exam 2 Flashcards
(206 cards)
1
Q
Cognitive changes –delirium, agitation, confusion, euphoria, insomnia,
Autonomic changes- fever, tachycardia, arrhythmias, elevated resp. rate, Increased BP,
Neuromuscular changes- tremor, hyperreflexes,
A
Serotonin Syndrome
2
Q
Selectively inhibit serotonin reuptake
Little or no effect on norepinephrine or dopamine reuptake
Result in increased serotonin concentrations at nerve endings
Examples:
fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa)
A
SSRIs
Depression:Second-Generation Antidepressants
3
Q
CNS Depressants: Sedative-Hypnotic Types
Long-acting
A
diazepam (Valium), clonazepam (Klonopin)
4
Q
Adverse Effects:
Uncommon and mild
Dysrhythmia, orthostatic hypotension, bradycardia, headache, dizziness, fatigue, nausea, vomiting, abdominal cramps, diarrhea, others
A
Antifibrinolytic Drugs
5
Q
When providing teaching for a patient who is prescribed a selective serotonin reuptake inhibitor (SSRI), which statement will the nurse include?
The SSRI will work faster than the older tricyclic antidepressants.
The SSRI will have an immediate beneficial effect on the patient’s depression symptoms.
The SSRI will not work well for severe cases of depression.
The SSRI may take several weeks to have a beneficial effect.
A
The SSRI may take several weeks to have a beneficial effect\
It may take several weeks to see the therapeutic effects of SSRIs.
6
Q
CNS depression Respiratory stimulation or depression Vasodilation, producing warm, flushed skin Increased sweating Diuretic effects More accurately known as ethanol (ETOH)
A
Alcohol (Ethanol)
7
Q
amphetamine (Dexedrine, Adderall)
methylphenidate (Concerta, Ritalin, Metadate CD)
atomoxetine (Strattera)
A
Drugs for ADHD and Narcolepsy
8
Q
powerful analgesic effects, for moderate and severe pain
Black box warning: GI risk, renal risk, cardiovascular thrombotic event, bleeding risk
FDA warning: less than five days use only
A
ketorolac (Toradol)
9
Q
Stimulate areas of the brain associated with mental alertness
Mood elevation or euphoria
Increased mental alertness and capacity for work
A
Drugs for ADHD and Narcolepsy
10
Q
During pregnancy to prevent neural tube defects
Should not be used until actual cause of anemia is determined
A
Folic Acid
11
Q
Used to treat the pain of osteoarthritis
Adverse effects:
GI discomfort
Drowsiness, headache, skin reactions (glucosamine)
A
Glucosamine and Chondroitin
12
Q
Follow instructions for diet and exercise
Take in the morning
Avoid caffeine
Fat-soluble vitamin supplementation may be needed
A
Anorexiants
13
Q
Drugs that break down, or lyse, preformed clots
Reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction
A
Thrombolytic Drugs
14
Q
Adverse Effects
Headache, drowsiness, dizziness, cognitive impairment, vertigo, lethargy
fall hazard for elderly persons
“Hangover” effect/daytime sleepiness
A
Benzodiazepines (Zepam or Zolam)
15
Q
Serum level: 0.6 and 1.2 mEq/L
Contraindication (risk of toxicity): dehydration, sodium imbalance, major renal and cardiovascular disease
Adverse effects:
toxicity: GI discomfort, tremor, confusion, somnolence, seizure, cardiac dysrhythmia and possible death
Others: drowsiness, slurred speech, choreoathetotic movement
A
Lithium carbonate and lithium citrate
16
Q
Interactions:
Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics, grapefruit juice
CNS depressants (alcohol, opioids)
Others: olanzapine, rifampin
A
Benzodiazepines (Zepam or Zolam)
17
Q
A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching?
“Take the medication with your evening meal.”
“You will need to take this drug for at least 2 years.”
“If you develop a dry mouth, stop taking the drug immediately.”
“Avoid intake of caffeine.”
A
“Avoid intake of caffeine.”
Caffeine in any form must be avoided by patients taking anorexiants. These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times. These drugs should not be abruptly stopped as a rebound increase of appetite may develop.
18
Q
Cause sleep, much more potent effect on CNS than sedatives
A
Hypnotics
19
Q
block the effects of ACh
Used to treat muscle tremors and muscle rigidity associated with PD
Adverse effects: Tachycardia, heat stroke, confusion, constipation, urinary retention
Contraindication: angle closure glaucoma
A
Anticholinergics
20
Q
Contraindications: acute or chronic cardiac problem or history of seizure
Commom Adverse Effects:anticholinergic adverse effect, orthostatic hypotension
A
Tricyclic Antidepressants
21
Q
alprazolam (Xanax) , lorazepam (Ativan), diazepam (Valium)
A
Benzodiazepines
22
Q
is used for smoking cessation treatment
Adverse effects: dizziness, confusion, tachycardia, agitation, tremor and dry mouth
A
*bupropion [Zyban]
23
Q
may be manifested by respiratory rate of less than 10 breaths/min, dyspnea, diminished breath sounds, or shallow breathing
A
Respiratory depression
24
Q
Indications:
Mild to moderate pain
Fever
Alternative for those who cannot take aspirin products
A
Acetaminophen (Tylenol)
25
Act to relieve pain associated with skeletal muscle spasms
Majority are centrally acting
Similar in structure and action to other CNS depressant
Muscle Relaxants
26
Normally used to:
Relieve pain, reduce cough, relieve diarrhea, and induce anesthesia
Also known as narcotics
Produce analgesia, drowsiness, euphoria, tranquility, other mood alterations
Opioids
27
Brief episode of abnormal electrical activity in nerve cells of the brain
Seizure
28
Physiologic adaptation of the body to the presence of an opioid
Physical Dependence
29
Signs/Symtoms
Increased psychomotor activity; agitation; hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature;
Treatment involves tapering of the drug over a course of a 7 to 10 or 10 to 14 days
Depressants Withdrawal
30
Peak period: 1 to 3 days, duration: 5 to 7 days
Opioid Drug Withdrawal
31
Inhibit reuptake of both serotonin and norepinephrine
Examples:
venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)
SNRIs
Depression:Second-Generation Antidepressants
32
The nurse has administered iron intravenously to a patient. To prevent orthostatic hypotension, it is recommended that the nurse have the patient remain in the recumbent position for how long?
10 minutes
30 minutes
60 minutes
90 minutes
30 minutes
It is recommended that the patient remain recumbent for 30 minutes after an intravenous injection of iron to prevent drug-induced orthostatic hypotension.
33
(Zepam or Zolam)
Benzodiazepines
34
drug stimulate the production of enzymes that enhance its own metabolism, which lead to lower than expected drug concentrations.
Black box warning: bone marrow suppression and skin hypersensitivity reaction
carbamazepine (Tegretol)
First-Line Antiepileptic Drugs
35
Adverse Effects: Toxicity and Overdose
Somnolence, confusion, coma , diminished reflexes
Do not cause hypotension and respiratory depression unless taken with other CNS depressants
Treatment symptomatic and supportive
Flumazenil as an antidote
Benzodiazepines (Zepam or Zolam)
36
CNS Depressants: Sedative-Hypnotic Types
Short-acting
midazolam (Versed)
37
analgesic and antipyretic effects
Black box warning: GI risk and cardiovascular risk
ibuprofen (Motrin, Advil)
38
Symptoms
Delirium, tachycardia, hyperreflexia, shivering, agitation, sweating, muscle spasms, coarse tremors
Symptoms of severe cases
Hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, disseminated intravascular coagulation (DIC)
Serotonin Syndrome
39
An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy?
Blood sugar
Liver function studies
Assessment of hearing
Renal function studies
Renal function studies
: NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and elderly patients are at greater risk for this adverse drug reaction.
40
Inhibit the action or formation of clotting factors
Prevent clot formation
Anticoagulants
41
Black box warning: severe neutropenia, orthostatic hypotension, bradycardia, syncope, seizure
clozapine (Clozaril),
42
A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this?
The patient’s pain should subside by that time.
There are concerns about addiction to the drug.
The drug can cause severe renal and gastrointestinal effects.
The drug loses its effectiveness over time.
The drug can cause severe renal and gastrointestinal effects.
The main adverse effects of ketorolac include renal impairment, edema, gastrointestinal pain, dyspepsia, and nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects on the kidney and gastrointestinal tract.
43
Adverse Effects
CNS: Restlessness, syncope (fainting), tremor, hyperactive reflexes, talkativeness, irritability, insomnia, euphoria
Cardiovascular: Palpitations, tachycardia, cardiac dysrhythmias, anginal pain, hypertension or hypotension, circulatory collapse,
Gastronintestinal: Dry mouth, metallic taste, anorexia, nausea, vomiting, diarrhea, abdominal cramps
Fatal hyperthermia
Stimulants
44
```
Anxiolytic drugs (for anxiety)
Mood-stabilizing drugs (Affective disorders)
Antidepressant drugs (depression)
Antipsychotic drugs (psychoses)
```
Types of psychotherapeutic drugs
45
Cardiovascular risk : cardiovascular thrombotic events, etc
Gastrointestinal risk : ulcer and GI bleeding*
FDA Warning on All NSAIDs
46
Adverse Effects:
Possible elevated blood pressure and heart palpitations
Anxiety, agitation, dizziness, headache
Anorexiants
47
Overdose
| Death results from: convulsions, coma, cerebral hemorrhage
Stimulants
48
A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern?
Pulse
Blood pressure
Temperature
Respirations
Respirations
Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations.
49
Signs and Symtoms
Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia, depression, suicidal thoughts and behavior, paranoid delusions
Peak period: 1 to 3 days
Duration: 5 to 7 days
Stimulant Withdrawal
50
Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms
Reduce the production of inflammatory neuropeptides
Triptans
Antimigraine Drugs
51
Monoamine oxidase inhibitors (MAOIs)
Second-generation antidepressants:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Miscellaneous
Tricyclic antidepressants
52
Reverse the effects of these drugs on pain receptors
Bind to a pain receptor and exert no response
Antagonists
53
Interactions:
1+1=2
Alcohol, antihistamines, barbiturates, benzodiazepines, monoamine oxidase inhibitors
Opioid Analgesics
54
Which statement regarding muscle relaxants does the nurse identify as being accurate?
Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.
Cyclobenzaprine (Flexeril) produces little sedation.
Patients taking muscle relaxants are at high risk to develop hypertension.
Patients taking muscle relaxants should be told to stop taking the medication if they feel sleepy.
Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.
: Baclofen (Lioresal) is sometimes used in an injectable form. Cyclobenzaprine (Flexeril) often results in deep sedation and sleepiness. Patients taking muscle relaxants are at risk to develop hypotension; therefore, they should be taught safety measures to prevent falls. Sedation and sleepiness are common side effects of muscle relaxants; however, a patient should not abruptly discontinue use of the medication. Safety procedures should be followed to prevent accidents and falls.
55
Adverse Effects, dose-related:
Tend to “speed up” body systems
Common adverse effects include:
Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others
Drugs for ADHD and Narcolepsy
56
A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for osteoarthritis. While taking a health history, the nurse finds out that the patient has few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?
Increased bleeding tendencies
Increased chance for gastrointestinal bleeding
Increased nephrotoxic effects
Reduced antiinflammatory effects of the nonsteroidal antiinflammatory drug (NSAID)
Increased chance for gastrointestinal bleeding
NSAIDs taken with alcohol may result in increased risk of gastrointestinal bleeding.
57
A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be
1000 mg.
2000 mg.
3000 mg.
4000 mg.
2000 mg.
: Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use. For this reason, a maximum daily dose of 2000 mg is generally recommended for these persons.
58
Chronic, progressive, degenerative disorder
Affects dopamine-producing neurons in the brain
Caused by an imbalance of two neurotransmitters
Dopamine
Acetylcholine (ACh)
Parkinson’s Disease (PD)
59
condition that results from inappropriate uric acid metabolism
Gout
60
Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy?
If you feel sleepy when taking the drug, decrease the dose by one half
Take the drug on an empty stomach
Call your health care provider if you experience a sore throat or fever
Patients with epilepsy are not able to hold a job and work, so you should apply for benefits
Call your health care provider if you experience a sore throat or fever
To prevent complications, patients should be taught to call the health care provider if they experience fever, sore throat, excessive bleeding or bruising, and new onset of nosebleeds. Drowsiness is a common side effect of these drugs; the dose should never be altered without consulting the prescriber. These medications should be taken with food to decrease GI upset. Most patients with seizure disorders are able to work and are protected by the Americans with Disabilities Act.
61
: Reduce anxiety by reducing overactivity in CNS
Anxiolytic Drugs
62
Signs and symptoms
Elevated blood pressure, pulse rate, and temperature, insomnia, tremors, agitation
Alcohol (Ethanol)
63
Indications:
Muscle spasms
Management of spasticity of severe chronic disorders (multiple sclerosis, cerebral palsy)
Work best when used along with physical therapy
Muscle Relaxants
64
Also known as antithrombotic drugs
Have no direct effect on a blood clot that is already formed
```
Used prophylactically to prevent:
Clot formation (thrombus)
An embolus (dislodged clot)
```
```
warfarin sodium (Coumadin)
enoxaparin (Lovenox)
heparin
dabigatran (Pradaxa)
fondaparinux (Arixtra)
argatroban (Argatroban)
```
Anticoagulants
65
```
Assist primary drugs in relieving pain
NSAIDs
Antidepressants
Anticonvulsants
Corticosteroids
```
Adjuvant Drugs
66
Alter platelet function
Hemorheologic drugs
67
Used to prevent clot formation in certain settings where clot formation is likely
Myocardial infarction, Atrial fibrillation, Indwelling devices, such as mechanical heart valves, Major orthopedic surgery
Anticoagulants
68
A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks (TIAs). The concern with taking these two drugs together is:
increased risk of gastric ulcer.
decreased action of the aspirin because of the interaction with the ginkgo.
increased risk of bleeding because of the ginkgo.
antagonism of the action of the aspirin because of the multivitamins.
increased risk of bleeding because of the ginkgo.
Ginkgo may cause some increased bleeding times, so taking aspirin with ginkgo may put the patient at a higher risk for bleeding episodes.
69
Promote blood coagulation
Antifibrinolytic or hemostatic
70
Drugs used to treat serious mental illness
Behavioral problems or psychotic disorders
Have been known as tranquilizers or neuroleptics
Antipsychotics
71
Adverse Effects:
Bleeding
May also cause: Heparin-induced thrombocytopenia (HIT)
Anticoagulants
72
Antiinflammatory properties
Used to treat migraine headaches, menstrual cramps, inflammation, and fever
May cause GI distress, altered taste, muscle stiffness
May interact with aspirin and other NSAIDs, and anticoagulants
Feverfew
73
Overdose:
Dangerous when taken with other sedatives or alcohol
Flumazenil may be used to reverse benzodiazepine effects
Treatment is generally symptomatic and supportive
Benzodiazepines
| Anxiolytic Drugs
74
Essential mineral in the body
Stored in the liver, spleen, and bone marrow
deficiency results in anemia
Iron
75
Serious: fatal anaphylactic reactions, major orthostatic hypotension
Test dose of 25 mg of iron dextran is administered before injection of the full dose, and then remainder of dose is given after 1 hour
Used less frequently now; replaced by newer products ferric gluconate and iron sucrose
Iron dextran (INFeD, Dexferrum)
76
Contraindication:
Children with flulike syndrome
Reye’s syndrome: life threatening, progressive neurologic deficit
NSAIDs
77
Major therapeutic uses (attention deficit hyperactivity disorder [ADHD], narcolepsy, obesity, migraine, and respiratory depression syndromes)
Classified according to: Chemical structural similarities
CNS Stimulants
78
When patients are taking selective serotonin reuptake inhibitors (SSRIs) for the first time for depression, which is most important to monitor for during the first few weeks of therapy?
Hypertensive crisis
Suicidal thoughts
Convulsions
Orthostatic hypotension
Suicidal thoughts
: Some studies have indicated a higher risk for suicide during the first few weeks of antidepressant therapy.
79
A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity?
Bradycardia
Hypoventilation
Constipation
Hyperglycemia
Hyperglycemia
Manifestations of salicylate toxicity include increased heart rate, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness, nausea, vomiting, diarrhea, sweating, thirst, hyperventilation, and hypoglycemia or hyperglycemia.
80
Benzodiazepines are the treatment of choice
diazepam (Valium), lorazepam (Ativan), or chlordiazepoxide (Korsakoff’s psychosis)
Dosage and frequency depend on severity
Alcohol (Ethanol)
81
Uses: stress reduction, improvement of physical endurance and concentration
May cause elevated BP, chest pain, palpitations, anxiety, insomnia, headache, GI symptoms
Interactions with anticoagulants, immunosuppressants, anticonvulsants, antidiabetic drugs
Herbal Products: Ginseng
82
A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use?
Administer the drug by rapid IV push
Infuse slowly, not exceeding 50 mg/min
Mix the medication with dextrose solution
Administer via continuous infusion
Infuse slowly, not exceeding 50 mg/min
Phenytoin should be mixed only with normal saline, and it should be given by slow IV infusion (but not as a continuous infusion
83
Used to treat obesity
Suppress appetite control centers in the brain
Increase the body’s basal metabolic rate
Anorexiants
84
The use of folic acid to prevent fetal neural tube defects should be started:
during a woman’s adolescence.
at least 1 month before pregnancy.
when a pregnancy is first discovered.
at the beginning of the last trimester of pregnancy.
at least 1 month before pregnancy.
: It is recommended that administration of folic acid begin at least 1 month before pregnancy and continue throughout early pregnancy to reduce the risk for fetal neural tube defects.
85
Indications:
Long-term maintenance therapy for chronic, recurring seizures
Acute treatment of convulsions and status epilepticus
Antiepileptic Drugs:
86
does not cross the blood-brain barrier and prevents levodopa breakdown in the periphery
Carbidopa
87
Considered second line, replaced by SSRI as first line
Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia
Tricyclic Antidepressants
88
is able to cross the blood-brain barrier
Levodopa
89
medication for Affective Disorders (Mood Disorders)
Lithium carbonate and lithium citrate
90
Result: larger dose is required to maintain the same level of analgesia
Opioid Tolerance
91
Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function
Conventional drugs
92
A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse monitors for autoinduction, which will result in
toxic levels of carbamazepine (Tegretol).
lower than expected drug levels.
gingival hyperplasia.
cessation of seizure activity.
lower than expected drug levels.
Carbamazepine (Tegretol) is associated with autoinduction of hepatic enzymes. Autoinduction is a process in which, over time, a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations.
93
Monitored by activated partial thromboplastin times (aPTTs)
Parenteral
Short half-life (1 to 2 hours)
Effects reversed by protamine sulfate
Heparin
94
Which drug will the nurse anticipate administering to a patient experiencing benzodiazepine overdose?
flumazenil
naltrexone
Vivitrol
flunitrazepam
flumazenil
Flumazenil is a benzodiazepine reversal agent. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the benzodiazepine receptor in the CNS and thus reversing sedation. For opioid abuse or dependence, naltrexone, an opioid antagonist, is administered. Naltrexone, which is also available as an injection called Vivitrol, works by blocking the opioid receptors so that use of opioid drugs does not produce euphoria. Flunitrazepam is a benzodiazepine.
95
Block specific dopamine receptors: dopamine-2 (D2) receptors
Also block specific serotonin receptors: serotonin 2 (5-HT2) receptors
Atypical Antipsychotics:
96
First and only remaining COX-2 inhibitor
Indicated for osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea
COX-2 Inhibitor: (Celebrex)
97
Potentially life threatening
| High fever, unstable BP, myoglobinemia
Neuroleptic malignant syndrome (NMS)
98
Adverse Effects:
Central nervous system
Diuresis, miosis, convulsions ,nausea, vomiting, respiratory depression
```
Non–central nervous system
Hypotension
Constipation
Urinary retention
Flushing of the face, neck, and upper thorax
Sweating, urticaria, and pruritus
```
Opioids
99
Contraindications: sulfa allergy
FDA black Box Warning:
Cardiac (fetal vardipvascular thrombotic events)
GI risk
COX-2 Inhibitor: (Celebrex)
100
Adverse Effects:
often necessitate a change in medication
Black box warning as of 2008
Suicidal thoughts and behavior
Antiepileptic Drugs
101
Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living
Psychosis
102
Calming effect on the CNS
Reduce excessive sensory stimulation, inducing sleep
Induce skeletal muscle relaxation
Benzodiazepines (Zepam or Zolam)
103
Elevation of mood
Reduction of fatigue
Increased alertness
Invigorated aggressiveness
Stimulants
104
Involuntary contractions of oral and facial muscles
Choreoathetosis (wavelike movements of extremities)
Occurs with continuous long-term antipsychotic therapy
Tardive dyskinesia (TD)
105
Drugs that stimulate a specific area of the brain or spinal cord
Sympathomimetic drugs
CNS Stimulants
106
Approved for alcohol –dependence patients to reduce cravings for alcohol
Naltrexone
107
Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia
Take on an empty stomach, 30 to 45 minutes before meals
Drugs for ADHD
108
Drug therapeutic levels are 10-20 mcg/ml
Highly Protein –bound
Black box warning: Cardiovascular risk with rapid infusion
IV infusion should not exceed 50 mg/min
Slow IV infusion, only can be diluted in normal saline
Long-term therapy with phenytoin (Dilantin) may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies
Other serious adverse effects : V fib, hypotension, cardiovascular collapse, thrombocytopenia, anemia
First-Line Antiepileptic Drugs
phenytoin (Dilantin)
109
Adverse Effects:
Bleeding
Other effects
Nausea, vomiting, hypotension, anaphylactoid reactions
Cardiac dysrhythmias; can be dangerous
Thrombolytic Drugs:
110
Adverse Effects:
extension of effects on CNS and skeletal muscles
Euphoria, Lightheadedness, dizziness, drowsiness, fatigue, muscle weakness
Muscle Relaxants
111
Adverse Effects:
CNS: Drowsiness, sedation, loss of coordination, dizziness, blurred vision, headaches, and paradoxical reactions
Gastronintestinal: Nausea, vomiting, constipation, dry mouth, and abdominal cramping
Pruritus and skin rash
“Amotivational” syndrome
Depressants
112
Nonsedating and non–habit forming
May have drug interaction with SSRIs (serotonin syndrome)
Do not administer with MAOIs
Anxiolytic drug: buspirone (BuSpar)
113
Adverse Effects
```
Sedation
Orthostatic hypotension
Photosensitivity
Dry mouth
Urinary hesitancy or retention
Leukopenia and agranulocytosis
```
Antipsychotics
114
Give 30 to 60 minutes before bedtime for maximum effectiveness in inducing sleep (depends on drug’s onset)
hypnotics
115
CNS Depressants: Sedative-Hypnotic Types
Intermediate-acting
alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril)
116
Three main emotional and mental disorders:
Anxiety
Affective disorders
Psychoses
117
Adverse effects:
Paradoxical anxiety
Blurred vision
Headache
Nausea
Anxiolytic drug: buspirone (BuSpar)
118
Contraindications:
Allergy, risk of bleeding, Category C-first two trimesters, and D-last trimester
NSAIDs
119
A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which finding does the nurse expect upon assessment of the patient?
Hyperthermia
Hypotension
Bradycardia
Somnulence
Hyperthermia
Delirium tremens are characterized by hypertensive crisis, tachycardia, agitation, and hyperthermia and may be life threatening.
120
Synthetic drugs that bind to the opiate receptors to relieve pain
Very strong pain relievers
Opioid Drugs
121
A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time?
Pressure should be applied to the lump for 3 to 5 minutes.
He will need to take two doses of warfarin tonight to prevent blood clotting.
He needs to be examined for possible internal bleeding from the fall.
As long as there is no bleeding, there is no concern.
He needs to be examined for possible internal bleeding from the fall.
Careful examination will be needed to ensure that there is no hematoma or other internal bleeding as a result of the fall, even if superficial bleeding is not noted.
122
Manifested as: Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, confusion
Opioid withdrawal/opioid abstinence syndrome
123
Inhibit the MAO enzyme system in the CNS, Amines (dopamine, serotonin, norepinephrine) are not broken down,
Monoamine Oxidase Inhibitors (MAOIs)
124
Sign and symptoms
Irritability, restlessness, decreased heart rate and BP
Cardiac symptoms resolve in 3 to 4 weeks, but cigarette craving may persist for months or years
Nicotine Withdrawal
125
Adverse Effects:
Serious: Most common cause of pediatric poisoning deaths
Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain
Causes black, tarry stools
Liquid oral preparations may stain teeth
Injectable forms cause pain upon injection
Iron:
126
Indications:
```
Acute MI
Arterial thrombolysis
DVT
Occlusion of shunts or catheters
Pulmonary embolus
Acute ischemic stroke
```
Thrombolytic Drugs:
127
A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate?
Strattera is highly addictive.
Psychotherapy is rarely helpful in cases of ADHD.
The patient should be monitored for possible suicidal thoughts and behavior.
Strattera is used to treat narcolepsy as well as ADHD
The patient should be monitored for possible suicidal thoughts and behavior.
: Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient’s family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.
128
Lyse (break down) existing clots
Thrombolytic drugs
129
oxycodone 5mg and acetaminophen 325 mg
Norco
130
Large and chemically diverse group of drugs with the following properties:
Analgesic
Antiinflammatory
Antipyretic
Aspirin-platelet inhibition
NSAIDs
131
When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information?
These medications have little effect on the normal sleep cycle.
Using this medication may cause drowsiness the next day.
It is safe to drive while taking this medication.
These drugs are safe to use with alcohol.
Using this medication may cause drowsiness the next day.
Benzodiazepines interfere with REM sleep and may cause a “hangover” effect or next-day drowsiness. They should not be used with alcohol, and persons taking these drugs should not drive.
132
Reduces inflammatory response to the deposits of urate crystals in joint tissue
Used for short-term management or prevention of gout
Adverse effects serious: myelosuppression
leukopenia and bleeding into the gastrointestinal or urinary tracts
colchicine
133
Adverse Effects:
```
CNS depression: Most serious adverse effect
Nausea and vomiting
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation
Itching
```
Opioid Analgesics
134
Bind to an opioid pain receptor in the brain
Cause an analgesic response (reduction of pain sensation)
Agonists
135
To control or prevent seizures while maintaining a reasonable quality of life
To minimize adverse effects and drug-induced toxicity
Antiepileptic Drugs (AEDs)
anticonvulsants
136
Several months later the patient returns to the health care provider’s office for follow-up regarding use of the SSRI. The patient tells the nurse that he is feeling better and stopped taking the SSRI yesterday. He doesn’t plan on taking the medication again. When talking with the patient, which knowledge should guide the nurse’s response?
Drug dependency will develop, so it is appropriate to stop therapy after a few months.
Drug therapy must be stopped as soon as the patient feels better to avoid serotonin syndrome.
The patient is the best person to determine when the drug therapy should end.
A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation.
A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation
: A taper period of 1 to 2 months is needed to prevent the development of adverse effects of withdrawal from the medication, which include dizziness, diarrhea, and a worsening of the depressive mood disorder. Serotonin syndrome is a result of taking too much of the medication. The patient and the provider should determine together when is the optimal time for drug discontinuation. There is no evidence of drug dependency associated with use of SSRIs.
137
Lethal when overdosed
Overdose: hepatotoxicity
Long-term ingestion of large doses also causes nephropathy
Recommended antidote: acetylcysteine regimen
Acetaminophen
138
Drugs that relieve anxiety, irritability, and tension
Used to treat seizure disorders and induce anesthesia
Depressants
139
Maximum daily dose for healthy adults: 3000 mg/day
Elderly or those with liver disease: 2000 mg
Acetaminophen
140
A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming “unbearable.” The nurse is reluctant to give him the ordered pain medication because the nurse does not want the patient to get addicted to the medication. The nurse’s actions reflect
appropriate concern for the patient’s best welfare.
appropriate caution for a patient who is already on a long-term opioid.
an uncaring attitude toward the patient.
a failure to manage the patient’s pain properly.
a failure to manage the patient’s pain properly.
: Patients with severe pain, including metastatic pain or bone pain, may need higher and higher doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain relief.
141
Indications:
Agitation relief
Sedation, sleep induction
Skeletal muscle relaxation
Anxiety relief, anxiety-related depression
Treatment of alcohol withdrawal
Treatment of acute seizure disorders
Balanced anesthesia, Moderate/conscious sedation
Benzodiazepines (Zepam or Zolam)
142
```
Seizures
Alcoholic hepatitis, progressing to cirrhosis
Cardiomyopathy
Fetal alcohol syndrome (FAS)
Nutritional and vitamin deficiencies (especially B vitamins)
Wernicke’s encephalopathy
Korsakoff’s psychosis
Polyneuritis
Nicotinic acid deficiency encephalopathy
```
Alcohol (Ethanol)
143
Which food will the nurse teach the patient to avoid when ingesting an iron supplement?
Eggs
Veal
Orange juice
Fish
Eggs
: Although eggs are a common dietary source of iron, they should be avoided when ingesting oral iron preparations. The other foods enhance iron absorption.
144
A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief
Psychologic Dependence (addiction)
145
A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct?
The patient is receiving a double dose of anticoagulants.
The heparin therapy was ineffective, so the warfarin was started.
The heparin provides anticoagulation until therapeutic levels of warfarin are reached.
The heparin and warfarin work together synergistically to provide anticoagulation.
The heparin provides anticoagulation until therapeutic levels of warfarin are reached.
Heparin has a faster onset and therefore is used to provide anticoagulation until therapeutic levels of warfarin are reached.
146
Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles
Convulsion
147
Used to treat insomnia
Examples: zaleplon (Sonata), zolpidem (Ambien), eszoplicone (Lunesta), and ramelteon (Rozerem)
Eszoplicone and extended-release zolpidem (Ambien CR) approved for long-term therapy
Nonbenzodiazepine Hypnotics
148
Contraindications/Interactions:
```
Should not be taken in the presence of
Drug allergy
Liver dysfunction
Possible liver failure
G6PD deficiency
Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic
```
Acetaminophen
149
Strong sedative effect
| Indication for depression, anxiety and insomnia
Trazodone (Desyrel)
150
promoting clot formation
prevention and treatment of excessive bleeding
Treatment of hemophilia or von Willebrand’s dx
Antifibrinolytic Drugs
151
Interactions:
Serious interactions can occur when given with:
Anticoagulants, Aspirin
Ulcerogenic drugs: Corticosteroids
Protein bound drugs
NSAIDs
152
Used to prevent uric acid production.
Adverse effects: serious
agranulocytosis, aplastic anemia;
Skin reaction: Stevens-Johnson
allopurinol (Zyloprim)
153
Inhibit the reabsorption of uric acid in the kidney
Adverse effects serious
blood dyscrasias
Contraindication: Allergic to sulfa
probenecid (Benemid), sulfinpyrazone (Anturane)
154
Cardiovascular: Increased heart rate
Central nervous: Tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness
Gastrointestinal: Nausea, vomiting, diarrhea
Metabolic: Sweating, thirst, hyperventilation, hypoglycemia, or hyperglycemia
Salicylate Toxicity
155
Does not cause CNS depression
No potential for abuse
No withdrawal signs and symptoms
Ramelteon (Rozerem) melatonin
156
Indications
Main use: to alleviate moderate to severe pain
also used for:
Cough center suppression; treatment of diarrhea; balanced anesthesia
Opioid Analgesics
157
Which action does the nurse perform when administering iron intravenously?
Premedicate the patient with an antihistamine to prevent anaphylaxis
Administer the iron with a running dextrose solution
Flush the intravenous line with 10 mL of normal saline
Have available Regitine to reverse vasoconstriction at the site should infiltration occur
Flush the intravenous line with 10 mL of normal saline
The appropriate nursing action when administering iron intravenously is to flush the intravenous line with 10 mL of normal saline prior to administering the iron.
158
The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patient
is unaware of his own disease history.
has been taking his wife’s medication by mistake.
may be taking this drug for neuropathic pain.
is reluctant to admit to having a seizure disorder.
may be taking this drug for neuropathic pain.
Gabapentin is commonly used to treat neuropathic pain.
159
The patient was admitted to the hospital for observation and has now recovered. Which information will the nurse include in patient teaching about SSRIs?
It usually takes 4 to 6 weeks until you will experience benefits from the medication.
The patient must avoid foods that contain tyramine.
If the patient develops an upset stomach when taking this medication, he should discontinue use.
The patient should take the medication at bedtime to enhance sleep.
It usually takes 4 to 6 weeks until you will experience benefits from the medication.
: Patients should be taught that the time period for SSRIs to take effect is 4 to 6 weeks. These medications can cause GI upset and taking them with food is recommended. SSRIs should be taken in the morning to prevent any sleep disturbances.
160
CNS depressant reduce: nervousness, excitability and irritability
Sedatives
161
Sedative-hypnotics—dose dependent
At__ doses, calm the CNS without inducing sleep
At _ doses, calm the CNS to the point of causing sleep
low
high
162
Inhibition of the leukotriene or prostaglandin or both pathway
Blocking the chemical activity of the enzyme called Cox
NSAIDs
163
Adverse Effects: orthostatic hypotension most common
Interactions:
sympathomimetic drugs: hypertensive crisis
SSRIs: serotonin syndrome
Monoamine Oxidase Inhibitors (MAOIs)
164
Before administering epoetin alfa to a patient in renal failure, it is most important for the nurse to assess which laboratory result?
BUN
White blood cell count
Hemoglobin level
Urine specific gravity
Hemoglobin level
: Use of epoetin and darbepoetin is contraindicated in cases of uncontrolled hypertension and when hemoglobin levels are above 10 g/dL for cancer patients and 12 g/dL for renal patients. Use in patients with head or neck cancers or patients at risk for thrombosis is controversial as these medications increase tumor growth and risk for thrombosis.
165
Highly protein-bound
| Serious adverse effects: hepatotoxicity, pancreatitis and bone marrow suppression
Valproic acid
First-Line Antiepileptic Drugs
166
Medications that relieve pain without causing loss of consciousness
Analgesics
167
Contraindications:
Known drug allergy and severe asthma
```
Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity and/or sleep apnea
Paralytic ileus
Pregnancy
```
Opioid Analgesics
168
Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern?
High white blood cell count
Low serum albumin levels
Low platelet levels
High hemoglobin levels
Low serum albumin levels
Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur.
169
A patient wants to take orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects?
Restrict dietary intake of fat
Restrict dietary intake of fiber
Increase intake of dairy products
Avoid intake of carbonated beverages
Restrict dietary intake of fat
: Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients.
170
Which statement does the nurse include when teaching a patient about disulfiram (Antabuse) therapy?
“Disulfiram (Antabuse) will cure your alcoholism if you take it as directed.”
“If you drink alcohol after taking disulfiram (Antabuse), your blood pressure will get very high.”
“You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).”
“If you miss a dose of disulfiram (Antabuse), double the dose the next time it is due.”
You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).”
The rationale for the use of disulfiram (Antabuse) is that patients know that if they are to avoid the devastating experience of acetaldehyde syndrome, they cannot drink for at least 3 or 4 days after taking disulfiram. Disulfiram (Antabuse) does not cure aolcoholism; blood pressure gets very low if alcohol is consumed with disulfiram (Antabuse); and patients should follow the prescribed dosing schedule and not double a dose.
171
Treatment for Opioid Withdraw
Clonidine and Methadone substitution
172
Chemical analogue of GABA, a neurotransmitter inhibits brain activity
Commonly used to treat neuropathic pain
Gabapentin (Neutontin)
First-Line Antiepileptic Drugs
173
Oral iron preparations are available as _______
ferrous salts
174
Used to treat pernicious anemia and other megaloblastic anemias
Administered orally or intranasally to treat vitamin B12 deficiency
Usually administered by deep intramuscular injection
Cyanocobalamin (Vitamin B12)
175
Drug interactions:
Enhances effects of warfarin
May increase insulin resistance (glucosamine)
Glucosamine and Chondroitin
176
Stimulates nicotine receptors
| Neuropsychiatric symptoms and suicidality
varenicline (Chantix)
177
Adverse effects: Vasoconstriction
Triptans
Antimigraine Drugs
178
Used to treat rheumatoid arthritis, osteoarthritis, acute bursitis or tendonitis, ankylosing spondylitis, etc
indomethacin (Indocin)
179
Releases epinephrine, which creates physiologic stress rather than relaxation
Tolerance develops
Physical and psychologic dependency
Withdrawal symptoms occur if stopped
Nicotine
180
Used in the treatment of emotional and mental disorders
Psychotherapeutic Drugs
181
Chronic, recurrent pattern of seizures
Epilepsy
182
Adverse effects:
Decreased CNS activity, sedation, hypotension, drowsiness, loss of coordination, dizziness, headaches
Others: nausea, vomiting, dry mouth, constipation
Benzodiazepines
| Anxiolytic Drugs
183
When providing teaching to a patient receiving an anticholinergic for the treatment of Parkinson’s disease, the nurse will include which information?
Take the medication first thing in the morning.
Limit fluid intake when taking this drug.
The tremors you experience will be reduced within 24 hours of taking this drug.
Do not take this medication at the same time as other medications.
Do not take this medication at the same time as other medications.
When anticholinergics are used for the treatment of Parkinson’s disease, these medications should not be taken at the same time as other mediations. The medications should be administered at bedtime. Fluid intake should not be restricted as they cause dry mouth, and it may take several days to weeks for the beneficial effects of the medication to become evident.
184
The “off-on phenomenon” that some patients with Parkinson’s disease (PD) experience is best explained as the
need to take a drug holiday to improve response to medications.
variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms.
alternating schedule of medications needed to control PD.
fluctuation of emotions that often occurs with PD.
variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms.
Some patients who take levodopa on a long-term basis experience times when their PD symptoms are under control and other times when symptoms are not well controlled.
185
Blocks pain impulses peripherally by inhibiting prostaglandin synthesis
Analgesic and antipyretic effects
Little to no antiinflammatory effects
Nonopioid Analgesics
Acetaminophen (Tylenol)
186
Given orally only
Monitored by prothrombin time and INR (PT-INR)
Antidote is vitamin K
Full therapeutic effect takes several days
May be started while the patient is still on heparin until PT-INR levels indicate adequate anticoagulation
Monitor PT-INR regularly—keep follow-up appointments
Many herbal products have potential interactions—increased bleeding may occur
Capsicum pepper,Garlic,Ginger, Ginkgo, St. John’s wort, Feverfew
warfarin sodium (Coumadin)
187
Irreversible inhibitor of COX-1 receptors
Inhibits platelet aggregation (81 mg or 325 mg daily)
Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders
Salicylic acid (aspirin)
188
Toxicity and Management of Overdose
Regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an opioid antagonist should be given.
two drugs are
naloxone (Narcan)
| naltrexone (ReVia)
189
Inhibit platelet aggregation
| Prevent platelet plugs
Antiplatelet drugs
190
For Anxiety (primary treatment) (CNS depressant)
Benzodiazepines
191
Two main pharmacologic classes:
Benzodiazepines (flunitrazepam)
Barbiturates
Depressants
192
Used for depression, anxiety, sleep disorders, nervousness
May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity
Severe interactions if taken with MAOIs and SSRIs; many other drug interactions
Food-drug interaction with tyramine-containing foods
Herbal Products: St. John’s Wort
193
Overdose
Tachycardia, circulatory collapse, seizures, coma
Treatment: protect brain and heart, eliminate toxin
Avoid foods that contain tyramine! (Hypertensive Crisis)
Aged, mature cheeses, smoked/pickled or aged meats, fish, poultry, yeast extracts, Red wines, Italian broad beans
Monoamine Oxidase Inhibitors (MAOIs)
194
Prior to administering a serotonin agonist, it is most important for the nurse to assess the patient for a history of
hypertension.
allergy to penicillin.
chronic bronchitis.
cataracts.
hypertension.
: The nurse should complete a thorough cardiac history as well as measurement of blood pressure and pulse rate and rhythm. If a patient has a history of hypertension, there is risk of further increases in blood pressure to dangerous levels with use of these drugs, and thus the need for careful assessment and documentation. In fact, generally these drugs are not prescribed for patients with migraines who also have coronary artery disease unless a thorough cardiac evaluation has been performed.
195
```
enoxaparin (Lovenox) and dalteparin (Fragmin)
More predictable anticoagulant response
Do not require laboratory monitoring
Given subcutaneously
Do NOT rub after administration
```
Low–molecular-weight heparins
196
The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is
pain management.
fever reduction.
treatment of osteoarthritis.
thromboprevention.
thromboprevention.
“Low-dose” aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher usually.
197
Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value?
Blood sugar
Sodium
Urine osmolality
Hematocrit
Sodium
: Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity.
198
Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated BP and pulse, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise
Opioid Drug Withdrawal
199
Used for treatment of anemia associated with end-stage renal disease, chemotherapy-induced anemia, and for anemia associated with zidovudine therapy
Contraindications: drug allergy, uncontrolled hypertension, head and neck cancers, risk of thrombosis
epoetin alfa (Epogen)
darbepoetin (Aranesp)
200
Used to relieve anxiety, stress and restlessness and to promote sleep
May cause CNS depression, hepatotoxicity
Interactions: CNS depressants, alcohol, MAOIs, phenytoin, warfarin,
Contraindicated in cardiac and liver disease
Patient should not operate heavy machinery during use
Kava and Valerian
201
The nurse is explaining the differences between transdermal nicotine and nicotine gum programs. Which statement by the nurse is correct?
“The nicotine patch will give you quick relief from cravings.”
“Chewing the gum rapidly will release an immediate dose of nicotine.”
“It seems that patients have better treatment compliance with the gum than the patch.”
“The dose of nicotine in the gum is approximately twice the dose the average smoker receives in one cigarette.”
“Chewing the gum rapidly will release an immediate dose of nicotine.”
: The patch system uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, and patient treatment compliance seems higher than with the gum. Acute relief from withdrawal symptoms is most easily achieved with the use of the gum, because rapid chewing releases an immediate dose of nicotine. The dose is approximately half the dose the average smoker receives in one cigarette, however.
202
Indicated for repletion of total body iron content in patients with iron-deficiency anemia who are undergoing hemodialysis
Doses higher than 125 mg are associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching
Ferric gluconate (Ferrlecit)
203
CNS Depressants Classified into three main groups:
Barbiturates
Benzodiazepines
Miscellaneous drugs
204
First nicotine-free prescription medicine to treat nicotine dependence
bupropion (Zyban)
205
Peak period
2 to 4 days for short-acting drugs,4 to 7 days for long-acting drugs
Duration
4 to 7 days for short-acting drugs, 7 to 12 days for long-acting drugs
Depressants Withdrawal
206
Involuntary muscle symptoms/ Pseudo parkinsonism
Akathisia (distressing muscle restlessness)
Acute dystonia (painful muscle spasms)
Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
Extrapyramidal symptoms (EPS)
