sedative - hypnotic, antiseizure agent pharmacologic: benzodiazepine, GABA receptor agonist

Answer 235

effects & uses: - routine management of GAD - reduce anxiety prior to surgery/medical procedure - reduce anxiety in mechanically ventilataed patients - off-label use for insomnia, seizures, ethanol withdrawal, status epilepticus mechanism of action: - potentiates GABA - can cause diff levels of CNS depression: relaxation, sleep (higher doses), coma (higher doses)

Answer 236

- aspirate prior to injection (IM) & give slowly - assess for paradoxical CNS excitement - advise pt to stop smoking - watch CBC, liver function & renal function - teach nonpharmacological methods first, before anti-anxiety drugs - assess for S/S overdose or abuse - teach nonpharmacological methods of sleep & relaxation - assess for suicidal ideation

Answer 237

- oversedation - "hangover" effect, lethary - hallucinations - blood dyscrasias - hypocalcemia - hepatic disease - N/V/D/C - paradoxical excitation in children or older adults

Answer 238

therapeutic: sedative-hypnotics & anti-epileptic drug pharmacologic: barbituate, GABA receptor agonist prototype drug: phenobarbital (Luminal) - for status epilepticus (IV route) and ST management of insomnia - dependence high, overdose / withdrawal severe

Answer 239

- **coma** - **SJS** - **angioedema** - **periorbital edema** - ** thrombophlebitis**

Answer 240

- monitor for resp depression - assess pt given IV barbituates q15 min - monitor for s/s blood dyscrasias - aspirate prior to injection - monitor therapeutic serum concentrations of drug (like dig, dilantin, lithium) - teach nonpharmacologic methods of relaxation/sleep - assess baseline hepatic + renal function and monitor during therapy - if pt develops fever, angioedema, and body rash - hold med & call MD

Answer 241

causes: - environmental - situational - hereditary - no longer thought to be related to parenting or unresolved childhood often does coexist with other conditoins - anxiety disorders - substance abuse - HTN or arthritis

Answer 242

a mood disorder - persistant disturbance in emotion that impairs ability to effectively deal with ADLs - 2 primary types of mood disorders = depression & bipolar disorder

Answer 243

- 3 or more weeks of antidepressant therapy may be required before pt's mood begins to improve - 6-8 weeks to reach maximal benefit - risk of attempted suicide highest in month before pharmacotherapy - majority of persons who commit suicide have been diagnosed with major depression

Answer 244

- careful monitoring of talk of suicide - weekly or daily patient contact - careful monitoring of medications

Answer 245

- once mainstay treatment of depression, but have many AEs - block reuptake transport of norepinephrine and serotonin @ synapses

Answer 246

many side effects - anticholinergenic effects/ sympathomimetic effects - orthostatic hypotension - sedation (worsened w/ concurrent use of other CNS depressants) - relatively high incidence of sexual dysfunction (often cause of cessation) - withdrawal symptoms if not tapered - don't stop suddenly - may take 3 weeks to see effects & 6 weeks to see optimum benefits

Answer 247

imipramine (Tofranil) - therapeutic = tricyclic antidepressant - pharmacologic = norepinephrine reuptake inhibitor - for major depressive disorder off-label uses: - adjuvant tx of ca / neuropathic pain - overactive bladder; ADHD; bulimia nervosa - social anxiety disorder - panic disorder

Answer 248

- MI, heart block, dysrhythmias - asthma, GI disorders, alcoholism, schizophrenia, bipolar disorder - avoid use w/ alcohol - seizure disorders

Answer 249

d/t sympathomimetic effect - suicidal tendencies - urinary retention - prostatic hyperplasia - cardiac/hepatic disease - increased intraocular pressure - hyperthyroidism - parkinson disease

Answer 250

- drugs of choice for treating depression d/t low incidence of serious AEs - fewer sympathomimetic & anticholinergic effects - for variety of MH disorders: social anxiety, PTSD, GAD, panic disorder, OCD

Answer 251

- monitor for suicidal ideation - be sure pt swallows each dose - encourage compliance - monitor for urinary retention / constipation - treat for dry mouth

Answer 252

fluoxetine (Prozac, Sarafem) therapeutic: anti-depressant, anti-anxiety pharmacologic: SSRI uses: - depression - bulimia - pediatric depression - panic attacks mechanism of action: - blocks uptake of serotonin @ neuronal presynaptic membrane - enhances action of serotonin

Answer 253

- when pt takes multiple medications (or overdose) that cause serotonin to accumulate in neurons in CNS - confusion, restlessness, tremors, lack of muscle control - conservative treatment to discontinue all serotonergic drugs

Answer 254

- **pediatric patients - personality disorder or hyperkinesia****** - N/V/D/C - anorexia - cramping/flatulence - fluctuations in weight - sexual dysfunction - seizures - poor concentration - nightmares - hot flashes - palpitations - nervousness - serotonin syndrome

Answer 255

- bipolar disorder - cardiac dysfunction - diabetes - seizure disorders - carefully observe peds pts for hyperkinesia and personality changes/disorders - late pregnancy

Answer 256

- effective antidepressants but rarely used d/t potentially serious AEs - off-label use for OCD, panic disorder, social anxiety disorder, migraine prophylaxis - potentiates effects of insulin, diabetic drugs ## Footnote NEED TO KNOW!!!

Answer 257

- avoid foods containing **tyramine** (MAO in food) - foods that have been **aged or fermented** - cheese, alcohol, condiments, certain aged meats, wine (think charcuterie board) - **avoid L-tyrosine (a.a)** - tyramine a component of tyrosine (found in some aged foods - fermented foods, e.g., sausages) - **avoid caffeine**

Answer 258

- **increased extrapyramidal side effects (EPS) with certain antipsychotics** - **incr risk of toxicity with phenytoin, digoxin, carbamazepine** - excessive sedation with other CNS depressants - incr risk of bleeding with warfarin, aspirin, NSAIDs

Answer 259

- dizziness/orthostatic hypotension - drowsiness/headache - sexual dysfunction - anorexia/ diarrhea

Answer 260

- **hypertensive crisis (foods with tyramine)** - dysrhythmias - SIADH- like symptoms (h2o retention) ## Footnote NEED TO KNOW!!!

Answer 261

high incidence of AEs & high level of NON-compliance

Answer 262

- assess for **suicidal ideation** - encourage compliance - **avoid foods containing tyramine (MAO in food) - aged / fermented - avoid L-tyrosine (a.a.) - tyramine a component of tyrosine** - avoid caffeine ## Footnote NEED TO KNOW!!!

Answer 263

- epilepsy - severe, frequent headaches - HTN - dysrhythmias - suicidal tendencies

Answer 264

- dependent on seizure type and characteristics - medical hx - results of EEG & other diagnostic tests - cormorbid conditions - never stop taking without guidance of HCP - can cause withdrawal seizures ## Footnote NEED TO KNOW!!!

Answer 265

- most important drugs in treatment of status epilepticus - control seizures by acting in limbic, thalamic, hypothalamic regions of CNS - limited applications (use for seizures when other drugs ineffective) - have resuscitation equipment available if administering by IV - monitor for CV collapse & resp depression ## Footnote NEED TO KNOW!!!

Answer 266

- educate on s/s resp depression + cv collapse - assess for decr in seizure activity - maintain pt safety pre & post seizures (watch for triggers) - assess for hx of smoking (may req larger doses) - assess for urinary retention - don't mix with other drugs parenterally ## Footnote NEED TO KNOW!!!

Answer 267

- most effective in management of most types of seizures, including general seizure, but have many AEs - desensitize sodium channels

Answer 268

phenytoin (dilantin, phenytek) - therapeutic: antiepileptic - pharmacologic: hydantoin, neuronal sodium channel modulator use = prophylactic therapy of all seizures except absence mechanisms of action: delays influx of sodium ions in neurons, doesn't elevate seizure threshold

Answer 269

- drug of choice for many tonic-clonic and partial seizures - acute mania - off-label: symptomatic treatment of neuropathic pain, hiccups, severe symptoms of dementia

Answer 270

- shake suspension well prior to administration - watch for extravasation with IV route - check bld levels regularly (like lithium, dig, tegretol) - monitor CBC (clotting) - watch for neurological changes & SE - monitor bld glucose in diabetics - assess folic acid deficiency

Answer 271

carbamazepine (carbatrol, tegretol, others) - t = antiepiletic drug - p = iminostilbene, neuronal sodium channel modulator - inhibits sodium channels, blocks repetitive, sustained firing of neurons

Answer 272

- hypersensitivity - increased ocular pressure - lupus - cardiac/hepatic disease - HTN - older adults (watch narrow safety margin) - pregnancy - category D

Answer 273

valproic acid (Depacon, Depakene, Depakote) - anti-epileptic drug, anti-manic agent; GABA agonist - for absence seizures/complex partial seizures; mania; migraine - incr conc of GABA in brain

Answer 274

- additive sedation w/ CNS depressants & alcohol - more rapid metabolish w/ enzyme-indcuing AEDs - incr serum levels of TCAs - incr serum levels w/ aspirin, isoniazid, cimetidine (watch for bleeding) - decr absorption w/ cholestyramine - binds with some fat-soluble vitamins

Answer 275

- monitor seizure activity & check serum levels - obtain baseline platelet counts & check PT/PTT/INR regularly during therapy - monitor for s/s hyperammonemia & bleeding - watch liver lab work - naloxone & hemodialysis for overdose treatment

Answer 276

- alternates between extreme feelings of sadness and extreme mania - significantly impacts social and occupational functioning - nonadherence = serious problems (d/t highs --> believes they don't need meds anymore ## Footnote need to know!

Answer 277

- identifying triggers: lack of sleep, excessive stress, poor nutrition - support groups - ECT

Answer 278

- medications - highly individualized based on severity and predominant symptoms

Answer 279

- conventional therapy for tx of BD - mood stablizers - traditional treatment = lithium carbonate

Answer 280

- **diuretics = incr risk of lithium toxicity (e.g., lasix)** - NSAIDs, thiazide diuretics - can incr lithium levels - anti-thyroid drugs, drugs containing iodine can incr hypothyroid effect - halperidol causes incr neurotoxicity - SSRIs, MAOIs, dextromethorphan may result in SES - some herbal, food interactions

Answer 281

- monitor serum levels Q1-3 days initially & 2-3 months after - assess s/s bipolar disorder before and during treatment **- obtain baseline thyroid, kidney, cardiac function, lyte levels** - **monitor for s/s lithium toxicity** - assess daily weight changes, edema, changes in skin turgor - lithium = salt --> dehydration incr lithium & overhydration decr lithium levels (n/v/d, or exercising) - **monitor sodium intake - take table salt to maintain osmotic hydration, but don't overdo it**

Answer 282

- n/v - persistent diarrhea - coarse trembling of hands or legs - frequent muscle twitching, e.g., pronounced jerking of arms or legs - blurred vision - marked dizziness - difficulty walking - slurred speech - irregular heartbeat - swelling of feet or lower legs

Answer 283

- precise etiology = unknown - genetic component: 5-10x greater risk if 1st-degree relative has disorder - neurotransmitter imbalance: overactive dopaminergic pathways in basal nuclei & association w/ dopamine type 2 (D2) receptors (antipsychotic drugs block receptors) ## Footnote need to know!

Answer 284

2nd generation (atypical) antipsychotics

Answer 285

- first doses of antipyschotics may be higher than normal ---> produces sedation if pti is agitated, aggressive, or posing dangers to others - most drugs provided orally - benzodiazepenes (lorazepam [Ativan]) --> provided IM to relax pt and may allow initial dose of antipsychotic to be reduced - benzos given oral after under control - acute symptoms usually resovle in 3-7 days

Answer 286

- refers to locations in CNS associated with postural and automatic movements includes: - acute dystonia - akathisia - parkinsonism - tardive dyskinesia (TD) common with typical anti-psychotics

Answer 287

- syndrome of symptoms characterized by bizarre facial and tongue movements, stiff neck, and difficulty swallowing - result of dopamine blockage - common with typical antipsychotics - treatment = discontinue antipsychotics - include ambulatory tardive dyskinesias & oral tardive dyskinesias

Answer 288

- variety of responses that originate outside the pyramidal tracts and in the basal ganglion of the brain - s/s: tremors, chorea, dystonia, akinesia, akasthisia - result of dopamine blockage - common w/ typical antipsychotics - treatment with anticholinergic drugs, e.g., benzotropine (Cogentin)

Answer 289

- potentially fatal adverse reaction - symptoms: high fever, diaphoresis, muscle rigidity, tachycardia, BP fluctuations - condition can deteriorate to stupor or coma without quick, aggressive treatment - treatment: antipyretics, electrolytes, muscle relaxants

Answer 290

- major cause of nonadherence - sexual, menstrual, breast dysfunction

Answer 291

- 1st-gen antipsychotics, same therapeutic applications and similar SEs as phenothiazines - similar SEs to phenothiazines (less sedation, fewer anticholinergic SEs) - greater or equal incidence of EPS

Answer 292

haloperidol (Haldol) - therapeutic: antipsychotic (1st-gen) - pharmacologic: nonphenothiazine, dopamine antagonist therapeutic use: high potency antipsychotic, treats acute + chronic psychotic disorders mechanism of action: anticholinergic effects, alpha1-adrenergic blocking effects, blocks neurotransmission at dopamine D2 receptors

Answer 293

- anticholinergic symptoms (blurred vision, dry eyes, glaucoma) - weight gain - headache - anemia - phototoxicity * *** most likely to produce EPS (> than phenothiazines)**

Answer 294

- tachycardia - cardiac arrest - laryngospasm - respiratory depression - seizures - agranulocytosis / leukopenia/ leukocytosis - neuroleptic malignant syndrome (NMS)

Answer 295

- = life-threatening neurological disorder most often caused by adverse reaction to neuroleptic / antipsychotic drugs - typically consists of muscle rigidity, fever, sweating, autonomic instability, and cognitive changes - cognitive changes: delirium, associated with elevated plasma creatine phosphokinase

Answer 296

- drugs of choice for schizophrenia prototype drug = risperidone (Risperdal) - pharmacologic: benzisoxazole & dopamine antagonist therapeutic effects: - 1993+: schizophrenia & related psychoses - 2003: acute mania associated w/ bipolar disorder mechanism: unknown; blocking binding of dopamine to its receptors? highest affinity for type D2, less on D1

Answer 297

- if medications cause drowsiness - take @ bedtime - watch pt for orthostatic hypotension (rise slowly) - assess for EPS/ TD / akathesias/ NMS - educate pt for s/s of SEs + what to watch for, when to contact HCP - encourage sips of h2o / hard candies for dry mouth & anticholinergic-like symptoms - avoid alcohol & caffeine - incr fluids + fibre - watch liver lab results & educate pt on s/s liver involvement (jaundice/stool) - tell pt to report significant weight gain (5lb/week) - ensure pt knows that definite improvement may not be seen for 6-8 weeks

Answer 298

1. quetiapine (Seroquel) 2. olanzapine (Zyprexa) 3. clozapine (Clozari, FazaClo) ## Footnote need to know!

Answer 299

prototype drug: aripiprazole (Abilify) - newer class of atypical antipsychotics - exhibit both antagonist & partial agonist activity on dopamine receptors = decr ADEs - minimal risk of EPS - for schizophrenia control & decr s/s

Answer 300

- monitor for EPS symptoms/ anticholinergic effects - ensure adequate nutrition, fluid - monitor for s/s NMS - watch labs (liver - hepatic pathway, CYP)

Answer 301

- monitor for weight gain/ changes in sexual characteristics (lactation in men) - can result in non-compliance; tell pt not stop suddenly - teach + document what you shared with pt & what they need to protect their health - no alcohol use or illegal drug use - no caffeine use - no smoking

Answer 302

know s/s of and which drugs cause: - TD (Tardive dyskinesia) - EPS - NMS - SES/SS (Serotonin syndrome)

Answer 303

- confusion - agitatoin or restlessness - dilated pupils (NMS) - headache - changes in BP and/or temp - N/V/D - rapid HR - tremor - loss of muscle coordination / twitching of muscles - shivering & goosebumps - heavy sweating serious: - high fever (super concerning) - seizures - irregular heartbeat - unconsciousness