Nervous System Medications Flashcards
(156 cards)
1
Q
Diazepam (Valium), lorazepam (Ativan), midazolam (Versed), and chlordiazepoxide (Librium) are examples of
A
Benzodiazepines
2
Q
Indications for benzodiazepines
A
- anxiety
- seizures
- muscle spasms
- alcohol withdrawal
- induction/maintenance of anesthesia
3
Q
Benzodiazepines enhance _____ in the CNS
A
GABA
4
Q
Side effects of benzodiazepines
A
Sedation, respiratory depression, amnesia, dependency/withdrawal
5
Q
Benzodiazepines are for _____-term use
A
Short
6
Q
Patient education for benzodiazepines
A
Do NOT discontinue these meds abruptly
7
Q
Nonbenzodiazepine indicated for anxiety, panic disorder, OCD, and PTSD
A
Buspirone (Buspar)
8
Q
Compare buspirone (Buspar) to benzodiazepines
A
Buspirone has fewer side effects, does not cause sedation, dependency unlikely, and can be used for LONG-term treatment
9
Q
Buspirone (Buspar) patient education
A
- full effects not felt for several weeks
- always take WITH OR WITHOUT food to prevent change in absorption level
- NO grapefruit juice
10
Q
Amytriptyline (Elavil) and imipramine (Tofranil) are examples of
A
Tricyclic antidepressants
11
Q
Tricyclic antidepressants increase the effects of _________ and _________ in the CNS
A
Serotonin; norepinephrine
12
Q
Side effects of tricyclic antidepressants
A
Sedation, orthostatic hypotension, anticholinergic effects, dysrhythmias, sweating, seizures
13
Q
Patient education to counteract anticholinergic side effects
A
Chew gum, wear sunglasses, increase fiber and fluid intake
14
Q
Phenelzine (Nardil) and tranylcypromine (Parnate) are examples of
A
MAOIs (for depression)
15
Q
Side effects of MAOIs
A
Agitation/anxiety, orthostatic hypotension, HYPERTENSIVE CRISIS
16
Q
MAOIs interactions
A
Many OTC cold medications and tyramine rich foods — result in severe hypertension
17
Q
Bupropion (Wellbutrin, Zyban) and trazodone (Oleptro) are examples of
A
Atypical antidepressants
18
Q
Medication indicated for depression and/or smoking deterrent
A
Bupropion (Wellbutrin, Zyban)
19
Q
Side effects of bupropion (Wellbutrin, Zyban)
A
Insomnia, weight loss, agitation, seizures
20
Q
Trazodone (Oleptro) side effects
A
Sedation, hypotension, dry mouth
21
Q
Trazodone patient education
A
Avoid alcohol; hard candy or gum for dry mouth
22
Q
Paroxetine (Paxil), sertraline (Zoloft), and fluoxetine (Prozac) are examples of
A
SSRIs
23
Q
SSRIs for anxiety and depression work by increasing
A
Serotonin
24
Q
SSRI side effects
A
Sexual dysfunction, weight gain, insomnia, serotonin syndrome
25
S/S of serotonin syndrome
Agitation, hallucinations, fever, diaphoresis, tremors
26
SSRI black box warning
Increased risk for suicidal thoughts
27
SSRI patient education
- DO NOT take w/ St. John’s wort (increased risk for serotonin syndrome)
- full effects not felt for 2 weeks or more
28
Duloxetine (Cymbalta) and venlafaxine (Effexor) are examples of
SNRIs
29
SNRIs for anxiety and depression work by increasing both
Serotonin and norepinephrine
30
Side effects of SNRIs
Fatigue, insomnia, GI upset (constipation, nausea), dysuria, decreased libido, serotonin syndrome
31
SNRI black box warning
Increased risk for suicidal thoughts
32
Common mood stabilizer for the treatment of bipolar disorder
Lithium (Lithobid)
33
Key lithium side effects (HINT: LITH)
Leukocytosis (elevated WBCs), Insipidus (DI, polyuria), Tremors (fine hand), Hypothyroidism
34
Additional side effects of lithium (excluding LITH)
Weight gain, KIDNEY TOXICITY, electrolyte imbalances
35
Lithium (Lithobid) black box warning
Lithium toxicity
36
Plasma levels > ___ mEq/L indicate lithium toxicity
1.5
37
S/S of lithium toxicity
Course tremors, confusion, hypotension, seizures, tinnitus
38
Medications to avoid on lithium (Lithobid)
Diuretics, anticholinergics, NSAIDs
39
Lithium (Lithobid) is contraindicated for patients with
Renal disease
40
Lithium (Lithobid) patient education
Need adequate fluid and sodium intake (closely monitor sodium levels!)
41
Carbamezapine (Carbatrol, Tegretol), valproic acid (Depakene), and lamotrigine (Lamictal) are examples of __________ for the treament of bipolar disorder and seizures/epilepsy
Mood stabilizers/anticonvulsants
42
Side effects of carbamazepine (Carbatrol, Tegretol)
- blood dycrasias: anemia, leukopenia, thrombocytopenia
- vision issues: nystagmus, diplopia
- hypo-osmolarity (r/t SIADH)
- skin rash
43
Carbamazepine (Carbatrol/Tegretol) nursing consideration
Monitor CBC levels and for S/S of infection
44
Side effects of valproic acid (Depakene)
Hepatoxicity, pancreatitis, thrombocytopenia
45
Is valproic acid (Depakene) safe for use during pregnancy?
NO! Black box warning for neural tube defects
46
Valproic acid (Depakene) nursing consideration
Monitor liver function tests d/t risk for hepatotoxicity (AST, ALT, LDH, bilirubin)
47
Lamotrigine (Lamictal) key side effects
Photosensitivity, skin rashes
48
Symptoms present in a schizophrenic patient that SHOULD NOT be there (delusions, hallucinations)
Positive symptoms
49
Lacking of symptoms that SHOULD be there in a schizophrenic patient (anergia, anhedonia)
Negative symptoms
50
List three examples of first generation (typical) antipsychotics
Chlorpromazine (Thorazine), haloperidol (Haldol), droperidol (Inapsine)
51
First generation (Typical) antipsychotics are indicated for psychotic disorders and schizophrenia and work by mainly controlling __________ symptoms
Positive
52
Side effects of first generation (Typical) antipsychotics
Extrapyramidal Symptoms (EPS), Neuroleptic Malignant Syndrome (NMS), agranulocytosis, anticholinergic effects, orthostatic hypotension, sedation, seizures
53
Extrapyramidal Symptoms (EPS)
- Dystonia: involuntary muscle contractions
- Parkinson’s symptoms: shuffling gait, rigidity)
- tardive dyskinesia: lip smacking, tongue rolling
- akathisia: restlessness, pacing
54
S/S of NMS
Fever, BP fluctuations, dysrhythmias, muscle rigidity
55
anticholinergics such as _________ can be used to control EPS symptoms associated with first generation (typical) antipsychotics
Benztropine
56
Muscle relaxants such as __________ can be used to treat NMS associated with first generation (typical) antipsychotics
Dantrolene
57
List three examples of second generation (atypical) antipsychotics
Risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril)
58
Second generation (atypical) antipsychotics work by
Controlling the positive and negative symptoms of schizophrenia
59
Many second generation (atypical) antipsychotics end in
-done or -pine
60
Side effects of second generation (atypical) antipsychotics
Diabetes, weight gain, increased cholesterol, sedation, orthostatic hypotension, anticholinergic effects, menorrhagia, decreased libido
61
Clozapine (Clozaril) carries risk for
Agranulocytosis (decreased WBC — risk for infection)
62
Second generation (atypical) antipsychotics nursing considerations
Monitor blood glucose levels and for s/s of infection
63
Methylphenidate (Methylin, Ritalin) and amphetamine mixtures (Adderall) are examples of
CNS stimulants for the treatment of ADHD and conduct disorders
64
Side effects of CNS stimulants
Insomnia, dysrhythmias, decreased appetite, weight loss
65
CNS stimulants black box warning
Drug abuse; dependence
66
CNS stimulant patient education
- do not administer meds at night; morning is better d/t risk for insomnia
- take med 30-45 minutes before meals
67
CNS stimulants nursing consideration
Monitor weight during therapy
68
Disulfiram (Antabuse), naltrexone (Vivitrol) and acamprosate are maintenance medications for
Alcohol abuse
69
Medication for alcohol abuse that results in unpleasant side effects (vomiting, sweating, palpitations, hypotension) if the patient ingests alcohol
Disulfiram (Antabuse)
70
Alcohol abuse medication that suppresses craving for alcohol
Naltrexone (Vivitrol)
71
Alcohol abuse medication that decreases abstinence symptoms (anxiety, restlessness)
Acamprosate
72
T or F: Maintenance medications for alcohol abuse can be used to treat acute alcohol withdrawal
FALSE; these are for long-term abstinence from alcohol
73
Alcohol withdrawal treatment is focused on stabilizing vital signs and preventing seizures through medications such as
Benzodiazepines, beta blockers, antiepileptic agents
74
Buprenorphine (Subutex) and methadone (Methadose, Dolophine) are examples of
Maintenance medications for opioid dependence
75
Varenicline (Chantix) is a medication used for
Smoking cessation
76
Side effects of varenicline (Chantix)
Anxiety, depression, irritability, insomnia, muscle pain
77
Acetaminophen (Tylenol) can cause __________ in high doses
Hepatotoxicity
78
Do not exceed ___ g/day of acetaminophen (Tylenol)
4
79
Ibuprofen (Advil, Motrin, Excedrin), naproxen (Aleve), ketorolac (Toradol), and indomethacin (Indocin) are examples of
NSAIDs
80
NSAID used to close patent ductus arteriosis (PDA) in premature babies
Indomethacin
81
NSAIDs side effects
GI upset, GI bleeding, renal toxicity, rash, headache
82
NSAIDs are contraindicated in patients with
PUD, bleeding disorders
83
NSAID patient education
Avoid alcohol (increases risk for GI bleed)
84
Celecoxib (celebrex) is an example of
Cox 2 inhibitor NSAID
85
Celecoxib (Celebrex) is indicated for
Osteoarthritis, RA
86
Celecoxib (Celebrex) side effects
Thrombosis (MI, stroke), GI bleeding, rash
87
Celecoxib (Celebrex) should not be administered to patients with allergy to
Aspirin, NSAIDs, or sulfonamides
88
Salicylate that doubles as an analgesic and platelet aggregation inhibitor (prevention of TIAs/MIs)
Aspirin (Bayer)
89
Aspirin (Bayer) side effects (HINT: ASPIRIN)
Abdominal pain, salicylism, Peptic ulcer disease, Intestinal blood loss (GI bleeding), Reye’s syndrome, Itchy rash, Noise (tinnitus)
90
Aspirin (Bayer) is contraindicated in
Patients with PUD or bleeding disorders; children with fever (risk for Reye’s syndrome)
91
S/S of salicylism
Tinnitus, vomiting/diarrhea, respiratory alkalosis
92
Anticonvulsant that can be used to treat neuropathic pain
Pregabalin (Lyrica)
93
Side effects of pregabalin (Lyrica)
Dizziness, drowsiness, dry mouth, edema
94
Pregabalin (Lyrica) patient education
Avoid alcohol; discontinue medication gradually
95
List four examples of opioid analgesics
Fentanyl, morphine, dilaudid, oxycodone (OxyContin)
96
Side effects of opioid analgesics (HINT: RUSH)
Respiratory depression, urinary retention, sedation, hypotension; additional: constipation, GI upset
97
Side effects of opioid analgesics (HINT: RUSH)
Respiratory depression, urinary retention, sedation, hypotension; additional: constipation, GI upset
98
Naloxone (Narcan) reverse analgesia and can result in
Hypertension, tachycardia, agitation
99
Example of a topical analgesic
Lidocaine (Xylocaine)
100
Nursing consideration for Emla cremation (containing lidocaine)
Apply and cover with occlusive dressing 1 hour before procedure to help minimize pain
101
Ergotamine (Ergomar) and sumatriptan (Imitrex) are examples of
Vascular headache suppressants
102
Ergotamine (Ergomar) side effects
GI upset, hypertension
103
Sumatriptan (Imitrex) side effects
Dizziness/vertigo, warm/tingling sensation
104
Vascular headache suppressants are contraindicated in patients with
Ischemic coronary artery disease or peripheral vascular disease
105
Non-selective beta blocker used to treat primary open angle glaucoma
Timolol (Timoptic)
106
How does timolol (Timoptic) work?
Decreases aqueous humor production which decreases IOP
107
Timolol (Timoptic) side effects
Mild: temporary stinging of eye
108
Patient education for administration of antiglaucoma agents
Do not touch eye with applicator; hold lacrimal duct for 1 min after application to prevent systemic effects
109
Systemic effects of timolol (Timoptic)
Effects of non-selective beta blockers: hypotension, bronchoconstriction, bradycardia
110
Normal IOP
10-21 mmHg
111
Carbonic anhydrase inhibitor used to treat glaucoma, heart failure, and altitude sickness
Acetazolamide (Diamox)
112
Side effects of Acetazolamide (Diamox)
Flu-like symptoms, GI upset, electrolyte imbalances (Na, K), hyperchloremic acidosis
113
Acetazolamide (Diamox) patient education
Take with food to minimize GI upset
114
Pilocarpine (Diocarpine) and acetylcholine (Miochol-E) are examples of
Direct-acting cholinergic antiglaucoma agent
115
Side effects of direct acting cholinergic agents for glaucoma
Blurred vision, stinging, eye pain
116
Travoprost (Travatan) and latanoprost (Xalatan) are examples of
Prostaglandin agonist antiglaucoma agents
117
Side effects of prostaglandin agonists for glaucoma
Stinging, eyelash growth, eye color change (increase in iris pigmentation)
118
Cholinergic agent indicated for Alzheimer’s disease
Donepezil (Aricept)
119
Patient education for Donepezil (Aricept)
Take at bedtime; does NOT CURE Alzheimer’s
120
Neostigmine (Bloxiverz) and pyridostigmine (Mestinon) are cholinergic agents indicated for
Myasthenia gravis
121
Cholinergics for myasthenia gravis work by increasing __________ at receptor sites by inhibiting __________
Ach; cholinesterase
122
Side effects of cholinergics for myasthenia gravis
Excess ACh: increased salivation, diarrhea, N/V, sweating, bradycardia
123
Cholinergic medication given to diagnose myasthenia gravis as opposed to cholinergic crisis
Edrophonium
124
If the nurse administers edrophonium to a patient suspected of having myasthenia gravis and they __________, then diagnosis of MG is confirmed. If the patient’s symptoms __________, then they were likely having an anticholinergic crisis
Improve; worsen
125
Levodopa/carbidopa (Sinemet) and Bromocriptine (Parlodel) are examples of
Dopamine agonists indicated for Parkinson’s disease
126
Side effects of dopamine agonists for Parkinson’s disease
N/V, drowsiness, dyskinesias (tics), orthostatic hypotension, darkening of urine and sweat, psychosis, diarrhea, sweating, bradycardia
127
High _________ meals decrease the effectiveness of levodopa/carbidopa
Protein
128
Dopamine agonists work to increase _________ in the CNS for Parkinson’s disease (__________ is converted to dopamine in CNS, and __________ prevents breakdown of levodopa).
Dopamine; levodopa; carbidopa
129
Anticholingeric indicated for Parkinson’s disease
Benztropine (Cogentin)
130
Benztropine (Cogentin) works by decreasing __________ in the CNS
ACh
131
Parkinson’s disease is characterized by too little __________ and too much __________
Dopamine, ACh
132
Side effects of Benztropine (Cogentin)
Anticholinergic effects
133
Patient education for Benztropine (Cogentin)
Chew gum, wear sunglasses, increase fiber and fluid to combat anticholinergic effects
134
Phenytoin (Dilantin), topirimate (Topamax), levetiracetam (Keppra), and primidone (mysoline) are examples of
Antiepileptics
135
Key side effect of phenytoin (Dilantin)
Gingival hyperplasia
136
Phenytoin (Dilantin) patient education
Monitor blood levels during therapy; decreases effectiveness of oral contraceptives
137
Phenytoin therapeutic range
10-20 mcg/mL
138
Key side effect of topiramate (Topamax)
Metabolic acidosis
139
A patient on topiramate (Topamax) will need to have serum __________ levels monitored before and during therapy
Bicarbonate
140
Key side effect of levetiracetem (Keppra)
Agranulocytosis
141
A patient on levetiracetam (Keppra) will need their __________ levels monitored
CBC
142
Key side effect of primidone (Mysoline)
Blood dyscrasias
143
Therapeutic range for primidone (Mysoline)
5-12 mcg/mL
144
Primidone (Mysoline) patient education
Monitor blood levels during therapy; decreases effectiveness of oral contraceptives
145
Zolpidem (Ambien) and eszopiclone (Lunesta) are hypnotic/sedatives indicated for
Insomnia
146
Key side effects of hypnotic/sedatives for insomnia
Daytime sleepiness, dizziness, abnormal thinking and behavior
147
Pentobarbital (Nembutal) and phenobarbital (Luminal) are examples of sedative/hypnotic __________
Barbiturates
148
Barbiturates may be indicated for
Preoperate sedation, seizures, coma induction in patients with high ICP
149
Patient education for insomnia medications
Allow for at least 8 hours of sleep
150
Key side effects of barbiturates
Drowsiness, lethargy, hypotension, respiratory depression, constipation
151
Barbiturates patient education
Avoid alcohol
152
Barbiturates nursing considerations
Monitor vital signs, have resuscitation equipment at bedside
153
General anesthetic agent used for induction and maintenance of general anesthesia, as well as sedation of intubated patients
Propofol (Diprivan)
154
Side effects of propofol (Diprivan)
Amnesia, bradycardia, hypotension, respiratory depression
155
T or F: general anesthetic agent propofol (Diprivan) provides analgesia
FALSE
156
Propofol (Diprivan) nursing considerations
Monitor vital signs continuously; use unused portions of propofol within 6 hrs due to risk of bacterial contamination
