Pharmacology II Prep U Chapter 58: Drugs Affecting Gastrointestinal Motility, Ch. 57: Focus on Nursing Pharmacology (Karch) - Drugs Affecting Gastrointestinal Secretions, Pharmacology Antibiotics and Antivirals, Chapter 52: Drugs Affecting the Urinar...

What are some characteristics of myoclonic seizures?

A brief shocklike contraction of muscles that may be restricted to part of one extremity or may be generalized. Lasts 1-5 seconds, consciousness is preserved

monoamine oxidase

A class of antidepressant drug that inhibits monoamine oxidase, which breaks down neurotransmitters, to increase levels of those neurotransmitters.

Higher doses of barbiturates can produce what?

Hypnosis followed by anesthesia then coma and finally death

A patient is to receive methenamine. The nurse anticipates administering this drug by which route? a) Subcutaneous b) Intravenous c) Oral d) Intramuscular

Oral

Most antidepressants prevent neuronal reuptake of multiple neurotransmitters. SSRIs selectively inhibit reuptake of _______________ (serotonin or sodium).

serotonin

What are hypnotic and anxiolytic drugs used for?

Sedation Coping with stress Smoothing effects of stimulants Potentiation of narcotics treatment of mental disorders Pleasurable sensations, including intoxication or potential for recreational use

Side effects of the older antidepressants like imipramine and amitriptyline include

Sedation, Dry mouth, sleep disturbances, fatigue, hallucinations, ataxia, constipation, and nausea and vomiting.

Least likely to cause orthostatic hypotension: A. desipramine (Norpramin) B. sertraline (Zoloft) C. doxepin (Sinequan) D. tranylcypromine (Parnate) E. amitriptyline (Elavil, Endep)

Sertraline

Low potential for anticholinergic side effects: A. amitriptyline (Elavil, Endep) B. amoxapine (Asendin) C. desipramine (Norpramin) D. imipramine (Tofranil) E. sertraline (Zoloft)

Sertraline (SSRI)

GI Protectant Prototype Summary: Sucralfate Indications:

Short-term treatment and maintenance treatment of active duodenal ulcer; treatment of oral and esophageal ulcers due to radiation, chemotherapy, or sclerotherapy.

What form of laxative would likely be prescribed to manage long-term constipation?

bulk-forming laxative plus increased water intake

Others

bupropion (Wellbutrin, Zyban) venlafaxine (Effexor)

What is the main adverse effect of benzodiazepines?

sedation

What are some adverse effects of phenobarbital?

sedation (partial tolerance develops); altered behavior in children; agitation and confusion in elderly

What effects do benzodiazepines have on sleeping disorders?

sedative and calming decrease latency of sleep onset

When treating insomnia with benzodiazepines it is important to balance what?

sedative effect with residual "hung over" effect

antacids

group of inorganic chemicals that neutralize stomach acid

MAOIs prevent metabolism of neurotransmitters, _____________ (decreasing or increasing) the amount of neurotransmitters available to bind with receptors.

increasing

GABA is the major _________ neurotransmitter in the CNS

inhibitory

Which is a likely cause of diarrhea experienced by an older adult?

laxative abuse

Nursing Interventions

-- Assess moisture in pt - turgor, mucus membranes, cap refill, fluid volume (Excess/deficit, lung sounds) - assess electrolytes ***

Osmotic Diuretics - Mannitol indications

-Promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established. Reduction of intracranial pressure and brain mass. Reduction of high intraocular pressure when the pressure cannot be lowered by other means.

serotonin syndrome

-Rapid development of hyperthermia, hypertension, rigidity, autonomic instability, and mental status changes that can include coma and delirium; MAOI should not be administered with SSRI's or potent TCA's due to development of this condition, Fever > 102, change in mental status, agitation, confusion, restlessness, flushing, diaphoresis, myoclonus (muscle twitching or jerks), tremors

Osmotic Diuretics Contraindications

-Renal disease and anuria · Dehydration · Intracranial bleeding -HF - allergy

Potassium Sparing Diuretics Indications

-adjuncts with thiazides or loop diuretics. Patients who are at risk for hypokalemia

TCAs

Examples: amitriptyline (Elavil), imipramine (Tofranil) - 2nd line drugs for treatment of depression - Poor choice for suicidal patient - OD lethal - Mech of Action: - Block reuptake of norepinephrine & serotonin at nerve endings - Adverse Effects: - Sedation, orthostatic hypotension, anticholinergic effects, weight gain, impotence, cardiac conduction disturbances - Other indications for use: - Short-term treatment of enuresis in children > 6 years - Anxiety disorders - Neuropathic pain - Contraindications: - Hypersensitivity to drug; within 14 days of MAOI; pregnancy; seizures; severe renal, hepatic, or heart disease; glaucoma; acute schizophrenia

SSRIs

Examples: fluoxetine (Prozac), sertraline (Zoloft) - Drugs of first choice for treatment of depression - Better tolerated than TCAs; usually taken once daily PO - Mech of Action - Block reuptake of serotonin into pre-synaptic nerve endings, increasing serotonin level at synapse - Adverse effects: - Nausea, vomiting, weight loss, sexual dysfunction (decreased libido, difficulty achieving orgasm), nervousness, insomnia - Serotonin syndrome - often from drug interaction - Increased risk of GI bleeding - avoid using with NSAID, aspirin, warfarin - Contraindications: - Hypersensitivity to drug, use of MAOI within last 14 days

MAO inhibitors

Examples: phenylzine (Parnate), tranylcypromine (Nardil) - 3rd line drugs for treatment of depression - For patient not responsive to other antidepressants - Many food and drug interactions - Mech of Action: - Inhibit production of monoamine oxidase (MAO), an enzyme that breaks down serotonin and norepinephrine - Adverse Effects: - Anxiety, agitation, orthostatic hypotension, anticholinergic effects, weight gain - Avoid tyramine rich foods: aged cheese, bananas, figs, chianti, (risk of severe hypertension); OTC adrenergic cold medications; CNS stimulants; SSRIs; TCAs; meperidine; buspirone (BuSpar) Bupropion - Do not confuse with buspirone! (Wellbutrin, Wellbutrin SR, Zyban) - Miscellaneous antidepressant - Also marketed as Zyban (sustained-release form) - for smoking cessation - Mech of Action: - Inhibits reuptake of dopamine, NE, serotonin at nerve endings in CNS - Adverse Effects: - Seizures (in clients with seizure disorders), dry mouth, headache, N/V, anxiety, insomnia, constipation - Less CV effects, no sexual side effects - Contraindications: - Hypersensitivity to drug; seizure disorder; anorexia nervosa; bulimia; concurrent use with MAOI

Name the Benzodiazepine antagonist

Flumazenil

(Fluoxetine or Amitriptyline) is the prototype of serotonin reuptake inhibitors (SSRIs).

Fluoxetine

Side effects of this antidepressant include nausea, vomiting, and insomnia: A. tranylcypromine (Parnate) B fluoxetine (Prozac) C. imipramine (Tofranil) D. amitriptyline (Elavil, Endep) E. doxepin (Sinequan)

Fluoxetine (SSRI)

What are characteristics of simple partial seizures?

Focal motor (specific muscle groups), sensory or speech disturbances; lasts 20-60 seconds and consciousness is preserved.

GI Protectant Prototype Summary: Sucralfate Actions:

Forms an ulcer-adherent complex at the duodenal ulcer site, protecting the ulcer from acid, bile salts, and pepsin, promoting healing of the ulcer; also inhibits pepsin activity in gastric juices.

What are the loop diuretic agents?

Furosemide (Lasix), Bumetanide, Torsemide (Demedex)

Antacids Prototype Summary: Sodium Bicarbonate Adverse Effects:

Gastric rupture, systemic alkalosis (headache, nausea, irritability, weakness, tetany, confusion), hypokalemia (secondary to intracellular shifting of potassium), gastric acid rebound.

An infant is brought to the pediatric clinic. The mother tells the nurse the child is constipated and she doesn't know what to do. What would the nurse tell the mother is the safest and most effective way to treat constipation in children prior to bowel training?

Glycerin suppositories

Benzodiazepines have replaced Barbiturates as the mainstay treatment for insomnia and sedation but Barbiturates are still used today to treat what?

HA and seizures

The nurse is caring for a client with Giardia lamblia and anticipates that the provider will order what drug for the treatment of this client's diarrhea?

Nitazoxanide

How do barbiturates affect pain management?

No analgesic effect and do not raise the pain threshold

The nurse is caring for an older adult. What is the primary nursing intervention to increase fluid intake in older adults? a) Offer a variety of fluids to the client every hour. b) Place a pitcher of water at the client's bedside. c) Increase the client's intake of salty foods. d) Ambulate the client every four hours to encourage thirstiness.

Offer a variety of fluids to the client every hour.

Proton Pump Inhibitors Protoype

Omeprazole

Proton Pump Inhibitors Prototype Summary: Omeprazole Adverse Effects:

Headache, dizziness, vertigo, insomnia, rash, diarrhea, abdominal pain, nausea, vomiting, upper respiratory infection symptoms, cough.

Prostaglandin Prototype Summary: Misoprostol Adverse Effects:

Nausea, diarrhea, abdominal pain, flatulence, vomiting, excessive bleeding or spotting, hypermenorrhea, dysmenorrheal, miscarriage.

Prostaglandin Prototype Summary: Misoprostol Indications:

Prevention of NSAID- or aspirin-induced gastric ulcers in patients at risk for complications of gastric ulcers; as an abortifacient with mifepristone.

Disulfiram

causes extreme discomfort in pts who drink alcohol. Makes them vomit if they drink alcohol

Antidepressants can cause weight loss.

false. Some of the older ones are associated with weight gain

A client has been taking a urinary tract anti-infective for two days for treatment of a severe urinary tract infection. Today, the client calls the clinic complaining of continued burning on urination. What is the nurse's best response? a) "All of your urinary symptoms should have stopped immediately after you started taking the medication. Are you sure you are taking it correctly?" b) "You must have a very severe infection. Come back to the clinic and we will give you your medication intravenously." c) "The medication is not working. Stop taking it and drink cranberry juice." d) "Burning on urination is a common side effect of these drugs. This may continue the entire time that you are on the medication."

"Burning on urination is a common side effect of these drugs. This may continue the entire time that you are on the medication."

A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response?

"By suppressing normal flora, antibiotics allow proliferation of the organism."

During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea?

"Can you tell me what you ate the last 24 hours?"

A caregiver of a 1-year-old asks the nurse if they can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response?

"Children younger than 1 year of age should not be given this medication."

A nurse is teaching a client about diarrhea. Which statement by the client regarding diarrhea would indicate a need for additional teaching?

"Diarrhea is a disease that has no cure."

The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructions regarding these medications when which statement is made?

"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."

Which statement by a client leads the nurse to believe that the client understands how to safely and effectively use bulk-forming laxatives?

"I will mix the medication with around a cup of fluid and then drink the mixture."

A client who is taking phenazopyridine (Pyridium) for urinary analgesia along with nitrofurantoin calls the clinic to report that her sclera appears yellowish. What is the nurse's best response to this client? a) "Come immediately to the clinic to be checked for hepatitis." b) "This is a result of the urinary tract infection and will go away once you have completed your anti-infective." c) "Phenazopyridine can cause your skin and your sclera to develop a yellowish discoloration." d) "Stop taking the nitrofurantoin and the health care provider will prescribe another medication."

"Phenazopyridine can cause your skin and your sclera to develop a yellowish discoloration."

Loop Diuretic Adverse Effects

**· Hypokalemia · Alkalosis o Loss in HCO3 in urine · Hypocalcemia Ototoxicity (tinnitus)

Antidepressants

- 3 main groups used to treat major depressive disorders - Selective serotonin reuptake inhibitors (SSRI) - Tricyclic antidepressants (TCA) - Monoamine oxidase inhibitors (MAOI) - A 4th group is now available, Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) - See chart p. 178-179 - dosage and indications for use in adults and children

Thiazide and Thiazide like Diuretics

- Also chemical derivatives of Sulfa antibiotics - often combined with anti htn drugs

Diuretics

- Drugs that accelerate the rate of urine formation - Resulting in removal of Na and H2O from body - Discovered by accident - Cause direct arteriolar dilation, decreases Peripheral vascular resistance - Also reduce extracellular fluid volume, plasma volume, and cardiac output - Work primarily in kidneys

Loop Diuretics Indications

- Edema assoc with heart failure, control htn, increase renal excretion of calcium in pts with hypercalcemia - may also be used in diastolic dysfunction heart failure pts

Depression

- Etiology unknown; 2 major theories - Deficiency of norepinephrine and/or serotonin & change in receptors (monoamine neurotransmitter dysfunction) - Excessive secretion of hypothalamic corticotropin-releasing factor (CRF) & change in cortisol receptors (neuroendocrine theory) - Other factors: genetic, environmental

Thiazide Diuretics Drugs

- Hydrochlorothiazide (most common, least expensive), Chlorothiazide, bendroflumethiazide

All Antidepressants

- Increase availability of serotonin and/or norepinephrine at synapses in brain, producing changes in # and sensitivity of receptors - Effective in relieving depression - Differ in adverse effects - Administered orally - Undergo first pass metabolism in liver, excreted by kidneys - Therapeutic effects seen after administration for 2-4 weeks - Interact with each other

Osmotic Diuretics - Drugs

- Mannitol (Osmitrol)

Acetazolamide (Diamox)

- PO, IV forms,

Spironolactone (Aldactone)

- blocks aldosterone receptors - Used in high doses for treatment of ascites - monitor K+ - Shown to reduce mortality when added to treatment plan

Five Types of Diuretics

- carbonic anhydrase inhibitors, loop diuretics, osmotic diuretics, potassium-sparing diuretics, thiazide and thiazide-like diuretics

Carbonic Anhydrase Inhibitors (CAIs)

- chemical derivative of sulfonamide antibiotics - Inhibits the enzyme carbonic anhydrase (found in the kidneys, eyes, and other body parts)

Loop Diuretics

- chemically related to Sulfa antibiotics (Cross reaction unlikely to occur) - have renal, cardiovascular, and metabolic effects

Diuretics

- classified according to sites of action within the nephron, chemical structure, diuretic potency - most potent diuretics are the loop diuretics, followed by mannitol, metolazone (a thiazide-like diuretic), the thiazides, and the potassium-sparing diuretics

Kidney

- filters out toxic waste from the blood while conserving essential substances --- maintained by the nephron Nephron: - main structural unit of kidney, each kidney contains approx 1 mil nephrons - diuretics take effect in the nephron - Initial filtering takes place in the glomerulus -- this rate at which is takes place is called the GFR (glomerular filtration rate) -- gauges kidney function

CAI Indications

- glaucoma, edema (secondary to heart failure), high altitude sickness - also used as adjunct in open angle glaucoma (causes increase in outflow of aqueous humor, thus lowering pressure)

Furosemide (Lasix)

- loop diuretics --- most common - Used in mgmt of pulmonary edema, edema w HF, Liver disease, nephrotic syndrome, ascites, also used to treat HTN usually caused by CHF - CONTRAINDICATED: anuria, hypovolemia, electrolyte depletion

Mannitol (Osmoitrol)

- osmotic diuretic drug of choice -- IV only - may crystallize when exposed to low temperatures -- keep in warmer, adm through filter

Hydrochlorthiazide (Hydrodiuril)

- very common, very safe and effective - often given as combo drug

Loop Diuretics - Mechanism of Action

- · Prevent sodium reabsorption in the Loop of Henle causing rapid/large diuresis with resultant loss of K+, and smaller amounts of Mg+, and Na+. · Most potent diuretics · Used when large diuresis is desired such as in acute HF exacerbation (decreases preload)

What is the underlying mechanism for the development of seizures?

Abnormal excessive neuronal activity in the brain that leads to changes in attention or behavior

bipolar disorder

A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.

serotonin

A neurotransmitter involved in sleep, wakefulness, appetite, aggression, impulsivity, sensory perception, temperature regulation, pain suppression, and mood. Lower levels = depression.

major depression

A severe form of depression that interferes with concentration, decision making, and sociability; A very serious mood disorder in which people lose interest in life and can no longer find enjoyment in anything

mania

A sympton of bi-polar disorders, it is characterized by an abnormally elevated mood, accompanied by a speeding up of thought processes and activities and an abnormally decreased need for sleep.

The patient's culture has grown gram-positive cocci, and the patient is prescribed two different antibiotics, one of which is gentamicin. To treat this type of infection, which type of drug is typically prescribed with gentamicin? A. A penicillin B. A cephalosporin C. A fluoroquinolone D. An aminoglycoside

A. A penicillin Correct In gram-positive cocci, gentamicin is usually given in combination with a penicillin. The other antibiotics are not typically prescribed with gentamicin for this culture result.

Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.) A. Abnormal cartilage development in children B. Prolongation of the QT interval C. Nephrotoxicity D. Tendon rupture E. Ototoxicity

A. Abnormal cartilage development in children Correct B. Prolongation of the QT interval Correct D. Tendon rupture Correct Quinolones are not used in prepubescent children due to the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or rupture tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones.

What are some characteristics of absence seizures?

Abrupt onset of impaired consciousness associated with staring and cessation of ongoing activities; lasts less than 30 seconds

When providing instructions to patients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.) A. Complete the entire course of therapy. B. Notify the provider of any possible reactions that occur. C. Save any leftover medication in a cool dry place for later use. D. Wash hands before and after preparing food. E. Increase fluid intake

A. Complete the entire course of therapy. Correct B. Notify the provider of any possible reactions that occur. Correct D. Wash hands before and after preparing food. Correct E. Increase fluid intake. Correct There should not be any leftover medication, and if there is, it needs to be discarded in the appropriate method. The provider typically only writes a prescription for the exact amount of medication needed by the patient.

Before administration of any antiviral medication, what nursing care would be performed? (Select all that apply.) A. Head-to-toe physical assessment B. Documentation of known allergies C. History of medication use D. Monitoring for adverse effects E. Baseline vital signs

A. Head-to-toe physical assessment Correct B. Documentation of known allergies Correct C. History of medication use Correct E. Baseline vital signs Correct Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the patient's baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the patient is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered.

The nurse is aware that viruses can enter the body through various routes. By which methods can viruses enter the body? (Select all that apply.) A. Inhalation through the respiratory tract B. Ingestion via the gastrointestinal (GI) tract C. Transplacentally from mother to infant D. Through an animal bite

A. Inhalation through the respiratory tract Correct B. Ingestion via the gastrointestinal (GI) tract Correct C. Transplacentally from mother to infant Correct D. Through an animal bite Correct Viruses can enter the body through at least four routes: inhalation through the respiratory tract, ingestion via the GI tract, transplacentally via mother to infant, and inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others).

Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.) A. Nonnucleoside reverse transcriptase inhibitors B. Protease inhibitors C. Reverse transcriptase inhibitors D. Fusion inhibitors E. Neuraminidase inhibitors

A. Nonnucleoside reverse transcriptase inhibitors Correct B. Protease inhibitors Correct C. Reverse transcriptase inhibitors Correct D. Fusion inhibitors Correct Neuraminidase inhibitors are used in the treatment of the influenza virus.

CAI prototype

Acetazolamide

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.) A. Patients stop taking an antibiotic once they feel better. B. New organisms arrive from foreign countries. C. Antibiotics are prescribed according to culture and sensitivity reports. D. Antibiotics are prescribed to treat a viral infection.

A. Patients stop taking an antibiotic once they feel better. Correct D. Antibiotics are prescribed to treat a viral infection. Correct Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. Administering antibiotics to treat viral infections is not effective and also may expose small amounts of bacteria that may be present to the antibiotic and therefore risk the development of resistance.

What types of seizures will phenytoin treat?

All types except absence seizures

The nurse will question the use of a floroquinolone antibiotic in a patient already prescribed which medication? A. amiodarone B. metoprolol C. furosemide D. omeprazole

A. amiodarone Correct Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by patients receiving class IA and class III antiarrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.

When administering a nonsteroidal antiinflammatory drug (NSAID) and penicillin concurrently, displacement of the penicillin antibiotic from the protein-binding sites results in A. increased free drug in blood. B. decreased free drug in blood. C. no change in free drug in blood. D. synergistic effect of drug.

A. increased free drug in blood. Correct Drugs that are not bound to protein are free and thus active to exert their therapeutic (or toxic, if too much free) effect.

When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B? A. oseltamivir (Tamiflu) B. ganciclovir (Cytovene) C. enfuvirtide (Fuzeon) D. indinavir (Crixivan)

A. oseltamivir (Tamiflu) Correct Oseltamivir (Tamiflu) and zanamivir (Relenza) are active against influenza virus types A and B and have been shown to reduce the duration of influenza infection by several days.

An antidepressant produces effect when? Soon after administration, A day later, After 2 to 4 weeks of administration, or After 6 months of administration

After 2 to 4 weeks of administration

Therapeutic use(s) of antidepressants include(s): A. severe anxiety disorder B. post-traumatic stress disorder C. panic-agoraphobia D. endogenous depression E. all of the above

All of the above

What types of seizures do benzodiazepines treat?

All types

What types of seizures does phenobarbital treat?

All types except absence seizures

norepinephrine

Also known as noradrenaline, it is involved in controlling alertness and wakefulness and is implicated in mood disorders such as depression and mania. Adrenoceptor agonist prototype: acts at all alpha and at beta1 adrenoceptors; used as vasoconstrictor. Causes reflex bradycardia. Tox: ischemia, arrhythmias, HTN

A nurse is planning care for a patient who is taking tolterodine. Which of the following is an appropriate nursing diagnosis that is an indication for using this drug? a) Risk for Injury related to multiple drug therapies and drug interactions b) Risk for Deficient Fluid Volume related to the action of the drug c) Risk for Injury related to hyperkalemia secondary to use of the drug d) Altered Urinary Elimination related to overactive bladder

Altered Urinary Elimination related to overactive bladder

What are the main uses of barbiturates?

Anticonvulsant (Phenobarbital) - long acting management for clonic-tonic seizures or febrile seizures Anxiety - milld sedation, anxiety or insomnia

sertraline (Zoloft)

Antidepressant - SSRI, MOA: block reuptake of serotonin in pre-synaptic space, Obsessive-compulsive disorder (OCD), I:depression, enuresis, PTSD, anxiety, OCD, Drug used for the treatment of depression, anxiety, and PTSD, 1. Few drug interactions, well-tolerated

amitriptyline (Elavil)

Antidepressant, TCA which can cause cardiac arrhythmias, Tricyclic Antidepressant, TCA widely used in the treatment of chronic pain and migraine prophylaxis?, A first line drug for Peripheral Neuropathy, Depression. In young adults and kids suicidal ideation may be worse. Gradually decrease dosage. s/s: n/v/constipation, difficulty urinating, pain in hands and feet, sweating, appetite and weight changes.

paroxetine (Paxil, Paxil CR)

Antidepressant, Which SSRI has the most anticholinergic side effects & is most commonly associated with sexual side effects?, GAD, OCD, PTSD, Panic disorders, social anxiety disorder (SAD), ejaculatory disorders, nausea, sweating, fatigue, and Somnolence, Serotonin syndrome, Suicide risk, Sexual dysfunction, Headache, dizziness, Sleep disruption

lithium (Eskalith, Lithobid)

Antimanic, Drug Treatment for Bipolar Disorders, Mood Stabilizers, prevent or control mania, NT stabilization, inhibits excitatory NT (NE, DA), Enhances 5HT to help with depression, used for acute maina, bipolar depression. Narrow toxic range, renal elimination, 1-3 weeks to see effect, intentional tremor, weight gain, polyuria, polydipsia, interacts with OTC and caffeine, take 2 to 3 times a day, salt intake should remain constant during treatment, treating bipolar (manic-depressive) disorder, acute mania and prophylaxis of unipolar and bipolar disorder. Only mood stabilizer that has consistently shown to decrease the risk of suicide for bipolar patients, Antimanic, mood stabilizing agent. Side Effects: Drowsiness, dizziness, headache, dry mouth, thirst, GI upset, Nausea/Vomiting, fine hand tremors, hypotension, arrhythmias, pulse irregularities, polyuria, dehydration, weight gain, Alters sodium transport in nerve and muscle cells by inhibiting the phosphoinositol cascade. Its antimanic effects may be the result of increased reuptake of norepinephrine. Some say it "effects shift toward intraneuronal metabolism of catecholamines." What to know is that it affects neuronal signaling cascades, likely involving cAMP (RS), Excreted unmetabolized by kidneys, Reabsorbed by kidney in exchange for Na, Low Na levels, increased lithium reabsorption and risk of toxicity, Narrow therapeutic range = 0.5 - 1.2 mEq/L, Dose based on serum lithium levels, Monitored 2 - 3 times/week initially; maintenance q 3 months, Draw levels 12 hours after last dose, Lower doses needed for: older adults, those on diuretics, low salt diet, or with renal impairment, Adverse Effects:, Metallic taste, hand tremors, nausea, polyuria, muscle weakness, edema, weight gain, reversible leukocytosis (elevated WBC count), Elevated drug levels - vomiting, diarrhea, ataxia, dizziness, muscle twitching, Toxicity (drug levels > 2.5 mEq/L), Nystagmus, tremors, confusion, oliguria, hallucinations, convulsions

The nurse cautions a client with what allergy to avoid the use of bismuth salts in the treatment of diarrhea?

Aspirin

Nursing Implications

Assess: - signs & symptoms of depression (agitation, feelings of worthlessness, decreased pleasure) - risk for suicide - support system - coping mechanisms - TCA - obtain baseline and follow-up EKG's, monitor drug levels - Lithium - obtain baseline renal, cardiac, and thyroid function studies; electrolyte levels. Monitor serum Na levels during treatment - Obtain baseline vital signs, weight - Check for drug interactions - many! - Observe for worsening depression, or suicidal ideation or tendencies - Provide for safety, check for orthostatic hypotension - Generally, give TCAs at bedtime, SSRIs in AM; give lithium with meals - Signs of lithium toxicity - withhold dose and contact physician - Teach patient - do not stop abruptly, (esp. drugs with short half-life) to avoid withdrawal symptoms - Do not take St. John's Wort - interacts with antidepressants - may result in severe hypertension - See p. 172 Patient Teaching; & p. 188 - 191

bupropion (Wellbutrin, Zyban)

Atypical Antidepressant, Inh Dopamine reuptake; tx: depression, ADHD, smoking cessation; less sexual dysfunction; CI: pts w/ seizures or head trauma, Atypical antidepressant; acts as a stimulate and suppresses appetite; antidepressant effects begin in 1 to 3 weeks; does not affect serotonergic, cholinergic, or histaminergic transmission; does not cause weight gain; similar structure to amphetamines; increases sexual desire and pleasure; many uses, Energizing, few sexual side effects, less weight gain. Can cause seizures at high doses. Possible increase in anxiety and insomnia

A patient prescribed azithromycin (Zithromax) expresses concern regarding gastrointestinal upset that he experienced when previously taking erythromycin. What is the nurse's best response? A. "I will call the doctor and ask for a different antibiotic." B. "This drug is like erythromycin with less severe gastrointestinal side effects." C. "You need this medication and will just have to deal with the nausea." D. "I will ask the doctor for a prescription for an antiemetic in case this drug makes you sick as well."

B. "This drug is like erythromycin with less severe gastrointestinal side effects." Correct Azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe gastrointestinal side effects than erythromycin.

Which information will the nurse include in discharge teaching for a patient receiving doxycycline? A. "Take the medication until you feel better." B. "Use sunscreen and protective clothing when outdoors." C. "Keep the remainder of the medication in case of recurrence." D. "Take the medication with food and milk to minimize gastrointestinal upset."

B. "Use sunscreen and protective clothing when outdoors." Correct Photosensitivity is a common side effect of doxycycline, a tetracycline antibiotic. The patient should avoid direct sun exposure while taking this medication. Exposure to the sun can cause severe burns.

A new vaccination, Zostavax, has been approved to prevent the development of what condition in adults over the age of 50? A. Herpes simplex B. Herpes zoster C. Influenza A D. Avian influenza

B. Herpes zoster Correct Zostavax is a new vaccination developed and approved for use in adults over the age of 50 to prevent the onset or outbreak of herpes zoster (shingles).

The nurse would teach a patient receiving metronidazole (Flagyl) to avoid ingestion of which drink? A. Milk B. Wine C. Coffee D. Orange juice

B. Wine Correct A disulfuram-like (Antabuse) reaction may occur with concurrent ingestion of metronidazole and alcohol, leading to flushing of the face, tachycardia, palpitations, nausea, and vomiting.

1. The nurse is obtaining a medication history from an 18-year-old female patient who has been diagnosed with genital herpes. Which drug would the nurse expect this patient to be prescribed? A. amantadine (Symmetrel) B. acyclovir (Zovirax) C. zidovudine (Retrovir) D. ribavirin (Virazole)

B. acyclovir (Zovirax) Correct Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV), zidovudine against human immunodeficiency virus (HIV), and amantadine against Haemophilus influenzae type A.

Your client taking phenelzine (Nardil) should avoid eating: A. eggs B. aged cheeses C. onions D. strawberries

B. aged cheeses

When teaching a patient being discharged on linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse must emphasize the importance of A. reporting any occurrence of constipation. B. avoiding ingestion of foods containing tyramine. C. stopping the drug as soon as the patient feels better. D. taking the medication with an antacid to avoid gastrointestinal upset.

B. avoiding ingestion of foods containing tyramine. Correct Acute hypertension may occur in patients consuming large amounts of tyramine while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease gastrointestinal distress. An antacid would interfere with absorption.

A patient who is allergic to penicillin is at increased risk for an allergy to which drug? A. tetracycline B. cefazolin sodium (Ancef) C. gentamicin (Garamycin) D. erythromycin

B. cefazolin sodium (Ancef) Correct Patients who are allergic to penicillins have a fourfold to sixfold increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.

he dose-limiting toxicity of ganciclovir treatment is assessed by monitoring A. liver function tests (LFTs). B. complete blood count (CBC). C. blood urea nitrogen (BUN). D. creatine phosphokinase (CPK).

B. complete blood count (CBC). Correct Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, CBC should be monitored.

A patient is prescribed metronidazole (Flagyl) for a gynecologic infection, and she provides a list of medications she takes routinely to the nurse. Which medication would lead the nurse to question the order for Flagyl? A. multivitamin B. lithium C. thyroid replacement hormone D. ibuprofen

B. lithium Correct Flagyl is known to cause and increase in neurologic-associated medications and specifically can lead to lithium toxicity. A patient who reports taking lithium should be a red flag for the nurse to alert the provider due to the potential significant interaction.

When a patient has just started on antidepressant therapy, it is most important to monitor for: A. social skills B. suicidal thoughts C. exercise routines D. cigarette smoking

B. suicidal thoughts

During antibiotic therapy, the nurse will assess the patient for a condition that may occur due to the disruption of normal flora. The nurse recognizes this as: A. organ toxicity. B. superinfection. C. hypersensitivity. D. allergic reaction.

B. superinfection. Correct Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections.

What drug have benzodiazepines largely replaces?

Barbiturates

What is the most common and widely used anxiolytic drug category?

Benzodiazepines

Benzodiazepines pharmacodynamics

Bind to the molecular components of the GABA receptors in the neuronal membrane in the CNS GABA inhibits synapses in the brain by binding to specific receptors in the plasma membrane Binding causes opening of ion channels that allows flow of ions in and out of cell, making cell more hyperpolarized

Antidepressant therapeutic effects may not be seen for two to four weeks A. serotonin-specific reuptake inhibitors (SSRIs) B. tricyclics antidepressants C. both D. neither

Both

The nurse should advise patients taking phenazopyridine (Pyridium) that their urine may become discolored, which of the following colors? (Choose one) a) Green b) Brown c) Purple d) Blue

Brown

Loop Diuretics - Drugs

Bumetanide, ethacrynic acid, furosemide, torsemide

Which statement, if made by a patient with HIV infection, demonstrates a need for continued patient teaching? A. "I will change my position slowly to prevent dizziness and potential injury." B. "I must take these medications exactly as prescribed for the rest of my life." C. "I don't need to use condoms as long as I take my medication as prescribed." D. "I should remain upright for 30 minutes after taking my zidovudine." A

C. "I don't need to use condoms as long as I take my medication as prescribed." Correct Antiretroviral drugs do not stop the transmission of HIV, and patients need to continue standard precautions.

When planning care for a patient receiving once-daily intravenous gentamicin therapy, the nurse schedules a trough drug level to be drawn A. 30 minutes after beginning the antibiotic infusion. B. 60 minutes after beginning the antibiotic infusion. C. 12 hours after completing the antibiotic infusion. D. 18 hours after completing the antibiotic infusion.

C. 12 hours after completing the antibiotic infusion. Correct Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.

The patient taking an antidepressant should be instructed to expect that depressive symptoms will start to improve in: A. 2-4 hours B. 2-4 days C. 2-4 weeks D. 2-4 months

C. 2-4 weeks

In an effort to prevent superinfections of the gastrointestinal tract (e.g., from Clostridium difficile), the nurse will instruct patients to eat which foods? A. Multigrain foods B. Raw fruits and vegetables C. Cultured dairy products such as yogurt D. Low-fat meats such as chicken and pork

C. Cultured dairy products such as yogurt Correct The natural flora in the gastrointestinal tract may be killed off by antibiotics, leaving other bacteria such as C. difficile to overgrow. This process may be prevented through consumption of probiotics (e.g., yogurt, buttermilk, kefir).

When planning care for a patient receiving a sulfonamide antibiotic, it is important for the nurse to perform which action? A. Advise the patient to report any tinnitus. B. Encourage a diet that causes an alkaline ash. C. Encourage fluid intake of 2000 to 3000 mL/day. D. Insert an indwelling catheter for accurate input and output.

C. Encourage fluid intake of 2000 to 3000 mL/day. Correct Patients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.

The most significant drug interactions with use of antivirals occur when antivirals are administered via which route? A. Topically B. Rectally C. Intravenously D. Optically

C. Intravenously Correct Significant drug interactions that occur with antiviral drugs arise most often when they are administered via systemic routes such as intravenously and orally. Many of these drugs are also applied topically to the eye or body, however, and the incidence of drug interactions associated with these routes of administration is much lower.

A patient with a known heart condition is scheduled to have dental surgery and is prescribed antibiotics before the dental surgery. What type of therapy is this considered? A. Empiric therapy B. Definitive therapy C. Prophylactic therapy D. Supportive therapy

C. Prophylactic therapy Correct Prophylactic antibiotic therapy is used to prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.

Which is a complication of vancomycin infusions? A. Cardiomyopathy B. Angioedema C. Red man syndrome D. Neurotoxicity

C. Red man syndrome Correct When infused too rapidly, patients receiving vancomycin may develop hypotension accompanied by flushing and warmth of the neck and face. This phenomenon is called red man syndrome.

Which statement best describes health care-associated infections? A. They occur outside the health care facility and are brought in by the patient. B. They are easier to treat than community-acquired infections. C. They are defined as health care-acquired infections that the patient did not have or incubate before admission. D. They develop in more than 30% of hospitalized patients.

C. They are defined as health care-acquired infections that the patient did not have or incubate before admission. Correct Health care-associated infections occur in 5% to 10% of hospitalized patients and are very difficult to treat. They are incubated once the patient is admitted to a health care facility and are caused by germs that live within that environment.

1. A priority assessment of a patient on antibiotic therapy includes questioning the patient about A. history of seizure activity. B. cardiac history. C. allergies. D. immunizations.

C. allergies. correct Antibiotic allergy is one of the most common drug allergies. An allergic reaction that occurs after administration of an antibiotic has the potential to cause severe anaphylaxis and possible death. Awarded 0.0 points out of 1.0 possible points.

Medications used to treat HIV infections are more specifically classified as A. antifungal drugs. B. antiviral drugs. C. antiretroviral drugs. D. antiparasitic drugs.

C. antiretroviral drugs. Correct HIV is a member of the retrovirus family; therefore drugs used to treat this virus are classified as antiretroviral drugs. Although antiretroviral drugs also fall under the broader category of antiviral drugs in general, their mechanisms of action are unique to the AIDS virus. So, they are more commonly referred to by their subclassification as antiretroviral drugs.

The nurse should assess a patient for nephrotoxicity and ototoxicity when administering which antimicrobial? A. cefazolin B. clindamycin C. gentamicin D. erythromycin

C. gentamicin Correct Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.

Fluoxetine (Prozac) should be taken in the morning to avoid which of the following side effects? A. blurred vision B. hypotension C. insomnia D. nausea

C. insomnia

Barbiturates depress ____ which produces a sedation and calming effect.

CNS

What are the side effects of barbiturates?

CNS depressant (causes drowsiness and impaired concentration to general anesthesia).

What is the definition of epilepsy?

Chronic brain disorder characterized by recurrent and unpredictable seizures.

Histamine-2 Antagonists Prototype

Cimetidine

What Benzodiazepines are used to treat anxiety disorders?

Clonazepam Lorazepam (Adivan) most common Diazepam (Valum) Alprazolam (Xanax) most common

What is epileptic syndrome?

Cluster of symptoms frequently occurring together and include seizure types, etiology, age of onset, and other factors

What are characteristics of complex partial seizures?

Complex symptoms; confused behavior; dreamy state, amnesia; lasts 30 seconds to 2 minutes and consciousness is impaired.

What is the major problem with epilepsy therapy?

Compliance because need for long term therapy and unwanted effects are common for many of these drugs

Adverse effects of Benzodiazepines

Confusion and drowsiness are the 2 most common side effects Ataxia at high doses (impairs fine motor coordination that is needed to drive a car) Cognitive impairment

Which nursing observation is an appropriate outcome to indicate effective anti-infective therapy for a urinary tract infection? a) Negative urinalysis b) Adequate fluid intake c) Continued urinary urgency d) Absence of skin rash

Negative urinalysis

1. The nurse would monitor which laboratory values in a patient receiving intravenous gentamicin (Garamycin)? A. Hematocrit and hemoglobin B. Serum glutamic-oxaloacetic transaminase (SGOT) and alanine transaminase (ALT) C. Prothrombin time (PT) and partial thromboplastin time (PTT) D. Blood urea nitrogen (BUN) and creatinine

D. Blood urea nitrogen (BUN) and creatinine Correct Gentamycin has a high potential for nephrotoxicity and is thus contraindicated in patients with elevated renal function tests such as BUN and creatinine. Awarded 0.0 points out of 1.0 possible points.

MAO inhibitors should not be administered with SSRIs in order to avoid: A. additive hypotensive effects B. liver toxicity C. sedation D. serotonin syndrome

D. serotonin syndrome

You are taking care of a 70-year-old woman who is depressed and is on an SSRI. Which of the following will you monitor over the next 3 months? A. blood glucose levels B. smoking C. visual disturbances D. weight loss

D. weight loss

Which adverse effect can result if tetracycline is administered to children under 8 years of age? A. Delayed achievement of developmental milestones B. Neurotoxicity C. Gastrointestinal bleeding D. Permanent discoloration of the teeth

D. Permanent discoloration of the teeth Tetracycline is contraindicated in children under 8 years of age because it can cause permanent discoloration of the adult teeth, which are still forming in the child.

How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? A. Megakaryocytes B. Red blood cell counts C. Lymphocyte counts D. Viral load

D. Viral load Correct All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.

(Depression or OCD) is considered the most common mental illness.

Depression

A nurse is caring for a client with pseudomembranous colitis. The health care provider has prescribed loperamide HCl to the client. How does the nurse know that the drug has been effective?

Diarrhea is resolved.

Name the prototype for Benzodiazepines

Diazepam

What Benzodiazepine is used to treat seizures?

Diazepam

Histamine-2 Antagonists Prototype Summary: Cimetidine Adverse Effects:

Dizziness, confusion, headache, somnolence, cardiac arrhythmias, cardiac arrest, diarrhea, impotence, gynecomastia, rash.

A patient with benign prostatic hypertrophy is receiving treatment with finasteride (Proscar). What is an appropriate patient instruction? a) You may donate blood every 3 months. b) Do not let your wife handle the pills. c) Your libido may be increased by this drug. d) Enhance the drug with saw palmetto.

Do not let your wife handle the pills.

The nurse would caution the client to avoid driving if which adverse reaction of urinary tract anti-infectives occur? a) Anorexia b) Drowsiness c) Rash d) Photosensitivity

Drowsiness

When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause?

E. coli

What mechanisms should a potential epileptic drug have?

Enhancement of GABA (inhibitory) transmission; Suppression of excitatory (usually glutamatergic) transmission; Modification of ionic conductances

A nurse is educating a patient undergoing treatment for genitourinary tract bacterial infections on an outpatient basis. What instructions should the nurse offer the patient as part of the patient teaching plan? a) Notify the PHCP if abdominal pain occurs. b) Discontinue the therapy if symptoms vanish. c) Decrease fluid intake if symptoms subside. d) Increase fluid intake to at least 2000 ml/d.

Increase fluid intake to at least 2000 ml/d.

Epileptic seizures result from hyperexcitable neurons caused by?

Increased activity of voltage-gated ion channels (Na and Ca Channels); Decreased inhibitory neurotransmission (GABA); increased excitatory neurotransmission (glutamate receptors); Alteration of extracellular ion concentrations (K and Ca)

In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid?

Increasing mass and water content of stool

tyramine

Indirectly acting sympathomimetic prototype: releases or displaces norepinephrine from stores in nerve endings. Usually inactive by the oral route because of high first pass effect but will cause potentially lethal hypertensive responses in patients taking MAO inhibitors; Adrenergic, indirect agonist

Does phenytoin inhibit of induce hepatic drug metabolizing enzymes?

Induces

Prostaglandin Prototype Summary: Misoprostol Actions:

Inhibits gastric acid secretion and increases bicarbonate and mucous production, protecting the lining of the stomach; increases stimulatory effects in the uterus.

Histamine-2 Antagonists Prototype Summary: Cimetidine Actions:

Inhibits the actions of histamine at H2 receptor sites of the stomach, inhibiting gastric acid secretion and reducing total pepsin output.

A prescriber adds psyllium to the medication administration record for a client experiencing diarrhea. Which is the best rationale for the addition of psyllium?

It absorbs toxins and water, decreasing fluidity of stools.

The nurse is aware that fosfomycin may be prescribed by the health care provider because of what feature that is unique among the other urinary tract anti-infectives? a) It is given one time only to treat urinary tract infections. b) It is used to treat acute bacterial urinary tract infections. c) Nausea and vomiting are the primary adverse effects. d) It is administered as an oral medication.

It is given one time only to treat urinary tract infections.

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?

Laxatives may reduce absorption of other drugs present in the GI tract.

Primary agent used in chronic management of mania in bipolar disorder: A. sufentanil (Sufenta) B. lithium C. valproic acid (Depakene, Depakote) D. imipramine (Tofranil) ? paroxetine (Paxil)

Lithium

Antacids Prototype Summary: Sodium Bicarbonate Actions:

Neutralizes or reduces gastric acidity, resulting in an increase in gastric pH, which inhibits the proteolytic activity of pepsin.

tranylcypromine (Parnate)

MAOI antidepressant, Depression. Blocks the action of the enzyme that breaks down the bodys moodelevating chemical, Inhibits the enzyme monoamine oxidase which breaks down the MAO neurotransmitter including serotonin and NE. Efficacy is similar to other antidepressants but dietary restrictions and potential drug interactions make this drug less desirable. Insomnia, nausea, agitation, and confusion can all result. Potential for hypertensive crisis or serotonin syndrome with concurrent use of other antidepressants, contraindicated with people taking other antidepressants, tyramine rich foods could bring hypertensive crisis, many drug interactions.Lag period 2-4 weeks, monitor BP, LFT's, suicide precautions, teach interaction

phenelzine (Nardil)

MAOI antidepressant, MAOI; last choice for Tx depression; SE = HTN crisis (w/ tyramine), serotonin syndrome, Irreversible Monoamine Oxidase Inhibitor = antidepressan, MAOI ANTIDEPRESSANT. Used to manage symptoms not responsive to other antidepressant meds. Drug effects may persist 2-3 weeks after discontinued. Abrupt withdrawal = rebound hypertension. Side effects are constipation, nausea, other GI symptoms, suicidal ideation may increase, interacts with TYRAMINE-containing foods. Tyramine elevates BP and can cause hypertensive crisis. Start with lowest dose possible. Should not be taken with other sympathomimetic drugs, can lead to hypertensive crisis. Chocolate and caffeine can cause hypertension.

What are some characteristics of tonic-clonic seizures

Massive contraction of skeletal muscle; rigid extension of trunk and limbs, then rhythmic contraction of arms and legs; lasts 1-5 minutes and Total loss of consciousness.

What is status epilepticus?

May be life threatening) Seizure more then 10 minutes long, repetitive without periods of consciousness, more then 3 per hour. This may lead to - Hypoxia, trauma, hyperthermia, hypoglycemia, aspiration, dehydration.

Prostaglandin Prototype

Misoprostol

Administration of an MAO inhibitor would most likely cause changes in the CNS concentration of: A. acetylcholine B. histamine C. norepinephrine

NE

Digestive Enzymes Prototype Summary: Pancrelipase Adverse Effects:

Nausea, abdominal cramps, diarrhea, hyperuricosuria.

A physician prescribes a urinary antispasmodic as a transdermal patch. The nurse identifies this as drug as which of the following? a) Flavoxate b) Tolterodine c) Oxybutynin d) Darifenacin

Oxybutynin

Digestive Enzymes Prototype

Pancrelipase

What are the classifications of seizures and where do they arise from?

Partial seizures: begin focally in a cortical site; generalized seizures: widely involve both hemispheres

Which drug would the nurse identify as turning a patient's urine reddish brown? a) Oxybutynin b) Norfloxacin c) Solifenacin d) Phenazopyridine

Phenazopyridine

Name the prototype for Barbiturates

Phenobarbital

Is withdrawal and dependence common with benzodiazepines?

Physical and psychological dependence common if given over prolonged period of time Withdrawal if abrupt discontinuous

What is the reason for administering a bulk-forming laxative like polycarbophil to a client experiencing liquid stools?

Polycarbophil absorbs large amounts of water and decreases fluidity of stools.

A client is scheduled for a colonoscopy in the morning. What laxative would the nurse expect to be prescribed the evening before the procedure?

Polyethylene glycol-electrolyte solution

A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is:

Polyethylene glycol-electrolyte solution (NuLYTELY)

What are the 3 main mechanisms of action of anti-seizure drugs?

Promotion of the inactivated state of voltage activated Na Channels which leads to limitation of the sustained, repetitive firing of neurons (use dependant block); Enhancement of GABA-mediated synaptic inhibition either by a presynaptic or postsynaptic action; inhibition of voltage activated Ca channels responsible for T-type Ca currents.

An instructor is teaching a group of students about appropriate interventions for a patient with cystitis who is receiving norfloxacin. The instructor determines that the students need additional teaching when they identify which intervention as appropriate? a) Providing citrus juices b) Instructing the patient to complete the full course of therapy c) Encouraging increased fluid intake d) Administering the drug with food if the patient experiences GI upset

Providing citrus juices

For which disorder would treatment with an anti-infective be appropriate? a) Urinary spasms b) Benign prostatic hypertrophy c) Overactive bladder d) Pyelonephritis

Pyelonephritis

Which is an important assessment for the nurse to make before administering a laxative?

Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.

What are the actions of Benzodiazepines?

Reduce anxiety by enhancing GABAergic transmission Sedative and Hypnotic actions Amnesia Anticonvulsant Muscle Relaxants

Busporine (BuSpar)

Reduces the signs and symptoms of anxiety without the CNS adverse effects. No sedative, anticonvusant, or muscle relaxant properties. Rakes appox 6 weeks to take effect

A nurse is caring for a patient with irritation of the lower genitourinary tract. The patient is administered phenazopyridine. Which of the following conditions in patients contraindicates the use of the drug? a) Renal impairment b) Diabetes c) Convulsive disorders d) Cerebral arteriosclerosis

Renal impairment

Digestive Enzymes Prototype Summary: Pancrelipase Indications:

Replacement therapy in patients with deficient exocrine pancreatic secretions

Digestive Enzymes Prototype Summary: Pancrelipase Actions:

Replaces pancreatic enzymes to aid in the digestion and absorption of fats, proteins, and carbohydrates.

venlafaxine (Effexor)

SNRI(Serotonin-Norepinephrine Reuptake Inhibitors), Antidepressant, Action: SNRIs->prevent reuptake of 5-HT and NE. Inhibits 5-HT more than NE, A cross between TCA's and SSRI's. Has been shown to have high efficacy in treatment of GAD (General Anxiety Disorder) and depression. Side effects are similar to SSRI's (it can also increase BP)., Name the prototype drug-of-choice to treat generalized anxiety disorder (or depression, panic disorder/PTSD or social phobia), Caution in pts with cardiovascular disease, ECG monitored recommended

fluoxetine (Prozac, Prozac Weekly, Sarafem)

SSRI, Antidepressant, Less ANS adverse effects and cardiotoxic potential than tricyclics. Tox: CNS stimulation, sexual dysfunction, seizures in overdose, serotonin syndrome.

escitalopram (Lexapro)

SSRI, Antidepressant, This drug may be used for GAD (generalized anxiety d/o) as well as depression., MOA: Increases availability of serotonin at postsynaptic receptor sites in CNS, Minimal interaction, sedation and weight gain. Possible initial anxiety, least side effects, well tolerated, Its SSRI for Depression, and Generalized anxiety, or social anxiety, causes 3 S's and this one specifically can cause ejaculatory disorders, nausea, sweating, fatigue, and Somnolence, Serotonin syndrome, Suicide risk, Sexual dysfunction, Headache, dizziness, Sleep disruption

Serotonin syndrome is seen with drugs like

SSRIs

Histamine-2 Antagonists Prototype Summary: Cimetidine Indications:

Short-term treatment of active duodenal or benign gastric ulcers; treatment of pathological hypersecretory conditions; prophylaxis of stress- induced ulcers; treatment of erosive gastroesophageal reflux; relief of symptoms of heartburn and acid indigestion.

Proton Pump Inhibitors Prototype Summary: Omeprazole Indications:

Short-term treatment of active duodenal ulcer or active benign gastric ulcer; treatment of heartburn or symptoms of gastroesophageal reflux; treatment of pathological hypersecretory syndromes; eradication of Helicobacter pylori infection as part of combination therapy.

What are some characteristics of partial with secondarily generalized tonic-clonic seizures?

Simple or complex partial seizure evolves into loss of consciousness, rigid extension of trunk and limbs, then rhythmic contraction of arms and legs; lasts 1-2 minutes and there is loss of consciousness

GI Protectant Prototype Summary: Sucralfate Adverse Effects:

Sleeplessness, dizziness, vertigo, insomnia, rash, constipation, diarrhea, nausea, indigestion, dry mouth, back pain.

Antacids Prototype

Sodium Bicarbonate

Antihistamine

Some antihistamine have sedating properties like, Diphenhydramine (Benadryl), Doxylamine (Nyquil), Hydroyzine (Vistaril, or atarax)

Proton Pump Inhibitors Prototype Summary: Omeprazole Actions:

Specifically inhibits the hydrogen-potassium adenosine triphosphatase enzyme system on the secretory surface of the gastric parietal cells, blocking the final step in acid production and decreasing gastric acid levels.

Potassium- Sparing Diuretics Drugs

Spironolactone (Aldactone)

Which is an appropriate intervention for a side effect of a urinary antispasmodic medication? a) Suck on ice or hard candy to treat dry mouth. b) Reduce fluid intake to avoid nocturia. c) Take milk of magnesia daily to control constipation. d) Use caffeinated drinks to prevent drowsiness.

Suck on ice or hard candy to treat dry mouth.

GI Protectant Prototype

Sucralfate

Antacids Prototype Summary: Sodium Bicarbonate Indications:

Symptomatic relief of upset stomach from hyperacidity; prophylaxis for GI bleeding and stress ulcers; adjunctive treatment of severe diarrhea; also used for treatment of metabolic acidosis; may also be used to treat certain drug intoxications to minimize uric acid crystallization.

The nurse is counseling a client who has been prescribed nitrofurantoin for treatment of a urinary tract infection. What should the nurse teach the client specific to timing of this medication? a) Take it immediately before going to bed. b) Take it two hours after meals. c) Take it with food or milk. d) Take it one hour before meals.

Take it with food or milk.

A client is admitted to the hospital for pneumonia. Since admission, the client has not had a bowel movement. The physician prescribes magnesium hydroxide. What should be an outcome of this therapy?

The client will have a bowel movement after taking the drug.

A client has been admitted to the hospital with dehydration and hypokalemia secondary to severe diarrhea. Why might the care team be reluctant to aggressively treat a client's diarrhea by slowing gastrointestinal (GI) peristalsis?

The client's body may be ridding itself of toxins.

How do Barbiturates work?

The depress the neuronal activity in the mid brain reticular formation, facilitating and prolonging the inhibitory effects of GABA. Actions are not antagonized by flumazenil

imipramine (Tofranil)

Tricyclic Antidepressant, Oldest TCA. Effective in childhood enuresis. Caution with children, CV effects. More effective than newer antidepressants., S:Imipramine (Tofranil), Anticholinergic, Sedation, Weight gain, MOA: block reuptake of NE and 5HT (serotonin), First choice for major depression

Antidepressant drugs like imipramine are effective in nerve pain.

True

The patient should always inform his/her doctor or pharmacist that he/she is taking an antidepressant.

True

Urinary tract anti-infectives act directly to destroy the bacteria or through acidification of the urine. a) True b) False

True

What types of seizures will carbamazapine treat?

Typically for partial

What are the general characteristics of hypnotic/anxiolytic drugs?

Widespread CNS depression Potentiation of other depressant drugs Tolerance

Antidepressants may also be used in the following condition/s: Migraine, Bedwetting, Both of the above, or None of the above

both

Which factors would predispose a female child to urinary tract infections? Select all that apply. a) Wiping back to front after using the toilet b) Evidence of recent sexual abuse c) History of congenital bladder conditions d) Taking daily showers instead of a bath e) Wearing cotton underwear

Wiping back to front after using the toilet • Evidence of recent sexual abuse • History of congenital bladder conditions

Are Benzodiazepines used for sleep disorders?

Yes

A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman? a) "You'll likely find that you have scant amounts of blood in your urine for the first few days, but this is not unusual or problematic." b) "You'll probably need to stop taking your hormone replacement therapy when you're taking Detrol." c) "It's good to measure your heart rate before you take your Detrol each day, and withhold it if your heart rate is below 60 beats/minute." d) "You might find that you get a dry mouth or a headache from this drug, but this does not mean it has to be discontinued."

You might find that you get a dry mouth or a headache from this drug, but this does not mean it has to be discontinued."

Tricyclic Antidepressants (TCA)

amitriptyline (Elavil) imipramine (Tofranil)

What is the definition of anxiety?

an unpleasant state of tension, apprehension or uneasiness a fear that seams to arise from an unknown source

How is chronic debilitating anxiety treated?

anxiolytic drugs/minor antianxiety drugs/"mild tranquilizers" Hypnotics (slee inducing agents)

prostaglandin

any one of numerous tissue hormones that have local effects on various systems and organs of the body, including vasoconstriction, vasodilation, increased or decreased GI activity, and increased or decreased pancreatic enzyme release

An older adult client has received a third dose of diphenoxylate. In addition to monitoring the number and consistency of the client's stools, the nurse should prioritize what assessment?

assessment of fluid and electrolyte balance

What is an important teaching point regarding intake for anyone using bulk-forming laxatives?

assure adequate fluid intake

What do Benzodiazepines NOT act as?

do not have antipsychotic activity or analgesic action do not affect autonomic nervous system

A client who has suffered a myocardial infarction is prescribed a laxative to help prevent straining during defecation. Which medication would the nurse expect to administer?

docusate

Buspirone: A. is effective in treating depression B. is cross-tolerant with benzodiazepines C. does not produce significant levels of sedation D. is a benzodiazepine E. has a rapid onset of action.

does not produce significant levels of sedatiom

proton pump inhibitor

drug that blocks the H+, K+-ATPase enzyme system on the secretory surface of the gastric parietal cells, thus interfering with the final step of acid production and lowering acid levels in the stomach

histamine-2 (H2) antagonist

drug that blocks the H2 receptor sites; used to decrease acid production in the stomach (H2 sites are stimulated to cause the release of acid in response to gastrin or parasympathetic stimulation)

GI protectant

drug that coats any injured area in the stomach to prevent further injury from acid or pepsin

Barbiturates effect involves the combination of what?

enhancement of inhibitory and inhibition of excitatory neurotransmission Inhibitory effect results from activation of GABA a receptor complex

digestive enzymes

enzymes produced in the gastrointestinal tract to break down foods into usable nutrients

peptic ulcer

erosion of the lining of stomach or duodenum; results from imbalance between acid produced and the mucous protection of the GI lining or possibly from infection by Helicobacter pylori bacteria

Selective Serotonin Reuptake Inhibitors (SSRI)

escitalopram (Lexapro) fluoxetine (Prozac, Prozac Weekly, Sarafem) paroxetine (Paxil, Paxil CR) sertraline (Zoloft)

GABA plays a major role in _________ regulation

excitatory

Mood Stabilizer

lithium (Eskalith, Lithobid)

Mood-Stabilizing Agent

lithium carbonate (Eskalith, Lithobid) - Indic for use: - Bipolar disorder, to treat & prevent manic phase - Mech of Action: - Unknown; increased activity of GABA, stabilizes nerve sensitivity by altering Na ion transport in nerve cells - Excreted unmetabolized by kidneys - Reabsorbed by kidney in exchange for Na - Low Na levels, increased lithium reabsorption and risk of toxicity - Narrow therapeutic range - 0.5 - 1.2 mEq/L *** NORMAL RANGE - Dose based on serum lithium levels - Monitored 2 - 3 times/week initially; maintenance q 3 months - Draw levels 12 hours after last dose - Lower doses needed for: older adults, those on diuretics, low salt diet, or with renal impairment - Adverse Effects: - Metallic taste, hand tremors, nausea, polyuria, muscle weakness, edema, weight gain, reversible leukocytosis (elevated WBC count) - Elevated drug levels - vomiting, diarrhea, ataxia, dizziness, muscle twitching - Toxicity (drug levels > 2.5 mEq/L) - Nystagmus, tremors, confusion, oliguria, hallucinations, convulsions, coma, death - Safe use guidelines: see p. 183

Benzodiazepines should be used cautiously in patients with _____ ______ and should be avoided in patients with _______ _____ - _______ ______.

liver dysfunction, acute narrow-angle glaucoma

Naltrexone (Narcan)

long acting opioid antagonist. Stops the working of the opioids. Blocks the receptors.

Describe benzodiazepines first pass effect

metabolize to active metabolites drug is excreted in urine Cross placental barrier (depress CNS of newborns)

Defecation is normally stimulated by what physiologic trigger?

movements and reflexes in the gastrointestinal tract

Eszopiclone (Lunesta)

newer agent for insomnia. Associated with sleep driving, next day sedation. memory loss, and loss of coordination.

TCAs inhibit reuptake of ________________ (norepinephrine or monoamine oxidase).

norepinephrine

What are some adverse effects of phenytoin?

nystagmus, vertigo, ataxia, gingival hyperplasia, hirsutism, megaloblastic anemia, birth defects

Monoamine Oxidase Inhibitors (MAOI or MAO inhibitors)

phenelzine (Nardil) tranylcypromine (Parnate)

How do anxiolytic drugs work?

prevent tension or fear

Antidepressant effects are believed to result from changes in the number and sensitivity of norepinephrine or serotonin __________________ (metabolites or receptors).

receptors

acid rebound

reflex response of the stomach to lower-than-normal acid levels; when acid levels are lowered through the use of antacids, gastrin production and secretion are increased to return the stomach to its normal acidity

What are some characteristics of Febrile Seizures

related to a very high fever and usually involve tonic clonic seizures. Occur most in children and are self limiting and disappear

What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools?

stool softener

What are common symptoms of anxiety?

tachycardia, sweating, trembling, palpitations all involve SNS activation

Primary use of fluoxetine (Prozac): A. treating obsessive-compulsive disorder B. management of morbid obesity C. treating endogenous depression D. management of alcohol withdrawal E. treating anxiety

treating endogenous depression

Thiazide Diuretics Indications

treatment of edema associated with CHF, liver, or renal disease. Monotherapy or adjuncts for HTN

How are benzodiazepines administered?

usually oral but may be given IM or IV short, intermediate, and long acting

Loop Diuretics Contraindications

· Allergy · Anuria · Hepatic coma

Potassium Sparing Diuretics Contraindications

· Allergy · Hyperkalemia · Renal disease · Anuria

CAI Contraindications

· Allergy to sulfanomides or thiazides Chronic noncongestive angle-closure glaucoma

Thiazide Diuretics Contraindications

· Allergy to sulfonamides · F&E imbalances · Severe renal disease May prevent diuretic from working

Thiazide and Thiazide like Diuretics Mechanism of Action

· Block chloride pump in distal convoluted tubule o Keeps Cl and Na in tubule to be excreted in urine · Mild diuretic compared to loop diuretics · First line drugs to manage hypertension

CAI Adverse Effects

· Disturbances in Acid/Base and electrolyte balances · Metabolic acidosis · Hypokalemia

Thiazide Diuretics Adverse Effects

· GI Upset · CNS complications · Hypovolemia · Hypokalemia o Weakness, muscle cramps, & arrhythmias · Decreased uric acid excretion (high levels of uric acid may result in gout)

Potassium Sparing Diuretics Adverse Effects

· Hyperkalemia o Lethargy, confusion, ataxia, muscle cramps, cardiac arrhythmias Avoids foods high in K+

Potassium Sparing Diuretics Mechanism of Action

· Loss of NA+ while promoting the retention of K+ · Often used as adjuncts with thiazides or loops in pts who are at risk for hypokalemia Drug of choice for hyperaldosteronism

Osmotic Diuretics Mechanism of Action -- Mannitol

· Mannitol is a sugar that is not well reabsorbed by the tubules · Pulls large amounts of fluid into the urine due to osmotic pull exerted by large sugar molecule · Not limited to kidneys Used to decrease intraocular pressure & intracranial pressure

CAI Mechanism of Action

· Mild diuretic Block CA then slow down movement of H+ ions so more Na+ and HCO3 are lost in the urine

Osmotic Diuretics Adverse Effects

· Sudden drop in fluid levels · N/V, hypotension, lightheadedness, confusion, HA Cardiac decompensation & shock

Which adverse effects might be experienced by a patient taking an antispasmodic? Select all that apply. a) Blurred vision b) Dizziness c) Diarrhea d) Bradycardia e) Vomiting

• Blurred vision • Vomiting • Dizziness

Which of the following drugs can be used to treat dysuria caused by a UTI? Select all that apply: a) Oxybutynin (Ditropan) b) Nitrofurantoin (Macrodantin) c) Phenazopyridine (Pyridium) d) Flavoxate (Urispas) e) Sulfamethoxazole/trimethoprim (Bactrim)

• Flavoxate (Urispas) • Phenazopyridine (Pyridium)

A patient with overactive bladder symptoms was given a new prescription for an antispasmodic. With which medications does this medication category interact? Select all that apply. a) Promethazine (Phenergan) b) Acyclovir (Zovirax) c) Metformin (Glucophage) d) Docusate (Colace) e) Haloperidol (Haldol)

• Haloperidol (Haldol) • Promethazine (Phenergan) • Acyclovir (Zovirax)

Prior to administering oxybutynin (Ditropan) to a client, the nurse should get a full medical history because the use of oxybutynin (Ditropan) is contraindicated in clients with which of the following? Select all that apply: a) Myasthenia gravis b) Hypertriglyceridemia c) Diabetes d) Intestinal blockage e) Urinary tract blockage

• Myasthenia gravis • Urinary tract blockage • Intestinal blockage

Fosfomycin (Monurol) is an anti-infective that when administered orally is found in high concentrations in the urine, which makes it ideal for treating which of the following infections? Select all that apply: a) Pyelonephritis b) Hepatitis c) Prostatitis d) Encephalitis e) Cystitis

• Pyelonephritis • Prostatitis • Cystitis