Exam 3 Flashcards
1
Q
Donepezil
A
Alzheimer’s Disease medication
2
Q
Memantine
A
Alzheimer’s Disease medication
3
Q
Atypical antipsychotics (ex. risperdone and olanzapine (SGAs))
A
Alzheimer’s Disease medication (help but increase mortality)
4
Q
Donepezil mechanism and effects
A
Increases acetylcholine levels
FDA approved for all stages
Side effects:
GI discomfort (common)
Bradycardia (rare)
5
Q
Memantine mechanism and effects
A
Helps regulate glutamate (too much glutamate = gas mephrotoxc)
FDA approved for only moderate and severe stages
Well tolerated
6
Q
Do Alzheimer’s medication work
A
Little window of improvement and then it goes to a normal digression. No other alternate
7
Q
What is a seizure
A
too much electrical activity in the brain
8
Q
3 types of seizures
A
- Tonic-clonic = shaking
- Absense = no shaking and just drifts
- Myoclonic = just fall and hit the ground (brief shock-like jerks of a muscle or group of muscles)
9
Q
Generalized seizures
A
Whole brain
10
Q
Partial (focal) seizures
A
Restricted to one part of the brain
11
Q
Phenytoin
A
Antiepileptic
12
Q
Carbamazepine
A
Antiepileptic (used also for neuropathic pain)
13
Q
Valproic Acid
A
Antiepileptic
14
Q
Lamotrigine
A
Antiepileptic
15
Q
Levetiracetam
A
Antiepileptic (Used the most in clinical)
16
Q
Antiepileptic mechanism of action
A
slow down CNS either by promoting GABA activity or a different mechanism
17
Q
Antiepileptic common themes
A
lots of drug-drug interactions
All have CNS side effects
Must avoid pregnancy
18
Q
Phenytoin side effects
A
- Very narrow therapeutic index (keep your pheny between 10 and 20)
- Gingival hyperplasia (make sure to brush teeth)
- Abnormal hair growth (hirsutism)
- Vitamin D and K interference
19
Q
Valproic Acid side effects
A
- May upset stomach (take with food)
2. Risk for hepatotoxicity (Monitor LFTs (AST and ALT 1-36) and watch for jaundice)
20
Q
Lamotrigine side effects
A
- Risk for Stevens-Johnson syndrome
2. Start LOW and go sLOW with LAMOtrigine (start a low dose and gradually go up)
21
Q
Antiepileptic client teaching
A
- These drugs help control seizures, but they are not a cure
- Don’t abruptly stop them - that can precipitate a seizure
- Carry extra medication when traveling
- You may need an alternative form of contraception
22
Q
What do you give for status epileptions (seizure that won’t stop)
A
benzodiazepine
23
Q
Parkinson’s Disease major symptoms
A
- Rest tumor
- Rigidity
- Bradykinesia
- Postural instability
- Dysarthria - trouble producing words
- Micrographia- writing very small
24
Q
Parkinson’s Disease treatment strategies
A
- Increase dopamine levels
- Decrease acetylcholine levels
- Slow the destruction of neurons
25
Levodopa/Carbidopa
Parkinson's Disease Med
26
Selegiline
Parkinson's Disease Med
27
Benztropine
Parkinson's Disease Med
28
Trihexyphenidyl
Parkinson's Disease Med
29
Levodopa/Carbidopa mechanism and effects
1. Increases dopamine
2. Most effective treatment
3. Carbidopa enables more levodopa to enter the CNS = smaller dose and decreasing many side effects
4. Avoid high protein meals, vitamin B6, and pyridoxine (if not a carb, probably can't eat it).
5. Psychosis
6. Orthostatic Hypotension
7. Takes several weeks to start working and only last about 5 years
30
Selegiline mechanism and effects
1. MAO-B inhibitor ( increases serotonin and dopamine)
2. Avoid tyramine foods
3. Avoid drugs that increase monoamines (ex. antidepressants, meperidine, and sympathomimetics)
31
Benztropine & Trihexyphenidyl mechanism of action and effects
1. Decreases acetylcholine
2. Centrally acting anticholinergics
3. Second-line therapy for tremors
4. Anticholinergic effects
5. Drowsiness/sedation
32
Symptoms of Diabetes Insipidus (DI)
1. Polydipsia (extra thirsty)
| 2. Large volumes of dilute urine (polyuria)
33
Causes of Diabetes Insipidus (DI)
1. Head trauma
2. Neurosurgery
3. Cancer
34
Vasopressin
Diabetes Insipidus (DI) med (only parenteral) (used in cardiac arrest) (identical copy of ADH)
35
Desmopressin
Diabetes Insipidus (DI) med (PO and parenteral) (real close copy of ADH)
36
Diabetes Insipidus (DI) medication common uses
1. Diabetes Insipidus (DI)
| 2. Cardiac arrest (vasopression)
37
Diabetes Insipidus (DI) medication mechanism of action
Synthetic version of ADH. Once absorbed, they help kidneys hold onto urine. Vasopression causes vasoconstriction
38
Evaluating Diabetes Insipidus (DI) medication
1. Too much of the medication, they don't pee.
| 2. If peeing 3 L, dose needs to go down
39
Diabetes Insipidus (DI) medication adverse effects
1. Over hydration (headache)
| 2. Excessive vasoconstriction (chest pain) (caused by vasopressin)
40
NSAIDs (Non steroid anti-inflammatory drug) common uses
1. pain
2. fever
3. inflammation
4. Stroke & MI prevention (aspirin only) (every other drug increases risk)
41
Aspirin
NSAIDs
42
Ibuprofen
NSAIDs
43
Naproxen
NSAIDs
44
Ketorolac
NSAIDs
45
Celecoxib
NSAIDs
46
COX-1 prostaglandin helps with what
1. gastric protection
2. renal perfusion
3. platelet aggregation
47
COX-2 prostaglandin helps with what
1. pain
2. fever
3. inflammations
48
NSAIDs mechanism of action
Inhibit the conversion of arachidonic acid into prostaglandins by inhibiting COX-1 and COX-2.
49
NSAIDs common themes
1. GI issues
2. Renal impairment
3. Heart attacks and strokes
50
GI issues caused by NSAIDs
1. Damage to gastric mucosa
2. Watch for signs of bleeding (black stool, blood in vomit, and/or small bruising)
3. Take with food or milk
4. Consider giving a proton pump inhibitor or histamine-2 blocker
51
Renal impairment by NSAIDs
1. Contraindication with clients with kidney problems. one kidney
2. Use cautiously if client has decreased renal funtion
3. Monitor intake and output, BUN, and creatinine
52
Heart Attacks and strokes by NSAIDs
1. All NSAIDs except aspirin increase risk
| 2. High risk with selective COX-2 inhibitors (ex. celecoxib)
53
Aspirin effects
1. Reduces risk of stroke and MI
2. Contraindicated for children (due to risk of Reye's syndrome). Especially with the flu. Only use for Kawasaki's disease
3. Antiplatelet effect occurs at low doses and lasts the lifetime of the platelet
54
Salicylism is what
```
Aspirin poisoning
Manifestations:
1. Tinnitus
2. Sweating
3. Headache
4. Dizziness
5. Acid-base disturbances (breathe faster/Kussmal respiration's)
```
55
Salicylism treatment
1. activated charcoal with 1-2 hours.
2. a lot of IV fluid
3. sodium bicarbon increases blood pH (dialysis)
56
Ketorolac effects
1. Pain relief similar to morphine
2. Short-term use only (up to 5 days)
3. Can be given IV or PO
57
Acetaminophen mechanism of action
Only works in the CNS and only decreases pain and fever.
58
Acetaminophen problems
Liver toxicity
1. Max dose is 3 or 4 g daily
2. Contraindicated for malnourished (not enough glutathione), heavy drinkers (turns toxic too fast), and people with liver disease
3. Hidden acetaminophen in other medications
4. Jaundice
59
Antidote for acetaminophen overdose
Acetylcysteine
1. it replaes depleted glutathione
2. very effective when given within 8-10 hours
60
Opioids common uses
1. Moderate to severe pain
2. Sedation
3. Cough suppresion (codeine)
61
Codeine
moderate to strong opioid
62
Hydrocodone and Acetaminophen
moderate to strong opioid
63
Oxycodone and Acetaminophen
moderate to strong opioid
64
Meperidine
```
Strong opioid (doesn't effect the pupils)
short term use only (less than 48 hours) due to seizure risks
```
65
Morphine
Strong opioid
66
Hydromorphone
Strong opioid
67
Fentanyl
Strong opioid
68
Opioid mechanism of action
Activate mu and kappa receptors in the CNS and elsewhere. This decreases neuronal activity, causing sedation and decreased pain transmission
69
Opioid most serious side effects
1. Respiratory depression (monitor respiratory rate)
| 2. Constipation (increase fluid/fiber intake, walking, give prophylactic laxative and/or stool softener)
70
Opioid regular side effects
1. Cough suppression (encourage coughing)
2. Itching (may need diphenhydramine)
3. Nausea/vomiting (may need ondansetron)
4. Sedation (avoid other CNS depressants and machinery)
5. Urinary retention (encourage to void every 4 hours)
71
Administration of Opioids
1. Double-checks
2. Hold and contact provider if Respiratory Rate (RR) is < 12
3. Another nurse witness waste
4. Administer IV slowly (usually 4-5 minutes)
72
Patient Controlled Analgesia administration
1. double check settings during handoff
2. only patient can push button
3. teach to stay ahead of their pain
4. guardrails prevent patient from overdosing
73
Fentanyl patches administration
1. Apply to intact, clean, dry, hair-free skin
2. Maximum effect in 1 day
3. Change every 72 hours
4. Fold and flush to dispose
74
Antidote for Opioids
Naloxone
75
Migraine characteristics
1. last 42 hours
2. unilateral (half the head)
3. pulsating
4. debilitating pain
5. worsening by movement
6. nausea and/or vomiting
7. photophobia (light) and phonophobia (sound)
76
What causes migraines
has something to do with vasodilation and inflammation of the brain's vasculature. The trigeminal nerve (CN V) innervates these blood vessels and plays a key role
77
2 types of migraine meds
1. Abortive Agents (Stop)
| 2. Prophylactic Agents (Prevent)
78
Triptans
Migraine medications (Stop) (Serotonin 1B/1D blockers)
79
Triptans mechanism of action
activate a subset of serotonin receptors. This causes the intracranial vessels to vasoconstrict and decreases their inflammation. 80% effective
80
Sumatriptan
Triptans to know
81
Issues with triptans
1. Chest pressure/heavy arms is common
2. Drug interactions
- Ergot alkaloids (wait 24 hours)
- Antidepressants (serotonin syndrome)
82
Triptans client teaching
1. not use for prevention
2. take immediately after symptoms start
3. avoid migraine triggers
4. report continuous or severe chest pain
83
Muscle relaxers and antispasmodics common uses
1. Muscle spasms due to injury/surgery
2. Spasticity due to cerebral palsy, spinal cord injury, or multiple sclerosis
3. Malignant (bad) hyperthermia (antidote = dantrolene)
84
diazepam
benzodiazepine (in this case muscle relaxer
85
Cyclobenzaprine
Muscle relaxer
86
Baclofen
Muscle relaxer
87
Dantrolene
antidote for malignant hyperthermia
88
Muscle relaxers and antispasmodics mechanism of action
1. Most act within the CNS by enhancing GABA activity
2. Dantrolene works directly on skeletal muscle. Suppresses the release of calcium, making the muscle weaker and less able to contract
89
Muscle relaxers and antispasmodics problems
1. all cause CNS depression.
2. Clients should avoid hazardous activity
3. avoid other CNS depressants
90
Baclofen extra problems
Visual hallucinations, paranoid ideation, and seizures if discontinued abruptly
91
Dantrolene extra problems
1. Hepatoxicity (jaundice)
2. Women older than 35 highest risk
3. Check liver function before treatment and monitor afterwards
92
Medications for Neuropathic pain
1. TCAs
2. SNRIs
3. Antiepileptics
- Carbamazepine
- Gabapentin (only prescribe for neuropathic pain)
- Pregabalin (only prescribe for neuropathic pain)
93
Carbamazepine, gabapentin, and pregabalin mechanism of action
They suppress the spontaneous firing of damaged neurons
94
Carbamazepine problems
1. Bone marrow suppression (leukopenia, anemia, thrombocytopenia)
2. Stevens-Johnsons Syndrome
3. Lots of interactions (warfarin, oral contraceptives, grapefruit juice)
95
Gabapentin problems
1. Fewer side effects
2. No significant interactions
3. Most common side effects: sedation, fatigue, ataxia
96
What does a new nurse need to know about neuropathic pain medications
They are to be used in combination with other drugs (opioids). Not by themselves
97
Local anesthetic common uses
1. Surgical procedures
2. Minor procedures (IV)
3. Chronic pain
98
Lidocaine (patch, Injection)
Local Anesthetic
99
Lidocaine/Epinephrine (vasoconstriction last longer)
Local Anesthetic
100
Lidocaine 2.5%/Prilocaine 2.5 (Cream)
Local anesthetic
101
Local anesthetic mechanism of action
1. Block the electrical conduction of axons by blocking sodium channels along the axons.
2. affected neurons can't transmit their signals, which leads to loss of sensation or loss of movement
102
Lidocaine problems
1. Lidocaine injections work fast (about 5 minutes)
2. Lidocaine cream work slower (wait 1 hour)
3. Does not last long
4. Cardiac toxicity (bradycardia, heart block, cardiac arrest)
5. CNS toxicity (seizures, respiratory depression, coma)
103
Never give Lidocaine where
1. Finger
2. Toes
3. Nose
4. "Hose" (penis)
104
Lidocaine cream administration
1. squeeze from the tube onto site
2. don't rub it
3. place a Tegaderm on top
4. Wait a least one hour
5. Remove dressing and cleanse sight
105
Glaucoma medication mechanism of action
1. Prostaglandin analogs- increase the outflow of aqueous humor
2. Beta-adrenergic blockers- decreases the production of aqueous humor
3. Alpha2-adrenergic agonist- do both
106
Latanoprost
Glaucoma med (Prostaglandin analog)
107
Timolol
Glaucoma med (Beta-adrenergic blockers)
108
Brimonidine
Glaucoma med (Alpha2-adrenergic agonists)
109
Glaucoma medication side effects (all)
1. temporary stinging
2. conjunctivitis
3. blurred vision
110
Prostaglandin analog extra side effects
1. very few systemic effects
| 2. Permanent increased pigmentation of iris and/or eyelids (30% of time)
111
Beta-adrenergic blockers extra side effects
1. Some are nonselective (timolol); others are beta1 selective
2. Bradycardia
3. Hypotension
4. Bronchoconstriction (small airway)
112
Alpha2-adrenergic agonists problems
1. hypotension
| 2. drowsiness (crosses the BBB)
113
Antihistamine common uses
1. Allergies
2. Itchiness
3. Hives (urticaria)
4. Nausea and vomiting
5. Anaphylaxis
114
Diphenhydramine
Antihistamine- 1st generation H1 blocker (crosses BBB)
115
promethazine
Antihistamine- 1st generation H1 blocker (crosses BBB)
116
hydroxyzine
Antihistamine- 1st generation H1 blocker (crosses BBB)
117
loratadine
Antihistamine- 2nd generation H1 blocker (doesn't cross BBB)
118
cetirizine
Antihistamine- 2nd generation H1 blocker (doesn't cross BBB)
119
fexofenadine
Antihistamine- 2nd generation H1 blocker (doesn't cross BBB)
120
desloratadine
Antihistamine- 2nd generation H1 blocker (doesn't cross BBB)
121
Antihistamine mechanism of action
Block H1 receptors, decreasing the effects of excessive histamine (runny nose, sneezing, itchy eyes, itchy rash, vasodilation)
122
Antihistamine common adverse effects
```
1st generation
- sedation
- anticholinergic effects
2nd generation
- well tolerated
-longer duration
```
123
Nasal glucocorticoids common uses
1. seasonal rhinitis
| 2. perennial (never ending) rhinitis
124
mometasone
nasal glucocorticoid
125
fluticasone
nasal glucocorticoid
126
nasal glucocorticoid mechanism of action
prevent the immune system from creating the chemical triggers of inflammation
127
nasal glucocorticoid effectiveness
1. the most effective drugs for allergic or perennial rhinitis
2. maximal effect takes about 1 week
3. use proper technique
128
nasal glucocorticoid side effects
1. drying of nasal mucosa
| 2. epistaxis (nosebleeds)
129
Epinephrine common uses
1. anaphylactic shock
2. cardiac arrest
3. local anesthetics
130
Epinephrine mechanism of action
activates alpha1, beta1, and beta2 receptors, causing vasoconstriction. Increasing cardiac contractility, and bronchodilation
131
Hypothyroidism symptoms
1. depression
2. fatigue
3. weight gain
4. cold intolerance
5. constipation
and many more..
132
causes of hypothyroidism
1. Iodine deficiency
2. Hashimoto's thyroiditis
3. Lithium therapy
133
Levothyroxine
Hypothyroidism med
134
Hypothyroidism med mechanism of action
levothyroxine is a synthetic version of T4. It is then converted to T3
135
Levothyroxine adverse effects
1. insomnia
2. anxiety
3. weight loss
4. sweating
5. increased HR and BP
136
Levothyroxine other issues
1. Many food/drug interactions
2. Narrow therapeutic index
3. Generic does same thing but do not change brands
137
Asthma controllers
taken daily and are not for acute symptoms
138
Asthma rescue medication
taken as needed and have a quick onset
139
Asthma and COPD med options
1. Beta2 agonist (use first and then wait 5 minutes)
2. Anticholinergics
3. Inhaled glucocorticoids
4. Combinations
140
Asthma and COPD med mechanism of action
1. Beta2 agonists- activate beta 2 receptors in lungs causing bronchodilation
2. Anticholinergics- block muscarinic receptors in the lungs, causing bronchodilation
3. Inhaled glucocorticoids- suppress the inflammatory/immune response in the lungs
141
Albuterol
Short-acting Beta2 agonist (asthma)
142
Levalbuterol
Short-acting Beta2 agonist (asthma)
143
Formeterol
Long-acting Beta2 agonist (COPD)
144
Salmeterol
Long-acting Beta2 agonist (COPD)
145
ipatropium
Short-acting anticholinergic
146
tiotropium
Long-acting anticholinergic
147
beclomethasone
inhaled glucocorticoid
148
fluticasone (for asthma)
inhaled glucocorticoid
149
Long-acting beta2 agonist must not be what?
used as monotherapy in asthma
150
Beta2 agonist adverse effects
Tachcardia and tremors
151
Anticholinergic adverse effects for asthma and COPD
Dry mouth and hoarseness (since it doesn't go into the stomach
152
Inhaled glucocorticoid adverse effects
oral candidiasis (wash mouth after use)
153
Glucocorticoids common uses
1. asthma and COPD
2. Allergic reactions
3. Autoimmune disorders
and many more...
154
Prednisone
oral glucocorticoid
155
prednisolone
oral glucocorticoid
156
methylprednisolone
oral glucocorticoid
157
dexamethasone
oral glucocorticoid
158
glucocorticoid mechanism of action
Decrease the body's immune response
159
glucocorticoid adverse effects
```
C- cataracts
U- ulcer (GI)
S- skin thinning
H- hypertension and hypokalemia
I- insomnia
N- Neck and face fat
G- glucose elevation
O- osteoporosis, obesity
I- infections
D- depression/mood changes
```
160
Adrenal insufficiency caused by glucocorticoids
1. Cortisol will stop being made
2. Don't stop abruptly if taken more than 7-14 days
3. flu-like symptoms and hypotension
