Pharm exam 1

Pregabalin (lyrica) drug interactions

Alcohol Opioids (Oxycodene, Morphine, Codene) CNS Depressants

Oxcabazepine (octellar XR, trileptal) clinical significance

-Clinically significant hyponatremia (sodium concentration below 125 ) The normal range for blood sodium levels is 135 to 145 mill equivalents per liter -Stevens-Johnson syndrome

dilantin drug interactions

-Decreases the effects of oral contraceptives ( May suggest that patient take a different form of birth control while on Dilantin -warfarin and glucocorticoids

Pregabalin (lyrica) adverse effects

-Dizziness, somnolence, blurred vision, significant weight gain, difficulty thinking, headache, peripheral edema, and dry mouth -Hypersensitivity reactions: Life-threatening angioedema -Rhabdomyolysis

Carbamazepine (tegretol) uses

-Epilepsy -Bipolar disorder -Trigeminal neuralgias -Glossopharyngeal neuralgias

patient/family teaching for dilantin

-Instruct patient to take medication as directed, at the same time each day -no double doses -abrupt withdrawal may lead to status epilepticus

therapeutic considerations of epilepsy

-Monitoring plasma drug levels -Promoting patient adherence -Withdrawing antiepileptic drug -Suicide risk: Antiepileptic drugs

Dilantin adverse effects

-Nystagmus- involuntary eye movement -Sedation -Ataxia- lack of gait coordination -Diplopia- double vision -Cognitive impairment -Gingival hyperplasia (good oral hygiene, brushing teeth, including dental flossing and gum massage) -Skin rash -Effects in pregnancy( cleft palate growth deficiency, deformities of the limb) -Cardiovascular effects ( hypotension, cardiac dysrhythmias)

morphine pharmacologic actions

-Pain relief for severe to moderate pain -Sedation -Euphoria -Respiratory -Depression -Cough Suppression -Suppression of bowel motility

morphine adverse effects

-Respiratory depression- Monitor Respiratory Rate of Patient may need Naloxone to reverse -Constipation-increase fiber intake as well as water -Urinary retention -Orthostatic hypotension -Emesis -Miosis- constriction of pupil -Cough suppression -Constipation- Laxatives or stool softener -Biliary colic -Tolerance and physical dependence

Naxalone (narcan) therapeutic uses

-reversal of opioid overdose -reversal of postoperative opioid effects -reversal of neonatal respiratory depression

dilantin therapeutic levels

10-20 mcg/mL

Gabapentin (neurontin, gralise) adverse reactions

Adverse reactions Very well tolerated Most common side effects: Somnolence, dizziness, ataxia, fatigue, nystagmus, and peripheral edema

morphine physical dependence

Abstinence syndrome with abrupt discontinuation

The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question? Cimetidine [Tagamet] Captopril [Capoten] Pantoprazole [Protonix] Ondansetron [Zofran]

Answer: A Rationale: Cimetidine will elevate phenytoin levels by reducing the rate at which phenytoin is metabolized. Phenytoin levels may increase to toxic levels. The use of cimetidine should generally be avoided in patients who are treated with phenytoin, because safer alternatives are available.

A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit

Answer: B Rationale: Grapefruit juice can inhibit the metabolism of carbamazepine, thereby causing plasma levels to rise. Grapefruit juice may increase the peak and trough levels of carbamazepine by up to 40%.

clinical use of opioids

Balance the need to provide pain relief with the desire to minimize abuse Minimize fears about the following: Physical dependence Addiction

morphine toxicity

Classic triad Coma Respiratory depression Pinpoint pupils

A patient is prescribed phenytoin [Dilantin] for epileptic seizures. • Which of the following is the priority for patient teaching? • A. Teach the patient to adjust the dose according to the presence of symptoms. • B. Tell the patient to take the medication with meals. • C. Inform the patient about the prevention of gingival hyperplasia. • D. Teach the patient to avoid the abrupt cessation of treatment

D o Rationale: The most important concept is to teach the patient to avoid the abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus. The patient should not adjust the dose without consulting the prescriber. Although teaching the patient to take the medication with meals and teaching the patient how to avoid gingival hyperplasia are indicated, they are not the priority.

A patient is prescribed phenytoin [Dilantin] for epileptic seizures. • Which of the following is the priority for patient teaching? • A. Teach the patient to adjust the dose according to the presence of symptoms. • B. Tell the patient to take the medication with meals. • C. Inform the patient about the prevention of gingival hyperplasia. • D. Teach the patient to avoid the abrupt cessation of treatment.

D o Rationale: The most important concept is to teach the patient to avoid the abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus. The patient should not adjust the dose without consulting the prescriber. Although teaching the patient to take the medication with meals and teaching the patient how to avoid gingival hyperplasia are indicated, they are not the priority.

2 types of gabapentin

Gabapentin Neurontin Gabapentin Enacarbil

morphine tolerance

Increased doses needed to obtain the same response Patient experiences a decreased analgesic effect

Oxcabazepine (octellar XR, trileptal) uses

Indicated for monotherapy and adjunctive therapy of partial seizures in adults and children

morphine is primarily at ____ receptors

Mu

Opiod receptors

Mu Kappa Delta

Encarbil (horizant) uses

Prodrug form of gabapentin Restless legs syndrome Not for epilepsy or neuropathic pain

Oxcabazepine (octellar XR, trileptal) drug interactions

Oral contraceptives-less effective Phenytoin (Dilantin)- can raise level Alcohol-Avoid Diuretics- due to decreasing sodium levels

Gabapentin (neurontin, gralise) therapeutic and off label use

Therapeutic use: Adjunctive therapy of partial seizures Off-label use: Neuropathic pain, prophylaxis of migraine, treatment of fibromyalgia, and relief of postmenopausal hot flashes

therapeutic goal of antiepileptic drugs

To reduce seizures in the extent that enables the patient to live a normal life

opioid antagonists use

Treatment of opioid overdose and relief of opioid-induced constipation

Methylnaltrexone (Relistor): use

Used to treat opioid-induced constipation as a last resort OTHERWISE drink water and eat fiber

morphine toxicity treatment

Ventilatory support Antagonist: Naloxone [Narcan]

Indicated for monotherapy and adjunctive therapy of partial seizures in adults and children antiseizure effects

Voltage-sensitive sodium channels in neuronal membranes blocked, hyperexcitable neurons stabilized, and seizures suppressed

opiod

a general term used for any drug, natural or synthetic, that has actions similar to those of morphine

kappa opiod receptors

analgesia and sedation; may underline pyschotomimetic effects seen with certain opiods

pure opiod agonists activate mu and kappa receptors which can produce:

analgesia, euphoria, sedation, respiratory depression, physical dependence, constipation, and other effects

Mu opiod receptors

analgesia, respiratory depression, euphoria, sedation, physical dpenedence

What kind of drug is dilantin

antiepileptic

agonists

bind to and activate receptors

partial agonists

bind to the same receptors as agonists and at low doses

antagonists

bind to the same receptors as full and partial agonists but do not cause activity at the receptor

delta opiod receptors

do not interact with

gingival hyperplasia caused by dilantin risk can be minimized by

good oral hygiene, brushing teeth, including dental flossing and gum massage

ataxia

lack of coordination

priorities for caring for a patient during a seizure

management of airway and ensure they are breathing

Naxalone (narcan) cannot be given

orally

you must monitor ____ during clinical use of opioids

pain

Naloxone (narcan) is

prototype of the pure opiod antagonists

monitor __________ when giving morphine

respiratory rate