Pharm 1 Flashcards

Question

antiparkinsonism - anticholinergics

Answer 1

benzotropine biperiden trihexyphenidyl HCI action - decreases involuntary movement, tremors, muscle rigidity

Answer 2

assessment - urine output as urinary retention may occur diagnosis - urinary retention related to atropine planning - pt secretions w decrease before surgery interventions - monitor vitals, intake and output, mouth care, bowel sounds

Answer 3

antihistamine - scopolamine - treats motion sickness, N/V - patch delivers dose for 3 days side effects - tachycardia, hypotension, dry mouth, constipation, blurred vision, flushing, muscle weakness

Answer 4

ADHD narcolepsy reversal of respiratory destress categories - amphetamines, caffeine (stimulate cerebral cortex, euphoria, alertness) - analeptics, caffeine ( stimulate respiration) - anorexiants (suppress appetite)

Answer 5

action - stimulate release of norepinephrine and dopamine - inhibit repuptake of norepinephrine and dopamine side effects - CV: tachycardia, palpitations, hypertension dysrhythmias - Neuro: restlessness, irritability, confusion, euphoria, insomnia, blurred vision GI: anorexia, dry mouth, weight loss, diarrhea, constipation excess used: psychosis

Answer 6

demethylphenidate methylphenidate controlled substance schedule II uses - increases attention span and cognitive performance - decreases impulsiveness, hyperactivity, and restlessness dosing - 30-45 min before meals - caffeine to increase effect - no evening or before bed cautions - CVD, HTN, PD, psychosis, hyperthyroidism, seizures - increases effects of oral anticoagulants, barbiturates, anticonvulsant, hypertensive crisis w MAOIs

Answer 7

methylphenidate modafinil increases wakefulness in pt w sleep disorders unknown mechanism of action

Answer 8

baseline VS, mental status, height, weight, growth baseline labs planning- hyperactivity will be decreased within 3 days, pt HR and BP with be within normal limits teaching - before meals, no alcohol, monitor weight

Answer 9

causes stimulate effect on hypothalamic and limbic areas of brain to suppress appetite no one under 12 side effects CV: Tachycardia, hypertension, palpitations Neuro: seizures nervousness, irritability sexual: ED example: benzphetamine, most commons is phentermine

Answer 10

primary use: stimulate respiration examples - caffeine, theophylline (asthma), used for neonatal apnea doxapram - used for post anesthesia respiratory destress side effects - (similar to those of anorexiants)

Answer 11

insomnia- fall asleep / stay asleep - more common in females and older pt - non- pharm sleep hygiene first - pharm- sedative hypnotics non-pharm management - wake up at same time - no napping - avoid caffeine, alcohol, and nicotine - no heavy meals - take warm bath

Answer 12

sedatives - treat sleep disorders sedative hypnotics cat - barbiturates - benzodiazepines - non benzodiazepines can be short or long term acting short term at lowest dose no hypnotics in those w severe respiratory disorders general side effects - hangover - vivid dreams and nightmares - drug dependence - drug tolerance - excessive depression - respiratory depression - hypersensitivity

Answer 13

long- intermediate- short/ ultrashort - acting restrict to short term - no longer than 2 weeks interactions - alcohol, opioid, other sedative hypnotics - decreases effects of oral anticoagulants, glucocorticoids, tricyclics antidepressant, quinidine short acting - secobarbital intermediate- butabarbitol

Answer 14

hypnotics - flurazepam, alprozolam, temazepam, triazolam( intermediate sedation), estazolam, quazepam sleep disorders and anxiety - lorazepam and diazepam action - interacts w neurotransmitter GABA to reduce neuron excitability Uses - reduce anxiety, treat insomnia antidote- flumazenil - vivid dreams and nightmares nursing process - assessment ( determine whether the pt has history of insomnia or anxiety - planning - receive hood sleep - observe for adverse reactions, teach about non pharm methods

Answer 15

zolpidem action - neurotransmitter inhibition - duration of action is 6-8 hours schedule IV - “4” use - treat short term (less than 10 days insomnia - often used for longer periods

Answer 16

newest cat ramelteon - not a controlled substance - first FDA approved hypnotic nit classified as a controlled substance - selective targets melatonin receptors to regulate circadian rhythm to treat insomnia - nit been shown to decrease REM sleep - adverse effects - drowsiness, dizziness, fatigue, headache, nausea, and suicidal ideation

Answer 17

ascertain the pt problem w sleep disturbance sleep deprivation due to anxiety pt will sleep 6-8 hours observe pt for side effects if non benzodiazepines

Answer 18

types general (depresses the CNS) - alleviate pain - loss of consciousness local - pain relief in limited area routes - inhalation - IV - topical - local - spinal

Answer 19

- a hypnotic given night before surgery - premedication ( w an opioid analgesic or benzodiazepines- example: midazolam) - with an anticholinergic - decreases secretions (atropine) - a short acting nonbarbiturates - propofol - inhaled gas - nitrous oxide and oxygen - muscle relaxant given as needed

Answer 20

nitrous gas (laughing gas) - doesn’t last long provides smooth induction usually combined w - non barbiturate - propofol - strong analgesic- morphine - muscle relaxant - pancuronium adverse effects - respiratory depression, hypotension, dysrhythmias, malignant hyperthermia

Answer 21

droperidol, etomidate, ketamine - rapid onset and short duration of action midazolam and propofol - sedation for minor surgery, can still be responsive to commands adverse effects - respiratory depression, hypotension

Answer 22

limited to mucous membranes, broken or unbroken skin surfaces, and burns forms - solution, liquid spray, ointment, cream, gel, and powder decreases sensitivity of nerve endings of the affected area

Answer 23

block pain at the site where the drug is given (decrease nerve sensitivity) consciousness is maintained use - dental procedure - suturing skin two groups ester and amides - have very low allergic reaction procaine hydrochloride- dental lidocaine hydrochloride - rapid onset, longer duration bupivacaine hydrochloride 3-10 hours

Answer 24

local ejected in the subarachnoid space adults - below first lumbar space children - below third lumbar space side effects - respiratory distress - headache - hypotension

Answer 25

spinal block - penetration of the anesthetic into subarachnoid membrane between the pia mater and arachnid membrane epidural block - placement of the local anesthetic in the epidural space posterior to the spinal cord or dura mater caudal block - placed through the sacral hiatus saddle block - placed at the lower end of the spinal column to block the perineal area

Answer 26

monitor the post op state of sensorium urine output vital signs

Answer 27

seizure disorder resulting from abnormal electric discharge from cerebral neurons characteristics - loss of consciousness - involuntary, uncontrolled movements cause - unknown - second to brain trauma or anoxia, infection, stroke isolated seizures (not epileptic) can occur due to fever, acid base imbalance, alcohol, drugs

Answer 28

common generalized seizure types - tonic- clonic (grand mal) • most common • generalized alternating muscle spasms and jerkiness - absence (petit mal) •brief loss of consciousness (10 seconds or less) • usually occurs in children common partial seizures - psychomotor- repetitive behavior - chewing or swallowing motions • behavioral changes • motor seizures

Answer 29

-anticonvulsants or anti epileptic drugs - are CNS depressants that • stabilize nerve cell membranes • suppress abnormal electric impulses in cerebral cortex prevent seizures but not curative

Answer 30

phenytoin - contraindications • pregnancy - therapeutic serum level • 10-20 mcg/mL - side effects • gingival hyperplasia, nystagmus, headache, dizziness, slurred speech, ventricular fibrillation, depression, hyperglycemia, thrombocytopenia, leukopenia (low platelets and low WBC), purple glove syndrome, stevens- johnson syndrome drug interactions - increased effects w cimetidine, isoniazid - decreases effects w folic acid, ginko, antipsychotic

Answer 31

renal and hepatic functions lab look at drug and herb use pt seizure frequency will lower seizure precautions female pt taking BC

Answer 32

phenobarbital action - enhances GABA activity uses - tonic clonic, partial, myoclonic seizures, status epilepticus therapeutic serum level - 20-40 side effects - sedation - tolerance discontinuation - should be gradual

Answer 33

clonazepam - treats absence and myoclonic seizures - tolerance may occur in 6 months diazepam - treats status epilepticus - must be administered IV for status epilepticus - short term effect • other antiseizure drugs must be given during it immediately after administration of diazepam “bridge” - still needs to do more

Answer 34

carbamazepine uses - tonic clonic, partial seizures - also used for psychiatric disorders, trigeminal neuralgia and alc withdraw therapeutic serum range 4-12 no grapefruit juice

Answer 35

valproic acid - uses- tonic clonic, absence, mixed seizures therapeutic range - 50-100 side effects - dizziness, drowsiness, insomnia, diplopia, weakness, GI distress

Answer 36

seizures increase during pregnancy anti seizure drugs are teratogenic anti seizure drugs tend to inhibit vitamin K - contributes to hemorrhage soon after birth anti seizure drugs increase loss of folate acid

Answer 37

seizures associated w a fever- children 3 months to 5 years prophylactic treatment for high risk pt phenobarbital- barbiturates diazepam - benzo

Answer 38

medical emergency treatment must begin immediately treatment - IV diazepam -IV lorazepam -followed by phenytoin IV for continued seizures: midazolam, propofol -slow IV admin to avoid respiratory depression

Answer 39

imbalance between dopamine and acetylcholine occurs due to degeneration of dopamine neurons excess acetylcholine stimulates GABA Characteristics - involuntary tremors - rigidity of muscles - bradykinesia ( slow movement ) - postural changes ( head and chest thrown forward, shuffling gate, lack of facial expression)

Answer 40

non pharm measures - education - steps, rugs in house, increase mobility and flexibility, well balanced diet treatments - anticholinergic (inhibit the release of acetylcholine) - dopamine replacement (stimulate dopamine receptors) - dopamine agonist ( stimulate dopamine receptors) - MAO- B - COMT inhibitors

Answer 41

anticholinergics action - inhibit release of acetylcholine - reduce muscle rigidity and some tremors - minimal effect of bradykinesia examples: benztropine, trihexphenidyl side effects - dizziness, drowsiness, weakness, anxiety, headache, insomnia, paresthesia, restlessness, blurred vision, GI distress, urinary retention

Answer 42

dopaminergics - carbidopa - levodopa action - converts to dopamine and increased mobility side effects - fatigue, insomnia, dry mouth, blurred vision, GI distress, orthostatic hypertension

Answer 43

dopaminergics example: apomorphine action: -stimulates dopamine receptors orphan drug side effects - dizziness, drowsiness, yawning, hallucinations, N/V

Answer 44

selegiline action - inhibit MAO-B enzyme that interferes w dopamine side effects - dizziness, headache, impulse control disorder, dry mouth, suicidal, hypertension, ortho hypotension interaction - large does may inhibit MAO-A, an enzyme that promotes metabolism of tyramine

Answer 45

Tolcapone action - gino it COMT enzyme that inactivates dopamine side effects - dizziness, drowsiness, headache, excess dreams, insomnia, hepatic dysfunction Entacapone - does nit affect liver - combo pill w carb

Answer 46

incurable chronic, progressive, neurodegenerative disorder marked cognitive function usually between 45-65 symptoms - mem loss, confusion, unable to communicate - agressive behavior, depression progression leads too loss of mem, logical thinking, and judgment, personality changes, time disoriented

Answer 47

Rivastigmine action - allow more acetylcholine in neuron receptors - increase cognitive function, slow disease process side effects - dizziness, headache, dry mouth, GI distress, Bradycardia, orthostatic, hypotension, dysrhythmias nursing process - mental and physical abilities mem and judgement pt mem will be improved maintain care vitals

Answer 48

autoimmune disorder lack of acetylcholine impairs transmission of messages at neuromuscular junctions myasthenia crisis- severe generalized muscle weakness

Answer 49

over dosing and underdosing similar symptoms -muscle weakness, dyspnea, bradiacardiac, drooling, abdominal cramping myasthenia crisis - caused by under dosing cholinergic crisis - symptoms become worse - caused by over dosing - atropine “antidote” acetylcholinesterase inhibitors - edrophonium - ultra-short acting for diagnosing - neostigmine - short acting - ambenonium - long acting action - increase muscle strength in pt w myasthenia gravis side effects - increased salivation and tearing, miosis, blurred vision, bradycardia, hypotension, GI distress

Answer 50

prednisone - drug of choice Plasma exchange IV immune globulin IVIG immunosuppressive drugs - azathioprine - need to monitor for leukopenia and hepatoxicity

Answer 51

myasthenia crisis muscle weakness w be reduced in 2-3 days take drug before meals admin in time

Answer 52

autoimmune disorder characteristics - remissions and exacerbation - motor: weakness or paralysis of extremities, muscle spasticity, diplopia sensory: numbness and tingling, neuropathic pain, severe fatigue classifications - relapsing remitting - full recovery and residual deficit - primarily progressive - slowly worsening neurologic function with no relapses or remissions - secondary progressive relapsing - progressive w onset w acute relapses with it without full recovery -clinically isolated syndrome- only one flare up

Answer 53

immunomodulators - first line treatment - slows disease progression and prevents relapses immunosuppressants - mitoxantrone (IV) corticosteroids - exacerbatations - reduces edema

Answer 54

central acting muscle relaxants - mechanisms of action not fully known - relieves muscle spasm and spasticity - have sedative effect peripherally acting muscle relaxants - dantrolene - decreases muscle spasm pain and increases range of motion side effects - drowsiness, dizziness, headache, nausea, vomiting cyclobenzaprine action - relax skeletal muscles uses - relieves muscle spasms side effects - blurred vision, dried mouth, GI distress, drowsiness, dizziness

Answer 55

factors that play - age/cognitive function - family related - social - individual positive fam relationships help

Answer 56

misuse of drugs hits on the reward circuit in our brain drugs mimic our own neurotransmitters related use = tolerance

Answer 57

action - inhibits the effect of GABA short term effects- N/V, headaches, impaired judgment long term- high rates of cancer, liver damage, brain issues alcohol toxicity - life threatening condition that can occur by drinking large amounts of alc over short period of time complications - dehydration, seizures, brain damage

Answer 58

few seek treatment inpatient and outpt drug-assisted treatment - disulfiram (Antabuse) - with any alc will get really sick - acamprosate (Campral) - can use through relapse - naltrexone (Vivitrol, Revia ) - have to watch for opioid withdraw should be used with therapy also

Answer 59

short-term- mem, learning impairment, inability to focus long term - res. issues, exposes to cancer treatment - no meds are currently approved for treatment non-pharm- CBT, MET, may help

Answer 60

effects - drowsiness, confusion, nausea, constipation - dose-dependent respiratory depression most get it from someone they know treatment - non-pharm drug assisted - naloxone (Narcan) - may have to give more than 1 time - Naltrexone (methadone - long term, tolerance will be low after using this med if opioids are taken while on med they will most likely overdose

Answer 61

short term- high HR and BP long term - cancer treatment -cognitive behavior therapy - helps develop new ways of thinking - self help materials - apps related to $$ save if they quit - telephone-based counseling- from own home drug assisted - nicotine replacement - bupropion (zyban) - increases levels of dopamine or ephi, after comfy taper pff - varenicline (Chantix start meds a week before

Answer 62

cold meds dextromethorphan - euphoria, dissociative effects promethazine- codeine - euphoria and relaxation

Answer 63

surgical pt post op and during

Answer 64

Loss of contact with reality Theory - Results from imbalance in neurotransmitter dopamine in the brain Characteristics - Difficulty in processing information - Disorganized thoughts, incoherence - Distortion of reality - Delusions, hallucinations, catatonia - Aggressive or violent behavior

Answer 65

Chronic psychotic disorder Symptoms usually develop in adolescence or early adulthood Major category of symptoms - Cognitive symptoms - Positive symptoms- agitation and speech doesn't make sense - Negative symptoms- decrease in function

Answer 66

Also known as neuroleptics or psychotropics Theory – dopamine imbalance in the brain Many antipsychotics block dopamine receptors Block dopamine – side effects are EPS or parkinsonism Two categories Typical Phenothiazines - block norepinephrine causing sedative/hypotensive effects Nonphenothiazines - block neurotransmitter dopamine Atypical Now are first-line therapy Decreased side effects than typical antipsychotics Adverse reactions Extrapyramidal syndrome Stooped posture, masklike facies, rigidity, tremors at rest Shuffling gait, pill-rolling motion of hands, bradykinesia Acute dystonia Akathisia Tardive dyskinesia Neuroleptic malignant syndrome (rare, potentially fatal) Symptoms: Muscle rigidity, hyperthermia, altered mental status, diaphoresis, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdo, acute renal failure, respiratory failure, and coma Treatment: stop antipsychotic!, hydration, hypothermic blankets, and antipyretics, benzos, and muscle relaxant

Answer 67

Phenothiazine groups Aliphatic: chlorpromazine Side effects Strong sedation, orthostatic hypotension, moderate EPS Piperazine: fluphenazine, perphenazine Side effects Dry mouth, urinary retention, agranulocytosis, more EPS than other groups Piperidines: thioridazine Side effects Strong sedation, low to moderate effect on blood pressure, few EPS

Answer 68

Fluphenazine Action Blocks dopamine receptors in brain Use Manages symptoms of schizophrenia and psychosis Interactions Increase depression when taken with alcohol or other CNS depressants Increased effects with MgSO4, lithium, beta blockers Side effects Sedation, dizziness, headache, seizures Dry mouth, nasal congestion, blurred vision, photosensitivity Urinary retention, sexual dysfunction, GI distress, peripheral edema, tachycardia, EPS

Answer 69

Haloperidol Action Blocks dopamine receptors Use Treats psychoses, schizophrenia, attention-deficit/hyperactivity disorder, Tourette’s syndrome Contraindications Narrow-angle glaucoma CNS depression Severe liver, kidney, and cardiovascular disease Blood dyscrasias Haloperidol Side effects Drowsiness, headache, insomnia Dry mouth, blurred vision, photosensitivity Tachycardia, orthostatic hypotension, dysrhythmias Seizures, weight gain Urinary retention, sexual dysfunction Blood dyscrasias, strong EPS, NMS Interactions Increased sedation with alcohol, CNS depressants Increased toxicity with anticholinergics Decreased effects with phenobarbital, carbamazepine, caffeine

Answer 70

Advantages Effective in treating both positive and negative symptoms of schizophrenia Less likely to cause EPS or tardive dyskinesia Action Block serotonin and dopaminergic D4 receptors Clozapine Use Severe schizophrenic patients unresponsive to traditional antipsychotics Side effects and adverse effect Dizziness, sedation, constipation Tachycardia, orthostatic hypotension Tremors, occasional rigidity Seizures, agranulocytosis Low likelihood of EPS Risperidone Use Manage symptoms of psychosis Side effects/adverse reactions Sedation, headaches, photosensitivity EPS, seizures Dry mouth, weight gain Tachycardia, orthostatic hypotension Urinary retention, sexual dysfunction Low possibility of EPS and tardive dyskinesia Aripiprazole Use Manage symptoms of schizophrenia, bipolar disorder, autism, depression, Tourette syndrome Side effects/adverse reactions Drowsiness, dizziness, headache Insomnia, anxiety, agitation, memory impairment Blurred vision, photosensitivity GI distress, weight gain/loss Tachycardia, orthostatic hypotension, dysrhythmias Seizures, sexual dysfunction Suicidal ideation, NMS Low possibility of EPS and tardive dyskinesia

Answer 71

Assessment Assess baseline vital signs Obtain a health history including present drugs Nursing diagnosis Relationship, ineffective related to social withdrawal Sleep pattern, disturbed related to medication adverse effects Planning Patient’s psychotic behavior will improve with medication, psychotherapy, and adjunct therapies Nursing interventions Monitor vital signs Remain with patient while medication is taken and swallowed Observe for EPS Assess for symptoms of NMS Inform patients that medication may take 6 weeks or longer to achieve full clinical effect Caution patients not to consume alcohol or other CNS depressants such as opioids

Answer 72

Nonpharmacologic treatment Relaxation techniques Psychotherapy Support groups Pharmacologic treatment Benzodiazepines Miscellaneous anxiolytics SSRIs SNRIs TCAs MAOIs

Answer 73

Lorazepam Action Inhibits GABA neurotransmission by binding to specific benzodiazepine receptors Use Anxiolytic, antiseizure, sedative-hypnotic, preoperative drug, substance abuse withdrawal Side effects Drowsiness, dizziness, ataxia, restlessness, weakness Headache, confusion, amnesia, blurred vision GI distress, sleep disturbance, hallucinations Bradycardia, hypotension/hypertension Seizures, suicidal ideation, NMS, respiratory depression Discontinuation Gradually decrease dose over several days Withdrawal symptoms Develops slowly, in 2 to 10 days, and may last several weeks Withdrawal symptoms Tremor, agitation, nervousness Sweating, insomnia Anorexia, muscle cramps

Answer 74

Assessment Assess for suicidal ideation Obtain a history of patient’s anxiety reaction Determine patient’s support system Nursing diagnosis Anxiety related to situational crisis Noncompliance related to adverse effects of medications Planning Patient’s anxiety and stress will be reduced Nursing interventions Observe patient for side effects of anxiolytics Monitor vital signs Encourage family to be supportive of patient Advise patient not to drive a motor vehicle or operate dangerous equipment when taking anxiolytics because sedation is a common side effect Warn patient not to consume alcohol or CNS depressant while taking an anxiolytic

Answer 75

Buspirone (BusPar) Action Binds to serotonin and dopamine receptors May not be effective until 1 to 2 weeks after continuous use Has fewer side effects of sedation and physical and psychological dependency associated with many benzodiazepines Common side effects Drowsiness, dizziness Headache, excitement Nausea, nervousness Interaction with grapefruit juice

Answer 76

Buspirone (BusPar) Action Binds to serotonin and dopamine receptors May not be effective until 1 to 2 weeks after continuous use Has fewer side effects of sedation and physical and psychological dependency associated with many benzodiazepines Common side effects Drowsiness, dizziness Headache, excitement Nausea, nervousness Interaction with grapefruit juice

Answer 77

Etiology Genetic predisposition Social and environmental factors Biologic conditions Pathophysiology theories Decreased levels of monoamine neurotransmitters Norepinephrine, serotonin, dopamine Signs and symptoms Depressed mood, despair, weight loss or gain Loss of interest in normal activities Fatigue, insomnia or hypersomnia Decreased ability to think or concentrate Suicidal thoughts Types of depression Reactive depression - after an event (bre) major depression - disease, loss of interest, worthlessness Bipolar disorder - #1 periods of depression along w mana

Answer 78

Ginkgo biloba and St. John’s wort Should not be taken with prescription antidepressants Discontinue use of herbal products 1 to 2 weeks before surgery Check with the health care provider before taking herbal treatments

Answer 79

Action Blocks uptake of neurotransmitters norepinephrine and serotonin in brain Elevates mood, increases interest in ADLs, decreases insomnia Use Major depression Response occurs after 2-4 wks of drug therapy - increase mood Side effects/adverse reactions Drowsiness, dizziness, blurred vision Dry mouth and eyes, GI distress Urinary retention, sexual dysfunction Weight gain, seizures Sleep-related behaviors, suicidal ideation Orthostatic hypotension, dysrhythmias Blood dyscrasias, cardiotoxicity EPS, NMS Interactions Alcohol and other CNS depressants potentiate CNS depression MAOIs may lead to toxic psychosis, cardiotoxicity Antithyroid drugs may increase dysrhythmias

Answer 80

Action Block uptake of neurotransmitter serotonin Do not block uptake of dopamine, norepi & do not block cholinergic receptors (fewer side effects) Uses Major depression Anxiety disorders Obsessive-compulsive disorder Panic disorders Phobias Posttraumatic stress disorder Prevention of migraine headaches

Answer 81

effective for sadness, panic, compulsion E- escitalopram F- Fluvoxamine, Fluoxetine S- sertraline P- paroxetine C- citalopram SSSS = Stomach upset, Sexual dysfunction, Serotonin sydrome, Suicidal thought

Answer 82

Action Decreases reuptake of serotonin, enhancing action of serotonin in nerve cells Use Depression, bulimia, OCD, anxiety/panic, PMDD Initial effect: 3-4 wks; therapeutic effect: 4-6 wks Side effects/adverse effects Headache, dizziness, drowsiness, insomnia, weakness, confusion, abnormal dreams, tremors, dry mouth, anorexia, nausea, constipation, sexual dysfunction, electrolyte disturbances, GI bleeding or obstruction, OH, tachycardia, SJS, serotonin syndrome, EPS, stroke, SI

Answer 83

Action Inhibit the reuptake of serotonin and norepinephrine Use Major depression Generalized anxiety disorder Social anxiety disorder Examples Venlafaxine Duloxetine Desvenlafaxine Side effects Drowsiness, dizziness, insomnia Headache, euphoria, amnesia Blurred vision, photosensitivity Adverse effects Tachycardia, hypertension Angioedema, seizures, suicidal ideation

Answer 84

Action Affect one or two of the three neurotransmitters: serotonin, norepinephrine, and dopamine Use Major depression, reactive depression, anxiety Interaction Do not take with MAOIs and do not use within 14 days after discontinuing MAOIs Trazodone may have a potential drug interaction with ketoconazole, ritonavir, and indinavir that may lead to increased trazodone levels and adverse effects

Answer 85

Action Monoamine oxidase enzyme inactivates norepinephrine, dopamine, epinephrine, and serotonin Use Depression not controlled by TCAs and second-generation antidepressants For mild, reactive, and atypical depression Used less frequently due to adverse reactions Drug interactions CNS stimulants such as vasoconstrictors and cold medications containing phenylephrine and pseudoephedrine can cause a hypertensive crisis Food interactions Foods that contain tyramine Some cheeses, cream, yogurt, coffee, chocolate, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, and red wines can cause a hypertensive crisis Side effects/adverse effects Agitation, restlessness, insomnia Anticholinergic effects Orthostatic hypotension Hypertensive crisis from tyramine interaction

Answer 86

Assessment Assess the patient’s baseline vital signs and weight for future comparisons Obtain a health history of depression episodes; assess for mental status and suicidal ideation Nursing Diagnosis Social isolation related to feelings of sadness Self-directed violence, risk for Planning Patient’s depression will be decreased Nursing interventions Observe patient for signs of depression, mood changes, insomnia, apathy, or lack of interest in activities Monitor vital signs Monitor for drug-drug and food-drug interactions Provide patient with a list of foods to avoid Caution patient not to consume alcohol or other CNS depressant concurrently

Answer 87

Lithium Use Bipolar affective disorder Action Alteration of ion transport in muscle and nerve cells Increased receptor sensitivity to serotonin Therapeutic serum range 0.8 to 1.2 mEq/L Serum lithium levels greater than 1.5 mEq/L may lead to toxicity Also need to monitor sodium levels Has a calming effect but may cause some memory loss and confusion Side effects/adverse reactions Headache, drowsiness, dizziness, blurred vision Restlessness, tremors, memory impairment Dry mouth, metallic taste, GI distress Hypotension, dysrhythmias Edema of hands and ankles, dehydration Increased urination, blood dyscrasias, NMS Serotonin syndrome, nephrotoxicity Interactions Increased lithium level with Thiazides, methyldopa, haloperidol, NSAIDs, antidepressants, theophylline, phenothiazines Decreased lithium level with Caffeine, loop diuretics

Answer 88

Assessment Assess for suicidal ideation Assess for baseline vital signs Obtain health history and drug history Nursing diagnosis Injury, Risk for Coping, Ineffective related to manic behavior Planning The patient’s manic-depressive behavior with decrease Nursing interventions Observe patient for depression, mood changes, insomnia, apathy, or lack of interest in activities Monitor vital signs Monitor lithium levels Check cardiac status Advise patient to avoid caffeine products Advise patient to maintain adequate sodium intake

Answer 89

Protective response to tissue injury and infection Inflammatory phases Vascular phase Occurs 10 to 15 minutes after injury Associated with vasodilation and increased capillary permeability Occurs when fluid, blood elements, leukocytes, and chemical mediators (histamines, kinins, prostaglandins) to accumulate at the injured site Delayed phase Leukocytes infiltrate inflamed tissue Cyclooxygenase (COX) enzyme Converts arachidonic acid into prostaglandins (which cause inflammation and pain at tissue injury site) Has two enzyme forms: COX-1: protects stomach lining and regulates blood platelets COX-2: triggers inflammation and pain

Answer 90

Antiinflammatory drug groups Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroids Disease-modifying anti-rheumatic drugs Antigout drugs

Answer 91

Action Inhibit the enzyme COX which is needed for biosynthesis of prostaglandins Effects Analgesic effect Antipyretic effect Inhibit platelet aggregation Mimic effects of corticosteroids but are not chemically related Most often used for musculoskeletal conditions First-generation NSAIDs Salicylates Para-chlorobenzoic acid derivatives Phenylacetic acids Propionic acid derivatives Fenamates Oxicams Second-generation NSAIDs Selective COX-2 inhibitors

Answer 92

Aspirin (acetylsalicylic acid) (ASA) Action Prostaglandin inhibitor; inhibits the COX enzyme Antiinflammatory, antiplatelet, antipyretic effects Therapeutic serum salicylate level 15 to 30 mg/d

Answer 93

Lab Increase PT, bleeding time, INR, uric acid Decrease cholesterol, T3 and T4 levels Foods containing salicylates Prunes, raisins, licorice Certain spices such as curry and paprika Drugs Increased bleeding with anticoagulants and other NSAIDs Risk for hypoglycemia with oral antidiabetics Increased gastric ulcer risk with glucocorticoids Decreased effects of ACE inhibitors, loop diuretics, probenecid Salicylate effects are decreased by corticosteroids Side effects/adverse reactions Dizziness, drowsiness, headache Tinnitus, hearing loss GI distress, bleeding, ulceration Thrombocytopenia, leukopenia, agranulocytosis, hemolytic anemia Hepatotoxicity Hypersensitivity/OD: Tinnitus, dizziness, bronchospasm Do not take with other NSAIDs Avoid in last trimester Avoid in children with flu-like symptoms – may cause Reye syndrome

Answer 94

Assessment Determine patient’s medical history Obtain a med/drug history Nursing diagnosis Injury, Risk for Pain, Chronic related to tissue swelling from injury Planning The patient’s inflammation will be reduced within 1 week Nursing interventions Monitor serum salicylate level (if on high doses) Observe the patient for evidence of bleeding Advise patient not to take aspirin with alcohol or warfarin to prevent increased bleeding Instruct patient to discontinue aspirin approximately 7 days before surgery to reduce risk of bleeding Warn parents not to give aspirin for virus or flu symptoms to children to avoid risk of Reye syndrome Educate parents to call the poison control center immediately if a child has taken a large or unknown amount of aspirin Inform patient that aspirin tablets can cause GI distress

Answer 95

Action Inhibits prostaglandin synthesis Use Rheumatoid arthritis, osteoarthritis, gouty arthritis Side effects/adverse effects Dizziness, headache, weakness GI distress and bleeding Sodium and water retention -> Hypertension

Answer 96

Action Inhibits prostaglandin synthesis Use Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and pain Minimal to no antipyretic effect Examples Ketorolac Oral, IV, IM, intranasal Efficacy equal or superior to opioids Diclofenac Oral or topical

Answer 97

buprofen Most widely used NSAID OTC Action Inhibits prostaglandin synthesis Use Pain, osteoarthritis, rheumatoid arthritis Side effects Drowsiness, dizziness, headache, confusion, insomnia, dreams Gastric distress and bleeding Tinnitus, dysrhythmias, nephrotoxicity, blurred vision, edema Drug interactions Increased bleeding with warfarin Increased effects with phenytoin, sulfonamides, warfarin, cephalosporins Decreased effect with aspirin

Answer 98

obtain drug and herbal history assess for GI distress observe pt for bleeding gumd, report ant GI issues, no alc

Answer 99

Fenamates Example: meclofenamate Use: For mild to moderate pain/arthritis Oxicams Examples: piroxicam and meloxicam Indicated for long-term arthritic conditions Long half life; typically dosed once daily Well tolerated; lower incidence of GI distress

Answer 100

Action Selectively inhibits COX-2 enzyme without inhibition of COX-1 2nd generation NSAID Use Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, pain, dysmenorrhea

Answer 101

Action Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site Use Arthritic flare-ups Not the drug of choice for arthritis because of their numerous side effects Discontinuation Taper off over 5-10 days if it has been used long-term

Answer 102

Types Immunosuppressive agents Immunomodulators Antimalarials Use Alleviate symptoms of rheumatoid arthritis when other treatments fail Osteoarthritis Severe psoriasis Crohn disease, ulcerative colitis

Answer 103

Colchicine Action Inhibits migration of leukocytes to inflamed site Alleviates gout symptoms Side effects GI distress Taken with food to avoid GI distress Contraindications Severe renal, cardiac, or GI problems Uric acid biosynthesis inhibitors (febuxostat, allopurinol) Action Decreases uric acid synthesis and lowers serum uric acid levels Prophylactic; prevents gout attacks Side effects Dizziness, headache, dry mouth, GI distress Arthralgia, pruritus

Answer 104

Assessment Assess serum uric acid value for future comparisons Nursing diagnoses Tissue integrity, Impaired related to inflammation of the great toe Pain, Acute related to tissue swelling Planning Patient’s pain will be controlled without side effects Nursing interventions Record urine output Monitor lab tests for renal and hepatic function Instruct patient to increase fluid intake to increase drug and uric acid excretion Advise patient to have a yearly eye exam as visual changes can result from prolonged use of allopurinol

Answer 105

Action Increase the rates of uric acid excretion by inhibiting its reabsorption Use Chronic gout Example Probenecid Usually given with colchicine Side effects Flushed skin, fever, dizziness, headache Blood dyscrasias Avoid aspirin as it inhibits action of probenecid

Answer 106

less potent mild to moderate pain effective for dull, throbbing pain of headaches, muscles aches and pain action site - PNS at pain receptor sites

Answer 107

OTC NSAIDs Aspirin Ibuprofen Naproxen Action Analgesic Antipyretic Antiinflammatory effects

Answer 108

Acetaminophen is not an NSAID Uses Muscular aches and pain, fever No anti-inflammatory properties Maximum dose 4 g/day If taken frequently 2 g/day Side effects Headache, insomnia Anorexia, nausea, vomiting, constipation – low incidence Rash

Answer 109

Use Moderate and severe pain Action site Act on CNS Suppress pain impulses Suppress respiration and coughing by acting on respiratory and cough centers in the medulla Many opioids possess antidiarrheal effects

Answer 110

Use -> moderate to severe pain Antidote -> naloxone Route -> PO, SC, IM, IV, rectal Side effects/adverse reactions Drowsiness, dizziness, euphoria, confusion, depression, Miosis, blurred vision GI distress, flatulence, constipation Orthostatic hypotension, weakness Urinary retention Psychological dependence Respiratory depression

Answer 111

Assessment Determine drug history and check for drug allergies Assess the type of pain, location, and duration before giving opioids Nursing diagnoses Pain, Acute related to surgical tissue injury Breathing Pattern, Ineffective related to excess morphine dosage Planning The patient’s pain will be reduced or alleviated within ____ time (depending on route) Nursing interventions Administer morphine before pain reaches its peak to maximize drug effectiveness Monitor vital signs frequently to detect respiratory changes Check for pupil changes and reaction Have naloxone available as an antidote to reverse respiratory depression if morphine overdose occurs

Answer 112

Use Primarily effective in GI procedures Preferred to morphine during pregnancy Route: PO, IM, IV Side effects Less constipation and urinary retention than morphine Hypotension Caution with large doses in older adults and patients with advanced cancer Neurotoxicity -> nervousness, agitation, irritability, tremors, seizures Not for long-term use

Answer 113

For moderate to severe pain Can be PO, rectal, SC, IM, IV Analgesic effect is approximately six times more potent than morphine Fewer hypnotic effects and less GI distress than morphine Monitor respirations closely

Answer 114

SE/AR Respiratory distress Orthostatic hypotension, drowsiness, dizziness, confusion, weakness Constipation Miosis Urinary retention Tolerance, dependence Contraindications Head injuries Respiratory distress/asthma Shock/Hypotension

Answer 115

Adjuvant therapy Usually used along with a nonopioid and opioid Developed for other uses but found to be beneficial for pain Adjuvant analgesics Anticonvulsants - gabapentin Tricyclic antidepressants - amitriptyline Corticosteroids Antidysrhythmics - mexiletine Local anesthetics – lidocaine patch

Answer 116

Action Blocks receptor and displaces opioid Use Antidote for opiate overdoses Reverse effects of opiates including respiratory depression, sedation, hypotension Example -> Naloxone (Narcan) Side effects/adverse effects Sweating, flushing, agitation, dyspnea Hypo/hypertension, tachycardia Nausea, vomiting Elevated PTT, bleeding Reversal of analgesia Nursing interventions Monitor vital signs and bleeding continuously

Answer 117

Characteristics Unilateral throbbing pain Nausea, vomiting, photophobia Can be with or without aura Lasts hours to days Triggers Cheese, chocolate, red wine, aspartame, fatigue, stress, monosodium glutamate, missed meals, odors, light, hormone changes, drugs, weather, too much or too little sleep

Answer 118

Characteristics Severe unilateral non-throbbing pain Usually located around eye Occur in a series of cluster attacks One or more attacks every day for several weeks Not associated with an aura Do not cause nausea and vomiting More common in males

Answer 119

Beta-adrenergic blockers Propranolol Atenolol Anticonvulsants Valproic acid Gabapentin Tricyclic antidepressants Amitriptyline Imipramine Management Analgesics Aspirin with caffeine, acetaminophen NSAIDs: ibuprofen, naproxen Opioid analgesics Meperidine, butorphanol nasal spray Ergot alkaloids Dihydroergotamine mesylate Selective serotonin1 receptor agonists Sumatriptan, zolmitriptan

Pharm 1 Flashcards

(143 cards)