Study Guide Exam 3 (lacking Diabetes)

Question 1

Symptoms of Parkinsons

Answer 1

	Tremors
	Muscle rigidity
	Bradykinesia
	Postural instability
	Affective flattening

Question 2

goals of drug therapy for Parkinsons and seizures

Answer 2

 Drug Therapy for Parkinsonism
 Restores dopamine function
 Blocks acetylcholine

Question 3

Difference between simple and complex Partial (focal) seizures

Answer 3

Simple
• Olfactory, auditory, and visual hallucinations
• Intense emotions
• Twitching of arms, legs, and face

Complex
• Aura (preceding)
• Brief period of confusion or sleepiness afterward with no memory of seizure (postictal confusion)
• Fumbling with or attempting to remove clothing
• No response to verbal commands

Question 4

Difference between Absence (petit mal), Atonic (drop attacks), and Tonic-clonic (grand mal) seizures?

Answer 4

Absence (petit mal)
• Lasting a few seconds
• Seen most often in children (child stares into space, does not respond to verbal stimulation, may have fluttering eyelids or jerking)
• Misdiagnosed often (especially in child) as ADD or daydreaming

Atonic (drop attacks)
• Falling or stumbling for no reason
• Lasting a few seconds

Tonic-clonic (grand mal)
• Preceeded by aura
• Intense muscle contraction (tonic phase) followed by alternating contraction and relaxation of muscles (clonic phase)
• Crying at beginning as air leaves lungs; loss of bowel/bladder control; shallow breathing with periods of apnea; usually lasting 1–2 minutes
• Disorientation and deep sleep after seizure (postictal state)

Question 5

Symptoms of Myoclonic Seizures?

Answer 5

• Large jerking movements of a major muscle group, such as an arm
• Falling from a sitting position or dropping what is held

Question 6

Neurotranmitters - Norepinephrine (NE)

Answer 6

•	binds with adrenergic receptors
       o	alpha (1 and 2)
       o	beta (1 and 2)

• Sympathetic (energetic, fight or flight)

Question 7

Neurotransmitters - Acetylcholine (Ach)

Answer 7

•	binds with cholinergic receptors
       o muscarinic (muscle/heart)
       o nicotinic (neuromuscular)

• Parasympathetic (rest and digest)

Question 8

Drugs that mimic the effect of norepinephrine (other names for them)

Answer 8

• sympathomimetics

* Adrenergic agonists

Question 9

Drugs that block the effects of norepinephrine (other names for them)

Answer 9

• sympatholytics
• adrenergic blockers
• adrenergic antagonists

Question 10

Drugs that mimic acetylcholine

(other names for them)

Answer 10

• parasympathomimetics
• cholinergic agonists
• cholinergic drugs

Question 11

Drugs that block acetylcholine (other names for them)

Answer 11

• parasympatholytics
• anticholinergics
• Cholinergic antagonists/blockers
• muscarinic blockers

Question 12

Epinepherine acts on more than one receptor (nonselective)…. so what does it do where? (so, for example, explain to a patient all the effects it might have)

Answer 12

– Alpha1, increases the blood pressure
– Beta1, increases heart rate (tachycardia)
– Beta2, promotes bronchodilation

Question 13

Steroids

Answer 13

Glucocorticoids - Used for short-term therapy for severe inflammation… are immunosuppressants. Examples: dexamethasone and prednisone.

Question 14

How to give Dilantin IV

Answer 14

IV is not compatible with other drugs… only with Normal Saline Solution (NS)… give it slowly

Question 15

Pathology of Cancer

Answer 15

• Characterized by rapid, uncontrolled growth of cells
• Cells lose normal functions and invade normal tissues
• Metastasize: travel to another location

Question 16

Growth Fraction

Answer 16

• Measure of how many cells are undergoing mitosis
  • Ratio of replicating cells to resting cells
• Solid tumors have low growth fraction; thus less sensitive to chemotherapy
• Leukemias and lymphomas have high growth fraction; thus chemotherapy more effective
• Hair follicles, bone marrow, gastrointestinal tissue have high growth factor—this explains many adverse effects

Question 17

Principles of Chemotherapy

Answer 17

• Transported through blood
• Has potential to reach each cancer cell
• Some drugs can cross blood-brain barrier
• Some drugs distilled directly into body cavities (ex: bladder)
• Often combined with or done after surgery and radiation to increase chance of cure
  * Called adjuvant therapy

Question 18

Side effect for Alkylating Agents

Answer 18

can cause significant bone-marrow suppression

immunosuppressant effects, thrombocytopenia
Nausea, vomiting, anorexia, diarrhea
Alopecia (hair loss), hemorrhagic cystitis

Question 19

Side effects for Antimetabolites

Answer 19

fatal bone-marrow toxicity at high doses
• Hemorrhage and bruising, low platelet counts
• Nausea, vomiting, anorexia
• Gastrointestinal ulceration, intestinal bleeding

Question 20

Side effects for Antitumor Antibiotics

Answer 20

cardiotoxicity, dysrhythmias
Irreversible heart failure, lower blood-cell counts
Nausea, vomiting

Question 21

Side effects for Hormones/Hormone Antagonists

Answer 21

nausea and vomiting
• Association with increased risk of endometrial cancer and thromboembolic disease
• Hot flashes, fluid retention, vaginal discharges common
Development of cross-gender secondary sexual characteristics
• Common, yet distressing, side effects of sex-hormone therapy

Question 22

Side effects for Natural Products

Answer 22

nervous system toxicity, numbness and tingling in limbs
• Muscular weakness, loss of neural reflexes, pain
• Paralytic ileus, constipation, alopecia

Question 23

gastric ulcer

Answer 23

• lesion in stomach
• Less common than the duodenal
  Loss of appetite, weight loss and vomiting are more common

Question 24

duodenal ulcer

Answer 24

• lesion in small intestine
• Characteristic symptom is a gnawing or burning, upper abdominal pain that occurs 1 to 3 hours after a meal.
  May lead to bleeding that may be evident as either bright red blood in vomit or black, tarry stools

Question 25

Associated with several risk factors for peptic ulcer disease

Answer 25

Family history, type O blood Tobacco use and caffeine Glucocorticoids and NSAIDs Psychological stress

Question 26

GURD

Answer 26

- Gastroesphageal Reflux Disease' - Caused by loosening of sphincter between esophagus and stomach - Associated with obesity - Acidic stomach contents move up into esophagus - Causes intense burning (heartburn) - May lead to esophageal ulcers, esophagitis, or strictures - Lifestyle changes can improve GERD symptoms

Question 27

Categories of drugs for Acid Reflux Disease

Answer 27

H2 - Receptor Blockers (ie. Zantac, Pepcid, Tagamet) - work by blocking H2-receptors in stomach to decrease acid production - administered after meals Proton Pump Inhibitor (i.e. Priolosec) - administered 30 min before meals, on empty stomach, may be administered with other antacids - reduces acid secretion in stomach by binding irreversibly to enzyme H1, K1-ATPase - more expensive Antacids (i.e. Amphojel, tums) - neutralizes stomach acid by raising pH of stomach contents

Question 28

Constipation

Answer 28

``` Common condition caused by -Diminished fluid intake -Slow motility of waste material through large intestine -Certain foods, medications, diseases -Lack of exercise -Insufficient dietary fiber ```

Question 29

Diarrhea

Answer 29

- Increase in frequency and fluidity of bowel movements - Occurs when colon fails to reabsorb enough water - Is a type of body defense - Eliminates toxins and pathogens - Eliminates certain medications and infections - If prolonged, can lead to fluid, electrolyte, and acid-base imbalance

Question 30

Categories of Laxatives

Answer 30

1. Stimulant Laxatives Increase peristalsis by irritating sensory nerve endings in the intestinal mucosa Examples : (Correctol,bisacodyl (Dulcolax), Senokot) 2. Osmotic (saline) laxatives Hyperosmolar…pull water into the colon and increase water in the feces to increase bulk that causes peristalsis. (Phospho-soda, Milk of magnesia, magnesium citrate, Potassium phosphate) 3. Bulk Laxatives Natural fibrous substances that promote large, soft stools by absorbing water into the intestine, increasing bulk and peristalsis Examples: (Fibercon, Citrucel, Metamucil) 4. Emollients (stool softeners) lowers surface tension and promote water accumulation in the intestine and stool Examples: Ducusate sodium (colace), Mineral oil

Question 31

Osmotic laxatives are contraindicated in what kind of patients?

Answer 31

renal failure and CHF

Question 32

Milk of Magnesium is what kind of Laxative?

Answer 32

Osmotic

Question 33

Metamucil is what kind of Laxative

Answer 33

Bulk Laxative

Question 34

Nursing Implication for Bulk Laxative:

Answer 34

They decrease absorption of multiple other drugs including dig, and anticoagulants. Separate by 2 hours.

Question 35

phenytoin (Dilantin) (Category, MOA, and Side Effects)

Answer 35

Category: Hydantoin MOA: desensitizes NA+ channels Side effects: CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension

Question 36

Nursing Implications for Dilantin

Answer 36

Monitor serum-drug levels Monitor for signs of toxicity Monitor for blood dyscrasias and bleeding disorders Monitor liver and kidney function Fatal hepatotoxicity can occur Monitor lab values Patients with hypersensitivity to hydantoin products should be cautious. Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block

Question 37

What is Dilantin used for?

Answer 37

All types of epilepsy except absence seizures

Question 38

Valproic acid (Depakene, Depakote) | used for?, category?, MOA? side effects?

Answer 38

Used for: absence seizures category: Phenytoin-like drug MOA: desensitize NA+ channels Side effects: limited CNS depression, visual disturbances, ataxia, vertigo, headache, gastrointestinal effects, hepatotoxicity, pancreatitis

Question 39

Nursing Implications for Valproic Acid?

Answer 39

Monitor serum-drug levels Monitor for signs of toxicity Monitor for blood dyscrasias and bleeding disorders Monitor liver and kidney function Fatal hepatotoxicity can occur Patients with hypersensitivity to hydantoin products should be cautious. Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block

Question 40

levodopa and carbidopa (Sinemet)

Answer 40

Dopaminergic drugs - used to treat parkinsen's MOA: Increases biosynthesis of dopamine within nerve terminals Side effects: dizziness, light-headedness, sleep dysfunction, fatigue, nausea, vomiting, constipation, orthostatic hypertension, dystonia, dyskinesia

Question 41

Infliximab (Remicade)

Answer 41

Suppresses inflammation in autoimmune disorders.... is an antibody immunosuppresant. Toxic to bone marrow Increase risk of infections and lymphoma

Question 42

Nursing Implications for Remicade (aka for immunosuppresants)

Answer 42

 Contraindicated in client with leukemia, metastatic cancer, active infection, renal or liver disease or those who are pregnant  Obtain vital signs and results of lab testing to provide baseline data  Monitor for indications of infection  Monitor degree of bone-marrow suppression (thrombocytopenia and leukopenia)  Monitor clients taking azathioprine (Imuran) for development of secondary malignancies

Question 43

methotrexate (Folex, Mexate, others)

Answer 43

Category: Antimetabolites MOA: blocks synthesis of folic acid (vitamin B9) to inhibit replication Side effects: **fatal bone-marrow toxicity at high doses • Hemorrhage and bruising, low platelet counts • Nausea, vomiting, anorexia • Gastrointestinal ulceration, intestinal bleeding

Question 44

tamoxifen (Nolvadex)

Answer 44

Category: Hormones/Hormone Antagonists MOA: blocks estrogen receptors on breast cancer cells Side effects: nausea and vomiting • Association with increased risk of endometrial cancer and thromboembolic disease • Hot flashes, fluid retention, vaginal discharges common Development of cross-gender secondary sexual characteristics • Common, yet distressing, side effects of sex-hormone therapy

Question 45

ranitidine (Zantac)

Answer 45

H2 Receptor blocker - works by blocking H2 receptors in stomack to decrease acid production. Give after you eat. Adverse effects: possible reduction in number of red and white blood cells and platelets, impotence or loss of libido in men

Question 46

Hydroxyzine (Vistaril)

Answer 46

Antihistamine, given post op with narcotics to decrease nausea. drowsiness and dry mouth are expected.

Question 47

Psyllium muciloid (Metamucil)

Answer 47

Bulk-type laxative; Natural fibrous substances that promote large, soft stools by absorbing water into the intestine, increasing bulk and peristalsis They decrease absorption of multiple other drugs including dig, and anticoagulants. Separate by 2 hours.

Question 48

Diphenoxylate (Lomotil)

Answer 48

Opiate drug used for Diarrhea, that has less potential for dependence than other opioids.

Question 49

Compazine

Answer 49

phenothiazine-like antinausea medicine that is given prior to chemotherapy.... causes dry eyes, blurred vision, dry mouth, constipation, drowiness, phtosensitivity, extrapyrradmidla symptoms, neuroleptic malignany dyndrome, agranulocytiosis.