Pharm quiz 1 - 2 Flashcards

Question

methadone use and precautions

Answer 1

🞑 Methadone suppression: Prevents opioid induced euphoria, by giving addicts larger doses of methadone (>100 mg/day) pt will develop tolerance to other opioids. Taking street drugs will not produce same euphoric effects.  Precautions 🞑 Severe dysrhythmias, prolongs the QT interval, V-fib 🞑 Respiratory suppression

Answer 2

Adverse Effects 🞑 Severe dysrhythmias, prolongs QT interval, V-Fib  DrugInteractions 🞑 Inhibitors: sertraline, rifampin 🞑 Inducers: tegretol, phenobarb, phenytoin, barbiturate anesthetics 🞑 Caution with many HIV ARV’s ( antiretroviral )  NursingConsiderations 🞑 ChestPain-> EKG 🞑 Patient should be in a medication program*  Pregnancy Category: C

Answer 3

 Tolerance 🞑 A larger dose of medication is required to produce the same effect previously elicited by a smaller dose 🞑 CrossTolerance  Refers to a person tolerant of one drug being tolerant of another dug in the same class(codeine, heroin, methadone, oxycodone)  Will not be tolerant to other CNS depressants like alcohol, barbiturates, benzodiazepines, general anesthetics

Answer 4

Physical Dependence 🞑 Withdrawal syndrome will occur if the drug is abruptly discontinued 🞑 Adaptive cellular changes occurdue to continuousdrug exposure 🞑 Body will require continued presence of drug to function normally

Answer 5

Abuse 🞑 Intentional misuseof drugs inconsistentwith medical or social norms

Answer 6

treated, not prevented

Answer 7

Selected Nursing Diagnoses Related to Opioid Therapy  Ineffective airway clearance related to cough reflex suppression  Ineffective breathing pattern: hypoventilation related to CNSdepressant effects of drug  Risk for deficient fluid volume related to nausea and/or vomiting  Constipation  Urinary retention  Risk for injury related to sensory/perceptual alterations

Answer 8

⦁ Children are left untreated or are inadequately treated for pain ⦁ Pain assessment in children is more difficult ⦁ Consider giving children medications for pain in same circumstances as an adult ⦁ Approach to child should be individualized ⦁ Growth and developmental characteristics of various ages of children should be understood ⦁ Assessment tools that meet developmental age of child (pain faces, stick figures, thermometer diagram) should be used ⦁ Listen to parents, family members, and guardians about child’s behavior when he or she is in pain

Answer 9

⦁ Dosage and dosing intervals are required ⦁ Observe for enhanced medication responses ⦁ Older adults have multiple medical problems and take numerous medications ⦁ Multiple assessment skills should be used ⦁ Height, weight, and body surface area are not accurate measurements for analgesic dosing in the older adult ⦁ Communicate, remembering cultural, physiologic, and psychological differences ⦁ Assessments should be adapted to meet the needs of the older adult ⦁ Some analgesics are inappropriate for the older adult

Answer 10

 Alcohol 🞑 Action:  Central Nervous system depressant  Enhances serotonin – mediated release of dopamine  Binds with GABA receptors- 🞑 Uses:  Prolonged life (moderate usage)  Dementia risk reduction (moderate usage)  MI risk reduction (moderate usage)  IncreasesHDL  Suppresses inflammatory component of atherosclerosis  Dilates cutaneous blood vessels

Answer 11

 Tolerance (needing more to achieve effect)  Dose dependent (Thiamine Deficiency)  Wernicke's encephalopathy (confusion, nystagmus)  Korsakoff’s psychosis (memory gaps, polyneuropathy) 🞑 Adverse effects  Damage to myocardium, HTN(dose dependent)  Respiratory depression  Liver damage, cirrhosis, cancer  Erosive gastritis, varices

Answer 12

Frequently abused substances and Street Drugs  Alcohol 🞑 Adverse effects  Breast and colorectal cancer 🞑 Drug Interactions  Inhibitors: Coffee, Milk (myths!)  Inducers: CNS depressants (barbiturates, benzodiazepines)  Interactions: NSAIDS = injury to gastric mucosa Tylenol® = liver damage with only 2-4 drinks per day (limit should not exceed 2 grams per day) 🞑 PregnancyCategory: (moderate use?,No know safe alcohol level)

Answer 13

Frequently abused substances and Street Drugs  Abuse Management of alcohol  “CAGE” 🞑 Cut down – have you ever thought about cutting down on your drinking? 🞑 Annoyed – Have people annoyed you by criticizing your drinking? 🞑 Guilty – have you ever felt guilty about your drinking? 🞑 Eye opener – Have you ever had a drink the first thing in the morning to steady your nerves or get rid of a hangover?

Answer 14

🞑 A set of symptoms that occur due to physiologic response to alcohol dependence 🞑 Low dependence:  12 – 24 hours:Anxiety, disturbed sleep, nausea, mild tremors and weakness 🞑 High dependence  12-72 hours: Cramps, nausea, vomiting, intense tremors, tachycardia, hypertension, fever 🞑 Severe dependence  Delirium Tremens(DT’s)occur in less than 1%  Hallucinations, Disorientation,Tremors,Seizures

Answer 15

 Alcohol Withdrawal Management 🞑 Benzodiazepines: (Librium®,Valium®, Ativan®)  Decrease the w/d symptoms and stabilize vital signs. Prevent seizures 🞑 Beta-adrenergic blockers (Inderal®, TenORmin®)  Improve vital signs, decrease autonomic component of withdrawal 🞑 Alpha-adrenergic blockers (CataPRES®)  Improve vital signs, decrease autonomic component of withdrawal

Answer 16

Chlor-DI-ze-POX-ide (Librium®)  Action: 🞑 Potentiates the actions of GABA, especially in the limbic system, reticular formation  Uses: 🞑 Short-term management of anxiety, acute alcohol withdrawal, preoperatively for relaxation

Answer 17

Chlordizepoxide  Precautions: 🞑 CNS: Dizziness, drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations 🞑 CV: Orthostatic hypotension, edema, ECG changes, tachycardia, hypotension  Adverse effects: 🞑 Decrease: effect—cowslip, kava, Queen Anne's lace, St. John's wort, valerian

Answer 18

Chlordizepoxide  NURSING CONSIDERATIONS 🞑 Assess: B/ P(lying, standing), pulse; if systolicB/ P drops 20 mm Hg, hold product, notify prescriber 🞑 Assistancewith ambulation during beginning therapy, sincedrowsiness/dizziness occurs • Checkto see PO medication hasbeen swallowed if patient isdepressed, suicidal

Answer 19

⦁ Stages of Sleep ◦ Non–rapid eye movement (non-REM) sleep  Stage 1: 2% to 5%  Stage 2: 50%  Stage 3: 5%  Stage 4: 10% to 15% ◦ REM sleep: 25-33%

Answer 20

 Blood pressure falls  Pulse rate is slowed  Metabolic rate is decreased  Gastrointestinal tract activity is slowed  Urine formation slows  Oxygen consumptionand carbon dioxide production are reduced  Body temperature decreases slightly  Respirations are slower and shallower  Body movement is minimal

Answer 21

Drug therapy in the treatment of anxiety orinsomnia What is the role of drug therapy in the treatment of anxiety orinsomnia? ⦁ After nondrug interventions are attempted first a drug therapy plan ischosen based onthe level of CNS suppression desired ⦁ Antianxiety / Anxiolytic ⦁ Sedatives ⦁ Hypnotics

Answer 22

Precautions 🞑 Children <12 yr, geriatric patients, debilitated, renal/hepatic disease, addiction, suicidal ideation, abrupt discontinuation  Adverse Effects 🞑 Dizziness, drowsiness, Orthostatic hypotension, ECG changes, tachycardia, hypotension; apnea, cardiac arrest (IV, rapid)

Answer 23

 Nursing Considerations: 🞑 That product may be taken with food 🞑 Not to use product for everyday stress or longer than 4 mos. unless directed by prescriber 🞑 May be habit forming 🞑 Toavoid OTC preparations (cough, cold, hay fever) unless approved by prescriber 🞑 Toavoid driving, activities that require alertness, since drowsiness may occur 🞑 To rise slowly

Answer 24

Benzodiazepines (typically end with “-zepam” or “-zolam”) ● Examples include alprazolam, oxazepam, midazolam, triazolam

Answer 25

 Sedatives reduce nervousness, excitability, or irritability by producing a calming or soothing effect  Hypnotics are used to induce sleep with greater CNS depression than sedatives 🞑 Other than benzodiazepines, may include chloral hydrate

Answer 26

Actions 🞑 Depresses subcortical levels of CNS, including limbic system, reticular formation  Uses 🞑 Anxiety, panic disorders with or without agoraphobia, anxiety with depressive symptoms 🞑 (Unlabeled use) Premenstrual dysphoric disorders

Answer 27

Adverse Effects 🞑 Dizziness, drowsiness,orthostatic hypotension, blurred vision,  Precautions 🞑 Geriatric patients, debilitated, hepatic disease, obesity, severe pulmonary disease  Contraindicated: 🞑 Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, closed-angle glaucoma, psychosis, addiction

Answer 28

🞑 Assess:• Mental status: anxiety, mood, sensorium, orientation, affect, sleeping pattern, drowsiness, dizziness, especially in geriatric patients prior to, and during treatment 🞑 B/ Plying, standing; pulse; if systolicB/ Pdrops 20 mm Hg, hold product, notify prescribe

Answer 29

Action 🞑 Benzodiazepine 🞑 Potentiates gamma-aminobutyric acid 🞑 Depress neuronal function at multiple sites in the CNS  Uses 🞑 IV forms used to treat status epilepticus 🞑 Anxiety and Panic Disorders 🞑 Insomnia 🞑 Muscle Spasm 🞑 ETOH withdrawal - #1

Answer 30

Precautions 🞑 Pregnancy Category D 🞑 Tolerance and Physical Dependence 🞑 Inject slowly into a large vein (5mg/min)flush pre/post with NSS  Adverse effects 🞑 CNS depression 🞑 Anterograde amnesia unable to make new memories after amnesia induced events 🞑 Paradoxical effects 🞑 Abuse

Answer 31

Nursing Considerations: Assess 🞑 For alcohol withdrawal symptoms, including hallucinations (visual, auditory), delirium, irritability, agitation, fine to coarse tremors 🞑 For seizure control and type, duration, intensity of seizures 🞑 For muscle spasms; pain relief

Answer 32

What are the advantages of benzodiazepines over other agents? ⦁ Low fatality rates ⦁ Low Abuse Potential ⦁ More favorable adverse effect profiles ⦁ Fewer seriousdrug interactions ⦁ What are the indications for benzodiazepines? 🞑Anxiety Disorders 🞑Alcohol Withdrawal 🞑 Preoperativemeds,Insomnia,Seizuresand NeuromuscularDisease

Answer 33

Do the benzodiazepines interact significantly with other drugs? 🞑 Nursing attention to other CNS depressants and benzodiazepine usage 🞑 Check for alcohol use 🞑 Combined with zidovudine(HIV antiviral) may increase toxic levels as the drug isnot metabolized as well

Answer 34

Benzodiazepine-like Drugs zolpidem tartrate ZAL-e-plon eszo-PIC-lone  Serotonergic Anxiolytics buspirone  Antihistamine Anxiolytics hydroxyzine

Answer 35

Limited ● May cause paradoxical reactions ● May be used in carefully selected situations (severe anxiety with asthma, pre-anesthesia, during seizures) ● Requires close monitoring by health care team

Answer 36

May also cause paradoxic reactions ● Requires careful dosage titration ● Requires careful monitoring by health care team

Answer 37

Antianxiety or anxiolytic agents reduce feelings of excessive anxiety (apprehension, fear, nervousness, worry, or panic); used when nondrug interventions are not effective or are inappropriate for the degree of symptoms present

Answer 38

(Enhanced CNS Depressant Effects)  Can occur when used with:  Alcohol  CNS depressants  Opioid analgesics  Anesthetics  Tricyclic antidepressants  Close monitoring is necessary because the dosage of one or both drugs may need to be adjusted

Answer 39

🞑 "thermal" (heat or cold), 🞑 "mechanical"(crushing, tearing, etc.) and 🞑 "chemical"(iodine in a cut, chili powder in the eyes).

Pharm quiz 1 - 2 Flashcards

(64 cards)