Cognition 1

Question 1

Benzodiazepines - drugs, action, side effects, nursing interventions?

Answer 1

Drugs: Alprazolam
Action: Bind with GABA, intensify effects of GABA
Side effects: Drowsiness, respiratory depression, sedation, lethargy, sleep hangover, dependence
Nursing interventions: Antidote - flumazenil, tolerance, avoid alcohol, safety (driving), take 30-60 minutes before bedtime.

Question 2

Barbiturates - action, side effects, nursing interventions?

Answer 2

Action: Depress CNS function @ all levels
Side effects: Resp. depression, hypotension, sedation, drowsiness, somnolence.
Nursing interventions: Rarely used - dependence high, W/D can be fatal, overdose – death

Question 3

Non-benzodiazepines, non-barbiturates - drugs, action, side effects, nursing interventions?

Answer 3

Drugs: Zolpidem
Action: Various
Side effects: Drowsiness, dizziness, headache, fatigue, dry mouth, diarrhea, hypotension, N&V
Nursing interventions: Buspirone - take several weeks before effective - accumulates, non-addicting

Question 4

Anti-seizure side effects?

Answer 4

Sedation, drowsiness, N&V, prolonged bleeding time.

Question 5

Beta blockers action, side effects?

Answer 5

Action: Suppress sympathetic system for anxiety
Side effects: Bradycardia, hypotension, confusion, fatigue

Question 6

Melatonin action, side effects?

Answer 6

Action: Melatonin receptor agonists
Side effects: Somnolence, dizziness, nausea

Question 7

Alprazolam (Xanax) classification?

Answer 7

Benzodiazepine

Question 8

Alprazolam (xanax) contraindications?

Answer 8

Acute narrow angle glaucoma
pulmonary disease
alone in primary depression or psychotic disorders
Bipolar disorders
Organic brain disorders

Question 9

Alprazolam (xanax) uses/action?

Answer 9

CNS depressant - acts on limbic, thalamic, hypothalamic levels of CNS
Uses: Anxiety, sedative, panic disorders, alcohol withdrawal

Question 10

Alprazolam (xanax) interactions?

Answer 10

Alcohol
CNS depressants
Anticonvulsants
Antihistamines
Barbiturates
Narcotics
St. John’s wort
Cigarettes < serum level by 50%

Question 11

Alprazolam (xanax) side effects?

Answer 11

Drowsiness
sedation

Question 12

Alprazolam (xanax) nursing interventions?

Answer 12

Safety - sedation
No alcohol, CNS depressants, OTC antihistamines
Do not drive until response known
Taper dose to D/C
Withdrawal: N&V, abdominal/muscle cramps, sweating, confusion, tremors, convulsions.

Question 13

Zolpidem (ambien) classification?

Answer 13

Sedative-hypnotic, non-barbiturate

Question 14

Zolpidem (ambien) contraindications?

Answer 14

Angioedema, suicidal ideation, depression

Question 15

Zolpidem (ambien) uses/action?

Answer 15

Uses: short-term treatment of insomnia
Action: Binds with GABA-A - inhibiting action potential in cortical region of the brain

Question 16

Before giving zolpidem (ambien)?

Answer 16

Assess respiratory rate - do not give if <12/min

Question 17

Zolpidem (ambien) interactions?

Answer 17

CNS depressants
alcohol
phenothiazines
food < absorption

Question 18

Zolpidem (ambien) side effects?

Answer 18

headache on awakening
drowsiness
fatigue
lethargy
sleepwalking

Question 19

Zolpidem (ambien) nursing interventions?

Answer 19

Give immediately before bedtime
Give on an empty stomach
Monitor for S/S of depression
Avoid alcohol, other CNS depressants
Do not drive until drug response is known
Report vision changes to prescriber

Question 20

Rivastigmine (exelon) classification?

Answer 20

Cholinesterase inhibitor, antidementia

Question 21

Rivastigmine (exelon) contraindications?

Answer 21

None

Question 22

Rivastigmine (exelon) uses/action?

Answer 22

Uses: Mild to moderate dementia of Alzheimer’s, Parkinsons disease related dementia.

Question 23

Rivastigmine (exelon) interactions?

Answer 23

Attenuate effects of anticholinergic agents

Question 24

Rivastigmine (exelon) side effects?

Answer 24

N&V
Anorexia
Diarrhea
abdominal pain
Dizziness
Headache
Insomnia

Question 25

Rivastigmine (exelon) nursing interventions?

Answer 25

Give with food
Monitor cognitive function & ability to perform ADLs
Withhold drug & notify HCP if N&V, anorexia, wt. loss occurs
Monitor ambulation - safety (dizziness)
Monitor diabetics for loss of glycemic control.
Weigh pt. weekly
Overdose: severe N&V, sweating, salivation, hypotension, bradycardia, convulsions, > muscle weakness.

Question 26

Memantine (Namenda) classification?

Answer 26

N-methyl-D-aspartate (NMDA) receptor antagonist; antidementia

Question 27

Memantine (Namenda) contraindications?

Answer 27

Renal failure

Question 28

Memantine (Namenda) Uses/action?

Answer 28

Uses: Moderate to severe Alzheimer’s
Action: Block NMDA receptors slowing intracellular calcium accumulation, preventing nerve damage without interfering w/ glutamate.

Question 29

Memantine (Namenda) interactions?

Answer 29

Carbonic anhydrase inhibitors
sodium bicarbonate
< effects of levodopa containing drugs

Question 30

Memantine (Namenda) side effects?

Answer 30

None

Question 31

Memantine (Namenda) nursing interventions?

Answer 31

Assess for & report S/S of focal neurologic deficits
Monitor diabetics for loss of glycemic control
Monitor LFTs, renal function, urine pH
Report to HCP: vision problems, skin rash, SOB, swelling of throat/tongue, agitation/restlessness, confusion, dizziness, incontinence.
Do not drive until reaction to drug is known.