Last Pharmacology

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What is the therapeutic range for lithium

0.5 - 1.5

How long for serotonin syndrome to appear

2-72 hours after initiation

What would be considered the toxic level of lithium

> 1.5- 2

A nurse should use caution when administering amitriptyline to which clients A clients with cardiac disease B clients with hypothyroidism C clients with diabetes D elderly clients E adolescent clients

A D

The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg po daily what assessment question should the nurse prioritize A how would you describe your mood and energy level today B on a scale from zero to ten, how would you rate your anxiety level C how are you feeling today D are you feeling happier today than in the past

A ( mirtazapine is an antidepressant and it is prudent for the nurse to assess the clients mood and level of energy.)

A client with bipolar disorder having experienced a depressive episode, its prescribed lamotrigine. After educating he client on this medication. The nurse determines that the education was successful when the client states what A i need to notify my physician if I develop a skin rash B i need to have my blood tested about once a month C i have to watch how much salt I use every day D This drug can affect my liver function

A (Stevens Johnson syndrome)

A client has been taking fluoxetine (Prozac) for the last 10 days. Today the client in the clinic reported not feeling any better. What is the nurses best response to this client A it may take another two to three weeks before the medication is completely effective B i realize this is frustrating but most medications for mood disorders aren't fully effective for 2 to 3 months C i will tell the healthcare provider ad see if there is another medication that would be better D please come tot he clinic immediately so you can be reassessed for suicidal thoughts

A (fluoxetine may take up to 4 weeks to be completely effective

What type of medication is lithium (lithobid) and lamotrigine (lamictal)

A mood stabilizer (antimanic)

A nurse education a client starting phenelzine (Nardil) should educate the client to avoid which foods A blue cheese B pepperoni C apples D chocolate E Celery

A, B, D

What is the antidote for tylenol

Acetylcysteine (mucomyst)

What are some types of tyramine foods

Ages cheeses Coffee Chocolate Raisins Pickled foods Sausage Beer, wine, yeast

What are symptoms of serotonin syndrome

Agitation, confusion Diaphoresis, fever Tachycardia Hypotension Muscle rigidity Sluggish pupils Tremors Hyper salivation Coma, death

What is the action of lithium (lithobid)

Alters Na+ ion transport in muscle and nerve cells Increased receptor sensitivity to serotonin Depletes sodium

What is a tricyclics antidepressants (TCA)

Amitriptyline (Elavil)

What is the drug of choice for adolescence

Amitriptyline (Elavil)

What is the indication of use for acetaminophen (Tylenol)

Analgesia Antipyretic

What are the indications of use for moderate to strong opioids

Analgesia Cough suppression

What are the indications for strong opioid use

Analgesia Sedation Cough suppression Suppression of bowel motility

What is the indication of use for ibuprofen ( Advil, Motrin)

Analgesic Anti inflammatory Antipyretic

What are the ADR of strong opioids

Apnea Respiratory depression Thrombocytopenia Bradycardia

What does capsicum/cayenne pepper do for the body

Arthritis Nerve pain Circulatory stimutlation

What are nursing considerations for ibuprofen

Assess renal function Take with food Hydrate

Which interventions should the nurse perform regarding the diet of a patient who is being administered lithium A take the drug on an empty stomach B ensure that extra salt is added to foods C drink at least five large glasses of fluid each day D increase food intake during drug regimen

B The nurse should ensure that food for the pt contains extra salt

A nurse is giving venlafaxine capsules to a client diagnosed with depression. What education will the nurse provide to the client about venlafaxine A if you have trouble swallowing the capsule, it can be opened and put in food B it's best to take the medication with food at the same time each day C you should notice an improved mood after taking he medication for two weeks D if you experience side effects, stop taking the medication immediately

B venlafaxine is prescribed to treat depressive disorders and should be taken with food at the same time each day.

What is the action of amitriptyline (Elavil)

Blocks reuptake of norepinephrine and serotonin in brain Blocks histamine receptors Elevate mood, increase interest in ADL Decreases insomnia Takes 2-4 weeks

What does Narcan do

Blocks the effects of opioid agonists

What are the ADR's of moderate to strong opiods

Bradycardia Respiratory depression

What are 3 known reasons for depression deficiencies

Broken down by MAO Rapid fire of neurons Number of postsynaptic receptors

What is the SE of capsicum/cayenne pepper

Burning sensation

What are the contraindications of remeron

CV Hepatic or Renal disease

What are some intervention to help avoid migraines

Caffeine Low stimulus environment Rescue noise and dim lights Cool cloth over eyes

What is common side effect of melatonin

Can potentiate CNS depressants

When assessing a patient on phenelzine (Nardil) what do you need to look for

Cardia dysfunction Impaired liver/kidney function Tyramine foods Suicidal ideation Vital signs

What is the contraindication and cautions of Lamictal

Caution with suicidal ideation Pregnancy category C Infant risk due to breast feeding

What are some common side effects of strong opioids

Chang in LOC Euphoria Pupil changes Decreased GI motility Urinary retention Hypotension Emesis

What are some prototypes of moderate to strong opioids

Codeine Oxycodone

When assessing a pt on Prozac what do you look for

Complete history review for depression/suicidal/mania Diabetes Glaucoma Pregnancy Lactation

What is affective disorder

Depressed mood, despair, insomnia Loss of interest in normal activities Fatigue, decreased ability to think Suicidal thoughts

What is the indication for use of Prozac

Depression

What is the indication of use for phenelzine (Nardil)

Depression not controlled by other antidepressents

Morphine is

Derived from opium or from the poppy seed

What are some common side effects fo lithium

Dry mouth Thirst Polyuria Weight gain Metallic taste Tremors Neuroleptic malignant syndrome

What are common side effects fo lamictal

Dysmenorrhea Rhinitis Liver failure-toxic Blurred vision

What is a selective serotonin reputable inhibitors (SSRI)

Fluoxetine (Prozac)

What are the contraindications and cautions of Nardil

HTN CAD Angina CHF Hyperthyroidism Seizure disorders

What are some nursing considerations to teach client about depression medications

Has delayed effect 3-4 weeks Shifts depression to hypo/mania in bipolar Serotonin syndrome

What are some common side effects of prozac

Headache Insomnia Anxiety Dry mouth Anorexia Change in taste Mensturation Impotence

What are common side effects fo SNRI's (Effexor)

Hypertension Insomnia Euphoria Amnesia Photo sensitivity Ejaculation dysfunction

What is the interaction of Nardil with TCA

Hypertensive crisis Coma Severe convulsions

When giving Prozac what are some contraindictions

Impaired renal or hepatic functions Diabetes Severely depressed or suicidal Pregnancy Lactation

What does MAO do

Inactivated norepinephrine and dopamine in the brain

What type of action does venlafaxine take

Increase availability of serotonin and NE, dopamine in synapse

What does Gingko Biloba do

Increase energy levels, fatigue and lethargy May improve sleep patterns, poor concentration and mood disturbances

Teaching a client on lithium about :

Increase fluids Avoid caffeine Therapeutic blood draws

When giving SSRI's to adolescents/young adults with severe depression can to what

Increase suicidal thoughts

What is the indication of use for Melatonin

Insomnia Jet lag

What is the action of phenelzine (Nardil)

Irreversibly inhibits MAO Enzyme found in nerves and other tissues

What does St John's Wort do

It can decrease reputable of the neurotransmitters serotonin, norepinephrine, and dopamine

What are ADR os lithium

Lithium toxicity Brady cardia

What is the ADR of acetaminophen

Liver failure in OD Hypoglycemia Hypokalemia Hypomagnesemia Pulmonary edema Stridor

What is the contraindictions and cautions of lithium

Liver/renal disease Hyponatremia Pregnancy

What is the indication of use for lamotrigine (Lamicatal)

Long term maintenance of bipolar disease

What is a general anesthetic

Loss of consciousness

What is a local anesthetic

Loss of sensation

When using Prozac you need to watch out for these medication interatctions

MAOI TCA St John's wort Evening primrose Ginkgo biloba Ginseng Valerian

What are some contraindications and cautions of amitriptyline (Elavil)

MI CV disease Angle closure glaucoma Urinary retention BPH Psychiatric pt's

What are some ADR to Elavil

MI Stroke Thrombocytopenia Hypoglycemia

What is the food interaction with Nardil

Mainly tyramine and other pressor amines resulting in high bP

What is the indication for sue of mirtazapine (Remeron)

Major depression

What are the indications for use of venlafaxine (Effexor)

Major depression Generalized anxiety disorder Social anxiety disorder

What is the indication of use for amitriptyline (Elavil)

Major depression and agitated depression

What is the nursing consideration when using Triptans

Mild GI effects

What is an Atypical antidepressant

Mirtazapine (Remeron)

The action of this medication is unknown

Mirtazapine (remeron)

What is the most important assessment for lithium

Monitor sodium intake and fluid intake

What are some strong Opiods

Morphine sulfate Fentanyl

What is the action of antidepressants

Most antidepressant work by effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood, to help relieve depression

What is an opioids

Natural or synthetic drugs that have actions similar to morphine

What are the key biogenic amines in key areas of the brain

Norepinephrine Serotonin Dopamine

When assessing a pt on Effexor look for this

Nsaids Antiplatelet agents MAOI Tca's

When would a general anesthetic be used

Operative procedures Diagnostic exams Injury to Respiratory control

What is the most effective pain relievers available

Opiods

What is serotonin syndrome

Over activation of serotonin receptors Rare and life threatening event

What is monoamine oxidase inhibitors (MAOI)

Phenelzine (Nardil)

What is the ADR fo lamotrigine (lamicatal)

Rash Stevens Johnson syndrome

When using Ergot what is a nursing consideration

Severe GI effects such as N/V, diarrhea

What are some client teachings when using Mirtazapine (Remeron)

Similar common SE to other antidepressants MORE sedative effects than other antidepressants

What are some physical manifestations of depression

Sleep disturbances Anorexia Alcoholism

Effexor (venlafaxine) has drug to drug interaction with

St. John's wort Amoxicillin Tramadol NSAIDs Antiplatelet agents Haloperidol

What is an adverse reaction to effexor

Suicidal ideation

What is the name of medication that treats migraines

Sumatriptan (imitrex) Ergotamine with caffeine (Cafergot)

What is the interaction of Nardil and sympathomimetics

Sympathomimetics effects mimic effects of the sympathetic nervous system

What are some nursing considerations for Tylenol use

Take on empty stomach or with food Not good for arthritic pain Can be alternated with NSaids

There can be an unsafe reaction between your antidepressant and St Johns wort, which is why taking them both is discouraged. What is the thinking behind this

The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rational. It is true that many herbal remedies contain inconsistent doses but this is not the primary risk of combining SSRI's with St Johns wort

What action does Prozac take

Thought to be linked to drugs inhibition of CNS neuronal uptake of serotonin

What are ADR of ibuprofen

Thrombocytopenia Hypokalemia Hypoglycemia Renal failure

What causes serotonin syndrome

Too high med interaction Medication combination of SSRI WITH MAOI

What is the indication of mood stabilizer use

Treatment of bipolar affective disorder

What is serotonin norepinephrine reputable inhibitors (SNRI)

Verlafaxine (effexor)

What is the common side effects for Elavil

Weight gain


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