Mega Pharm #2 Exam

What is nitrous oxide?

"Laughing gas" Only inhaled gas currently used as a general anesthetic Weakest of the general anesthetic drugs Used primarily for dental procedures or as a supplement to other, more potent anesthetics

beta blockers generic names end in _________

"olol" ex: metropolol

Attention-deficit disorder

(ADD) inability to focus attention on a task for a sufficient length of time

Acetylcholinesterase

(AchE) enzyme that degrades acetylcholine within the synaptic cleft, enhancing effects of the neurotransmitter

new dosing reccs for zolpidem products

(Ambien, Ambien CR, and Edluar), (sleep meds) next-morning impairment extended-release (Ambien CR)―either 6.25 mg or 12.5 mg―should not drive or engage in other activities that require complete mental alertness, day after taking zolpidem levels can remain high the next day and impair functioning

Electroencephalogram

(EEG) diagnostic test that records brainwaves through electrodes attached to the scalp

Epilepsy (Part 3)

(PART 3) Primary (idiopathic) ´Cause cannot be determined ´Roughly 50% of epilepsy cases ´Secondary (symptomatic) ´Distinct cause is identified. ´Trauma, infection, cerebrovascular disorder ´Febrile in young children

Analgesics: Nursing Process: Assessment (Part 1)

(Part 1) Before beginning therapy, perform a thorough history regarding allergies and use of other medications, including alcohol, health history, and medical history. ´Obtain baseline vital signs and I&O. ´Assess for potential contraindications and drug interactions.

Opioid Analgesics: Nursing Implications (Part 1)

(Part 1) Oral forms should be taken with food to minimize gastric upset. ´Ensure safety measures, such as keeping side rails up, to prevent injury. ´Withhold dose and contact physician if there is a decline in the patient's condition or if vital signs are abnormal, especially if respiratory rate is less than 10 to 12 breaths/min.

(Part 1) What is pain transmission?

(Part 1) Tissue injury causes the release of: ´ Bradykinin ´ Histamine ´ Potassium ´Prostaglandins ´ Serotonin ´These stimulate nerve endings, starting the pain process.

Opioid Analgesics: Nursing Implications (Part 2)

(Part 2) Check dosages carefully. ´Follow proper administration guidelines for IM injections, including site rotation. ´Follow proper guidelines for IV administration, including dilution, rate of administration, and so on. ´Constipation is a common adverse effect and may be prevented with adequate fluid and fiber intake. ´Instruct patients to follow directions for administration carefully and to keep a record of their pain experience and response to treatments. ´Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension.

Nursing Implications (Part 2)

(Part 2) Give hypnotics 30 to 60 minutes before bedtime for maximum effectiveness in inducing sleep (depends on drug's onset). Most benzodiazepines cause REM rebound and a tired feeling the next day; use with caution in older adults. Instruct patients to avoid alcohol and other CNS depressants.

Analgesics: Nursing Process: Assessment (Part 2)

(Part 2) Perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and relieving factors, type, remedies, and other pain treatments. ´Pain is now considered a "fifth vital sign." ´Rate pain on a 0 to 10 or similar scale ´Use appropriate scale for age, cognition

(Part 2) What is pain transmission?

(Part 2) The nerve impulses enter the spinal cord and travel up to the brain. ´The point of spinal cord entry or the "gate" is the dorsal horn. ´This gate regulates the flow of sensory impulses to the brain.

Benzodiazepines: Indications (Part 2)

(Part 2) Treatment of acute seizure disorders Treatment of alcohol withdrawal Agitation relief Balanced anesthesia Moderate or conscious sedation

Neuromuscular Blocking Drugs (Part 2)

(Part 2) Typical time course of NMBD-induced paralysis Muscle weakness Total flaccid paralysis: first fingers and eyes then limbs, neck and trunk; finally, intercostal muscles and diaphragm NMBDs do not cause sedation or pain relief. Recovery occurs in reverse order of paralysis.

Nursing Implications (Part 2)

(Part 2)Each perioperative phase has its own complex and very specific nursing actions. Provide preoperative teaching about the surgical procedure and anesthesia plan. Perform close and frequent observation of the patient and all body systems. During a procedure, monitor vital signs and ABCs. Watch for sudden elevations in body temperature, which may indicate malignant hyperthermia.

Mechanism of Action and Drug Effects: Amphetamines (Part 2)

(Part 2)´Respiratory effects ´Relaxation of bronchial smooth muscle ´Increased respiration ´Dilation of pulmonary arteries

Opioid Analgesics: Nursing Implications (Part 3)

(Part 3) *Monitor for adverse effects* ´Contact physician immediately if vital signs change, patient's condition declines, or pain continues. ´Respiratory depression may be manifested by respiratory rate of less than 10 breaths/min, dyspnea, diminished breath sounds, or shallow breathing.

Nursing Implications (Part 3)

(Part 3) Check with the prescriber before taking any other medications, including over-the-counter medications. Rebound insomnia may occur for a few nights after a 3- to 4-week regimen has been discontinued.

(Part 3) What is pain transmission?

(Part 3) Closing the gate stops the impulses. ´If no impulses are transmitted to higher centers in the brain, there is no pain perception.

Nursing Implications (Part 3)

(Part 3) During recovery, monitor for cardiovascular depression, respiratory depression, and complications of anesthesia. Implement safety measures during recovery, especially if motor or sensory loss occurs because of local anesthesia. Reorient patient to his or her surroundings. Teach the patient about postoperative turning, coughing, and deep breathing.

Psychotherapeutic Drugs: Nursing Implications (Part 3)

(Part 3) ´Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected. ´Advise patients to avoid abrupt withdrawal. ´Advise patients to change positions slowly to avoid postural hypotension and possible injury.

Opioid Analgesics: Nursing Implications (Part 4)

(Part 4) *Monitor for therapeutic effects* ´Decreased complaints of pain ´Decreased severity of pain ´Increased periods of comfort ´Improved activities of daily living, appetite, and sense of well-being ´Decreased fever (acetaminophen)

(Part 4) What is pain transmission?

(Part 4) Body has endogenous neurotransmitters. ´Enkephalins ´Endorphins - bind to opioid receptors mu and cappa receptors (help to close the gates) ´Produced by body and bind to opioid receptors ´Inhibit transmission of pain by closing gate ´Rubbing a painful area with massage or liniment stimulates large sensory fibers. ´Result ´Closes gate ´Reduces pain sensation

Nursing Implications (Part 4)

(Part 4) Safety is important: Keep side rails up or use bed alarms. Do not permit smoking. Assist patient with ambulation (especially older adults). Keep call light within reach. Monitor for adverse effects. Age-appropriate considerations

Psychotherapeutic Drugs: Nursing Implications (Part 4)

(Part 4)´The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquire more effective coping skills. ´Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts. ´Simultaneous use of these drugs with alcohol or other CNS depressants can be fatal.

Nursing Implications (Part 5)

(Part 5) Monitor for therapeutic effects: Increased ability to sleep at night Fewer awakenings Shorter sleep-induction time Few adverse effects, such as "hangover" effects Improved sense of well-being because of improved sleep For muscle relaxants: decreased spasticity, decreased rigidity

Adverse Effects: Antipsychotic Drugs - Part 2

(part 2) Insulin resistance ´Weight gain ´Changes in serum lipid levels ´Metabolic syndrome

Epilepsy (part 2)

(part 2) Following terms are often used interchangeably but they do not have the same meaning. ´Seizure ´Brief episode of abnormal electrical activity in nerve cells of the brain ´Convulsion ´Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles ´Epilepsy ´Chronic, recurrent pattern of seizures

Dopamine Modulator (part 2)

(part 2) ´Amantadine (Symmetrel) (cont.) ´Used early in the course of the disease ´Usually effective for only 6 to 12 months ´Used to treat dyskinesia associated with carbidopa-levodopa ´Common adverse effects associated with amantadine are relatively mild and include dizziness, insomnia, and nausea. ´Drug interactions: increased anticholinergic adverse effects when given with anticholinergic drugs

Analeptics (part 2)

(part 2) ´Doxapram (Dopram) ´Treatment of respiratory depression associated with anesthetic drugs and drugs of abuse, COPD-induced hypercapnia ´Monitor deep tendon reflexes, in addition to vital signs and heart rhythm, to prevent overdosage of this drug.

Nursing Implications (part 2)

(part 2) ´Monitor for therapeutic responses ´ADHD: decreased hyperactivity, increased attention span and concentration ´Anorexiant: appetite control and weight loss ´Narcolepsy: decrease in sleepiness ´Serotonin agonist: decrease in frequency, duration, and severity of migraines ´Monitor for adverse effects

Dopamine Replacement Drugs (part 2)

(part 2) ´Replacement drugs ´Carbidopa is given with levodopa. ´Carbidopa does not cross the blood-brain barrier and prevents levodopa breakdown in the periphery. ´As a result, more levodopa crosses the blood-brain barrier, where it can be converted to dopamine.

Antiepileptic Drugs (Part 2)

(part 2) ´Single-drug therapy is started before multiple-drug therapy is tried. ´Serum drug concentrations must be measured. ´Therapeutic drug monitoring ´Serum concentrations of phenytoin, phenobarbital, carbamazepine, and primidone correlate better with seizure control and toxicity than do those of valproic acid.

Psychotherapeutic Drugs: Nursing Implications (Part 2)

(part 2)´Assess for possible contraindications to therapy, cautious use, and potential drug interactions. ´Assess for level of consciousness, mental alertness, and potential for injury to self and others. ´Check the patient's mouth to make sure oral doses are swallowed.

Nursing Implications of Antiepileptic Drugs (part 2)

(part 2)´Teach patients to keep a journal to monitor: ´Response to AED ´Seizure occurrence and descriptions ´Adverse effects ´Instruct patients to wear a medical alert tag or ID. ´AEDs should not be discontinued abruptly. ´Follow driving recommendations.

Antiepileptic Drugs (part 3)

(part 3) ´Antiepileptic drugs traditionally used to manage seizure disorders include: ´Barbiturates ´Hydantoins ´Iminostilbenes plus valproic acid ´Second- and third-generation antiepileptics

Nursing Implications of Antiepileptic Drugs (part 3)

(part 3) ´Teach patients that therapy is long term and possibly lifelong (not a cure). ´Monitor for therapeutic effects: ´Decreased or absent seizure activity ´Monitor for adverse effects: ´Mental status changes, mood changes, changes in level of consciousness or sensorium ´Eye problems, visual disorders ´Sore throat, fever (blood dyscrasias may occur with hydantoins) ´Many others

nursing process related to drug therapy (interventions) for sedative drug class

- Monitor vital signs (watching for orthostatic hypotension) - Monitor neurological status ----Flumazenil (Romazicon) may be used to reverse benzodiazepine effects - Assess for changes in the patient's mood or affect - Safety measures: side rails, monitor for confusion, instruct patient not to drive/operate dangerous machinery - Monitor other medications, OTC, herbal supplements and drinks the patient is taking - Monitor for signs of withdrawal; don't abruptly stop drug use

nursing process related to drug therapy (patient-family teaching) for sedative drug class

- report side effects of dizziness • Instruct patient to get up slowly from a lying position or to a standing position - Teach patient / family to report signs of confusion, ataxia, lethargy - Instruct patient/family to report mood/affect changes - Avoid alcohol & other antidepressant drugs (antidepressant effects of both will be potentiated) - Avoid driving/using heavy machinery until effects of drugs are known. - Instruct the patient not to take OTC drugs, herbal supplements/caffeine/alcohol until talking w/ physician/nurse - Instruct patient in long term therapy not to suddenly discontinue drug - Take the drug before bedtime - Take with meals / snack to avoid gastric discomfort - Inform physician if planning to become pregnant or become pregnant

CNS depressant drugs (assessment)

1) complaints of insomnia w/attn to onset, duration, freq, pharmacologic and nonpharmacologic 2) concerns of sleep disorders, sleep patterns, difficulty sleeping, frequent waking 3) time it takes to fall asleep, energy level upon waking, 4) vital signs w/attn to blood pressure (supine, standing), pulse rate, rhythm, respiratory rate, rhythm, depth, body temp, presence of pain 5) physical assessment/exam for baseline comparisons 6) neurological findings: focus on mental status, memory, cognitive abilities, alertness, level of sedation, mood changes, depression/other mental disorders, changes in sensation, anxiety, panic attacks 7) misc. info about medical history, caffeine intake, med profile (past, present)

antiepileptics nursing process diagnoses

1) deficient knowledge related to lack of familiarity, minimal exp. w/ and lack of info concerning antiepileptic drug use 2) noncompliance w/therapeutic regimen related to patient's misuse of drugs/lack of understanding about disorder and tx 3) chronic low self esteem related to diagnosis of lifelong disease and adverse effects assoc. w/antiepileptic drugs 4) risk for injury related to decreased sensorium and CNS depression assoc. w/actions and adverse effects of antiepileptic drugs

CNS stimulants assessment

1) thorough med history, esp. cardio, cerebrovascular, neurologic, renal, liver systems 2) past, current history of addictive substance use 3) med profile w/listing of Rx, OTC, herbals, alcohol, nicotine, social/illegal drugs 4) nutritional, dietary history (CNS stimulants increase pulse rate, BP, lead to seizures, intracerebral bleeding, toxicity) inquire about: lifestyle exercise nutrition any history of eating disorders education level social support structures self esteem stress levels MSE mental health issues diabetes

bipolar tx lithium nursing implications

1. When initially starting the drug treatment, it is important to check to be sure that the lithium serum levels are within the normal range. Anytime a dosage is changed, serum drug levels should be monitored. 2. The patient should have drug levels drawn every 3-6 months after being their blood levels are stabilized. 3. Monitor for signs of lithium toxicity. monitor/assess low sodium serum levels creatinine BUN fluid status (2-3) liters/daily weighing patient daily

Preparation for the NCLEX® Examination Questions - Chapter 13 1. The nurse is providing care for a neonate diagnosed with apnea of prematurity. The prescription by the health care provider is for caffeine citrate intravenously at 5 mg/kg once daily. The infant's weight is 5.4 lb. What is the correct dosage to administer to the patient?

12.3 mg 5.4 lb ÷ 2.2 = 2.45 kg × 5 mg/kg = 12.27 mg. Because doses are rounded to tenths for neonates, the answer is 12.3 mg.

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 7. The medication order reads: "atomoxetine (Strattera) 1.2 mg/kg/day inn 2 divided doses." The child weighs 66 lbs. How much will be given with each dose?

18 mg/dose

Local Anesthetic: Adverse Effects: "Spinal headache"

70% of patients who either experience inadvertent dural puncture during epidural anesthesia or undergo intrathecal anesthesia. Usually self-limiting Treatment: bed rest, analgesics, caffeine, blood patch

A patient is experiencing a seizure that has lasted for several minutes, and he has not regained consciousness. The nurse recognizes that this is a life-threatening emergency known as A. status epilepticus B. tonic-clonic convulsion C. epilepsy D. secondary epilepsy

A

A patient is taking pregabalin (Lyrica) but does not have a history of seizures. The nurse recognizes that this drug is also indicated for A. postherpetic neuralgia B. viral infections C. Parkinson's disease D. depression

A

Which response would the nurse expect to find in a patient with a phenytoin (Dilantin) level of 25 mcg/mL? A. Ataxia B. Hypertension C. Seizures D. No unusual response; this level is therapeutic

A

Drug-abusing

A ______-_________ patient with a high tolerancefor street drugs may require larger doses of anesthesia-related drugs.

physical dependence

A condition in which a patient takes a drug over a period of time and unpleasant physical symptoms (withdrawal symptoms) occur if the drug is stopped abruptly or smaller doses are given. The physical adaptation of the body to the presence of an opioid or other addictive substance.

agonist

A drug that binds to and stimulates the activity of one or more receptors in the body

1 Carbidopa-levodopa is an antiparkinson drug that should decrease symptoms such as tremors. Increased urination and appetite and a decrease in dry mouth are not therapeutic effects of this medication therapy.

A patient has started on carbidopa-levodopa. What assessment indicates the patient is having a therapeutic effect of the medication? 1 Decreased tremors 2 Increased urination 3 Increased appetite 4 Decrease in "dry mouth"

4 The nurse should call the health care provider because some medications for Parkinson disease interact with vitamin B6 supplements. The patient should be prescribed an antiparkinson drug, such as ropinirole, because this drug does not interact with vitamin B6 supplements. If the patient is prescribed other drugs, the medication dose may need to be increased to overcome possible side effects.

A patient is diagnosed with Parkinson disease. The nurse finds that the patient is taking vitamin B6 supplements. What is the nurse's best action? 1 Tell the patient to stop the vitamin supplement. 2 Continue to monitor the patient; there is no risk with this supplement. 3 Call the patient's family to find out the type of vitamin supplement taken. 4 Call the health care provider because this may interfere with some medication therapy.

3 The priority is safety. The nurse should keep the patient in bed and then call the health care provider. Medications can be given to decrease the side effects of levodopa, but the primary nursing priority is safe patient care. Reassuring the family and assisting with daily activities are interventions that can be completed once the patient is safe.

A patient is experiencing constant impairment of voluntary actions after taking levodopa. What is the nurse's priority action? 1 Call the health care provider. 2 Reassure the family members. 3 Instruct the patient to stay in bed. 4 Assist the patient in daily activities.

3 Benztropine is an anticholinergic drug used for Parkinson disease and also for extrapyramidal symptoms from antipsychotic drugs. Benztropine is to be used with caution in hot weather or during exercise because it may cause hyperthermia. Other adverse effects include tachycardia, confusion, disorientation, toxic psychosis, urinary retention, dry mouth, constipation, nausea, and vomiting. Anticholinergic syndrome can occur when it is given with other drugs that are associated with a high incidence of anticholinergic effects. Alcohol is to be avoided. Benztropine is available as tablets and in injectable form. It is not necessary for the patient to assess his weight daily. Benztropine may be taken with or without food. It is not correct to say that this drug cannot be taken with any other medications; patients should consult their physicians.

A patient is receiving benztropine. What is essential for the nurse to teach the patient about therapy? 1 "Assess your weight daily." 2 "Take the medication with food." 3 "Tell your health care provider if you exercise." 4 "Do not use this drug if you are on other medications."

4 When Parkinson's disease is diagnosed, the nurse teaches the patient and family about the disease, including its pathophysiology and treatment options, to help them learn to manage this chronic, progressive neurodegenerative disorder. After patient education, both the patient and family are better equipped to understand the disease's progression, the related pharmacotherapy, the need for physical activity, and the role of assistive devices.

A patient receives a diagnosis of Parkinson's disease. Which intervention does the nurse implement first? 1 Instituting pharmacotherapy 2 Encouraging physical activity 3 Teaching about assistive devices 4 Explaining the disease's characteristics

2 Erythromycin should not be given with bromocriptine because both of them used the cytochrome P450 pathway. This competition leads to toxicity.

A patient receiving which medication cannot receive bromocriptine? 1 Tramadol 2 Erythromycin 3 Carbamazepine 4 Calcium carbonate

4 The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The symptoms return and continue on a constant basis despite treatment and medications. Chorea is a condition characterized by involuntary, purposeless, rapid motions such as flexing and extending the fingers, raising and lowering the shoulders, or grimacing. Dystonia is impaired or distorted voluntary movement, involving the head, neck, or feet. On-off phenomenon is a common experience of patients taking medication for Parkinson's disease in which they experience periods of greater symptomatic control ("on" time) alternating with periods of lesser symptomatic control ("off" time).

A patient who has been taking antiparkinson medications for years begins to have increased symptoms on a constant basis. In documenting these symptoms, what term will the nurse use? 1 Chorea 2 Dystonia 3 On-off phenomenon 4 Wearing-off phenomenon

4 Benztropine is an anticholinergic drug used for Parkinson disease. The side effects of the drug include tachycardia, confusion, and disorientation. A patient who has been prescribed benztropine should be advised to avoid alcohol while taking the medication because it may worsen the side effects. Patients need not avoid yogurt because tyramine in the yogurt does not diminish the effect of the drug. The dose of benztropine is 0.5 to 6 mg per day in either a single or two divided doses. Taking 8 mg in single dose may cause serious toxicity. Patients are not advised to do regular exercise because the drug may increase body temperature and cause hyperthermia.

A patient with Parkinson disease has been prescribed benztropine. What information is essential to teach the patient? 1 Avoid yogurt in your diet. 2 Take 8 mg/day of the medication. 3 Exercise regularly to be physically fit. 4 Do not drink alcohol while on the medication.

4 Antibiotics such as ciprofloxacin reduce the clearance of ropinirole. This may lead to toxic effects caused by the accumulation of ropinirole. The nurse should assess the patient for toxicity and notify the health care provider so that an adjustment in the medication can be made. The patient's antiparkinson drug or the antibiotic will need to be changed. It would be a good idea to obtain a urine specimen to culture for susceptible medications to treat the organism, but it is not the priority intervention. There is no reason to assess coagulation. The nurse should not stop the ropinirole without discussion with the primary health care provider.

A patient with Parkinson disease is prescribed ropinirole. Upon reviewing the patient's prescriptions, the nurse notes that the patient has been prescribed ciprofloxacin for a urinary tract infection. What is the nurse's best action? 1 Stop the ropinirole. 2 Assess coagulation. 3 Obtain a urine specimen. 4 Assess the patient for toxicity and notify the health care provider

2 Many patients tend to have on-off phenomena when they are taking a dopamine medication such as levodopa. On-off phenomenon is characterized by the increase and decrease of dopamine levels. This fluctuation causes dyskinesia, in which the patient has impaired voluntary movements. Levodopa does not alter the respiratory rate because it does not affect pulmonary function. The on-off syndrome is related to the efficacy of the drug; it is unrelated to delusions and hallucinations. Levodopa does cause suicidal intentions and aggressive behavior.

A patient with Parkinson disease is treated with levodopa. During the follow-up visit, the nurse finds that the patient is having an on-off phenomenon caused by the medication. Which findings caused the nurse to reach this conclusion? 1 Sudden increase in respiratory rate 2 Uncontrollable voluntary movements 3 Frequent delusions and hallucinations 4 Suicidal intentions and aggressive behavior

4, 6 To help diminish the patient's tremors, the nurse plans to administer an anticholinergic agent to oppose the effects of acetylcholine; these agents include trihexyphenidyl and benztropine. This is necessary because the tremors and other abnormal movements associated with Parkinson disease are the result of an imbalance between acetylcholine and dopamine wherein the dopamine is deficient. Selegiline is a monoamine oxidase-B inhibitor used in combination with carbidopa-levodopa to inhibit the breakdown of dopamine and reduce the dosage of levodopa needed. Amantadine is the only presynaptic dopamine release enhancer used to increase the release of dopamine from terminal vesicles. Ropinirole is a nonergot dopaminergic agent used to activate production of more dopamine. Pramipexole is also a nonergot dopaminergic agent used to activate production of more dopamine.

A patient with Parkinson disease takes carbidopa-levodopa but experiences disabling tremors. Which adjunct medications can be administered for alleviation of the patient's tremors? Select all that apply. 1 Selegiline 2 Amantadine 3 Ropinirole 4 Benztropine 5 Pramipexole 6 Trihexyphenidyl

4 Patients who have been on levodopa for a time may experience periods of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon. Patients taking levodopa do not develop resistance; rather their condition worsens due to a reduced number of dopaminergic terminals. This condition can occur frequently, is not that rare, and is treatable. A change of medication helps to reduce the on-off phenomenon.

A patient with Parkinson disease who has been responding well to drug treatment with levodopa suddenly develops a relapse of the symptoms. Which explanation by the nurse is appropriate? 1 "You have developed resistance to your current medication and will have to change to another drug." 2 "You should continue taking your medication at the current dose. These effects will go away with time." 3 "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." 4 "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."

What is psychologic dependence?

A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

psychologic dependence

A pattern of compulsive use of opioids or any other addictive substance characterized by a continuous craving for the substance and the need to use it for effects other than pain relief (also called addiction)

What is anesthesia?

A state of reduced neurologic function

Phenytoin (Dilantin) is prescribed for a patient. The nurse checks the patient's current list of medications and notes that interactions that may occur with which drugs or drug classes? (Select all that apply) A. Proton pump inhibitors B. Warfarin (Coumadin) C. Sulfonamide antibiotics D. Corticosteroids E. Oral contraceptives

A, B, C

The nurse is administering an antiepileptic drug and will follow which guidelines? (Select all that apply) A. Monitor the patient for drowsiness B. Medications may be stopped if seizure activity disappears C. Give the medication at the same time every day D. Give the medication on an empty stomach E. Notify the prescriber if the patient is unable to take the medication

A, C, E

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? A. Blocking the reuptake of neurotransmitters at nerve endings B. Increasing alertness levels in the brain C. Decreasing levels of epinephrine and serotonin at nerve endings D. Increasing the placebo effect

A. Blocking the reuptake of neurotransmitters at nerve endings SSRIs block the reuptake of serotonin. TCAs block the reuptake of norepinephrine and serotonin.

The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What is the nurse assessing for in the patient? A. Dystonia B. Orthostatic hypotension C. Dry mouth and constipation D. Neuroleptic malignant syndrome

A. Dystonia Dystonia, an impairment of muscle tone, is the only extrapyramidal side effect listed. The other side effects also occur but are not extrapyramidal effects.

Uses of CNS Stimulants

ADHD Narcolepsy Obesity (no longer recommended) Reversal of respiratory distress

CNS stimulants ADHD indications for amphetamines

ADHD, narcolepsy

Muscle Relaxants

Act to relieve pain associated with skeletal muscle spasms Majority are centrally acting. CNS is the site of action. Similar in structure and action to other CNS depressants Direct acting Act directly on skeletal muscle Closely resemble GABA

CNS stimulants anti migraine indications

Acute moderate to severe migraine headache Not used for preventive therapy Triptans often more effective

Barbiturates: Drug Interactions

Additive effects Alcohol, antihistamines, benzodiazepines, opioids, tranquilizers Inhibited metabolism MAOIs prolong the effects of barbiturates. Increased metabolism Reduces anticoagulant response, leading to possible clot formation

Who can administer general anesthesia?

Administered by anesthesia providers Anesthesiologist Nurse anesthetist (CRNA) Anesthesia assistant

What is parenteral anesthetics?

Administered intravenously

Second-Generation Antidepressants: Adverse Effects

Adverse effects: insomnia (partly caused by reduced rapid eye movement sleep), weight gain, and sexual dysfunction

reuptake

After the neurotransmitter connects to receptor, some of it is returned to the presynaptic neuron to be recycled or destroyed.

Safety Considerations with all IV infusions

All IV infusions should be checked every half-hour or hour to ensure the correct rate of infusion and to assess for potential problems Problems commonly associated with IV infusions include: Kinked tubing Infiltration "Free-flow" IV rates

What is moderate sedation?

Also called conscious sedation and procedural sedation Does not cause complete loss of consciousness and does not normally cause respiratory arrest Combination of an IV benzodiazepine (e.g., midazolam) or propofol and an opiate analgesic (e.g., fentanyl or morphine) Anxiety and sensitivity to pain are reduced, and the patient cannot recall the procedure. Preserves the patient's ability to maintain own airway and to respond to verbal commands Used for diagnostic procedures and minor surgical procedures that do not require deep anesthesia Rapid recovery time and greater safety profile than general anesthesia

What are local anesthetics?

Also called regional anesthetics Used to render a specific portion of the body insensitive to pain Interfere with nerve impulse transmission to specific areas of the body Do not cause loss of consciousness

Neuromuscular Blocking Drugs

Also known as NMBDs Prevent nerve transmission in skeletal and smooth muscle, resulting in muscle paralysis Also paralyze the skeletal muscles required for breathing: the intercostal muscles and the diaphragm Used with anesthetics during surgery When used during surgery, artificial mechanical ventilation is required. These drugs paralyze respiratory and skeletal muscles. The patient cannot breathe on his or her own. They do not cause sedation or pain relief. The patient may be paralyzed yet conscious

Nursing Implications

Always assess past history of surgeries and response to anesthesia. Assess past history, allergies, and medications. Assess use of alcohol, illicit drugs, and opioids. Assessment is vital during preoperative, intraoperative, and postoperative phases. Vital signs Baseline lab work, ECG Oxygen saturation ABCs (airway, breathing, circulation) Monitor all body systems

sedative drugs that don't treat anxiety

Ambien, Sonata, and Lunesta produce sedative effects but do not treat anxiety. they bind with the GABA receptor and inhibit the CNS response.

What is Lidocaine?

Amide class of local anesthetics Most commonly used anesthetic Can be combined with epinephrine Used for: Infiltration Nerve block Also available topically

CNS Stimulants

Amphetamines Amphetamine-like drugs Anorexiant Analeptic Respiratory CNS Stimulant Ergot Alkaloids Selective Serotonin Receptor Agonists

Which of the following individuals should not receive hydrochlorothiazide (HydroDIURIL)?

An individual with a blood pressure of 96/50

Malignant Hyperthermia

An uncommon, but potentially fatal, genetically linked adverse metabolic reaction to general anesthesia.

Metabolized

Anesthetics are also quickly _____________.

Ester

Anesthetics belongs to the ______ family are metabolized by cholinesterase in the plasma and liver.

Psychotherapeutic Drugs: Nursing Implications - Antianxiety Drugs

Antianxiety drugs In elderly patients, monitor closely for oversedation and profound CNS depression

Psychotherapeutic Drugs: Nursing Implications - Antidepressants

Antidepressants ´Many cautions, contraindications, and interactions exist pertaining to the use of antidepressants. ´Inform patients that it may take several weeks to see therapeutic effects. ´Monitor patients closely during this time, assess for suicidal tendencies, and provide support. Assist older adult and weakened patients with ambulation and other activities because falls may occur because of drowsiness or postural hypotension

Drug Classifications Used to Treat Insomnia

Antidepressants: tricyclic antidepressants and second-generation antidepressants Antihistamines Benzodiazepines Chloral derivatives Hypnotics Neuroleptics Sedatives Selective melatonin receptor agonist

General Anesthesia: Interactions

Antihypertensives: increased hypotensive effects Beta blockers: increased myocardial depression

Psychotherapeutic Drugs: Nursing Implications - Antipsychotics (phenothiazines)

Antipsychotics—phenothiazines ´Instruct patients to wear sunscreen because of photosensitivity. ´Tell patients to avoid taking antacids or antidiarrheal preparations within 1 hour of a dose. ´Inform patients to avoid alcohol and other CNS depressants with these medications. ´Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups; report these symptoms to the physician.

Psychotherapeutic Drugs: Nursing Implications - Antipsychotics (phenothiazines—part 2)

Antipsychotics—phenothiazines—part 2 ´Oral forms may be taken with meals to decrease GI upset. ´These drugs may cause drowsiness, dizziness, or fainting; instruct patients to change positions slowly.

What is a topical local anesthetic?

Applied directly to skin or mucous membranes Creams, solutions, ointments, gels, ophthalmic drops, powders, suppositories

antidepressant drug class

As anxiety and depression affect the same region of the brain, the limbic system many of the drugs used as antianxiety agents are from the antidepressant class.

antiparkinson drugs nursing process

Assessment: Assess for Parkinson signs and symptoms including extrapyramidal symptoms Assess vital signs especially blood pressure Diagnoses: risk for injury Interventions: Administer drug accurately Monitor for adverse effects Monitor for drug interactions Carbidopa/levodopa combination: the number following the drug name represents the mg of each respective drug Patient/Family teaching: Take as directed and do not double doses. If miss a dose take as soon as remembered unless it is within 2 hours of the next dose. (levodopa) May darken urine , sweat and saliva (carbidopa / levodopa) "Wearing off" effect may happen before next dose (carbidopa / levodopa) Avoid driving or using heavy machinery until the effects of the drugs are known. Instruct patient to get up slowly from a lying position or to a standing position Report any changes in skin lesions Instruct the patient to consult with physician before starting any OTC or herbal medication. Patients taking carbidopa / levodopa should avoid vitamins with B12 Caution patient to avoid alcohol, CNS depressants, and foods or beverages containing tyramine

Moderate Sedation

Associated with more rapid recovery time than general anesthesia as well as a better safety profile bc of lower cardiopulmonary risks.

World Health Organization Three-Step Analgesic Ladder: Step 1

At this step these are non-opioid - NSAIDs - aspirin Paracetamol +Adjuvant

World Health Organization Three-Step Analgesic Ladder: Step

At this step these are strong opioids - morphine - oxycodone - hydromorphone - methadone + non-opioid + adjuvant

The metabolic process that occurs when the metabolism of a drug increases over time, which leads to lower than expected drug concentrations

Autoinduction

What forms is Diazepam (Valium) available in?

Available in multiple forms: ´Oral ´Rectal ´Injectable

Benzodiazepines: Interactions

Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics, grapefruit juice CNS depressants Alcohol Opioids (Black Box Warning when combined) Olanzapine Rifampin Herbal Interactions Kava and Valerian Food-drug Interactions

A patient has been admitted to the emergency department with status epilepticus. The nurse knows that which of these drugs is considered the drug of choice for this condition? A. Phenobarbital (Luminal) B. Diazepam (Valium) C. Valproic acid D. Phenytoin (Dilantin)

B

A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse monitors for autoinduction, which will result in A. toxic levels of carbamazepine (Tegretol). B. lower than expected drug levels C. gingival hyperplasia. D. cessation of seizure activity.

B

A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use? A. Administer the drug by rapid IV push. B. Infuse slowly, not exceeding 50 mg/min. C. Mix the medication with dextrose solution. D. Administer via continuous infusion.

B

Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern? A. High white blood cell count B. Low serum albumin levels C. Low platelet levels D. High hemoglobin levels

B

The nurse is preparing to give medications. Which is the most appropriate nursing action for intravenous (IV) phenytoin (Dilantin)? A. Give IV doses via rapid IV push B. Administer in normal saline solutions C. Administer in dextrose solutions D. Ensure continuous infusion of the drug

B

The nurse is providing discharge instruction to the patient who will be taking phenytoin (Dilantin). With an understanding of the side effects of phenytoin (Dilantin), which instruction is the most important? A. Drink plenty of fluids throughout the day B. Perform mouth care at least twice a day C. Limit intake of spinach D. Use sunscreen liberally

B

The nurse is reviewing the drugs currently taken by a patient who will be starting drug therapy with carbamazepine (Tegretol). Which drug may raise a concern for interactions? A. digoxin (Lanoxin) B. acetaminophen (Tylenol) C. diazepam (Valium) D. warfarin (Coumadin)

B

Which drug is considered the first-line treatment partial and tonic-clonic seizures? A. Carbamazepine (Tegretol) B. Diazepam (Valium) C. Oxcarbazepine (Trileptal) D. Ethosuximide (Zarontin)

B

The nurse is giving an intravenous dose of phenytoin (Dilantin). Which guidelines will the nurse follow for administration? (Select all that apply) A. Inject phenytoin quickly B. Inject phenytoin slowly C. The injection of phenytoin is followed by an injection of sterile saline D. Do not infuse phenytoin continuously E. Mix the phenytoin with D5W (5% dextrose and water) for the infusion

B, C, D

A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient reflects understanding of patient education? A. "I can just stop taking my Elavil and start taking the Celexa as ordered." B. "I will not get as dizzy when I change positions after I switch medications." C. "The doctor is switching me to this medication because it is less expensive but just as effective." D. "I will need to limit my intake of cheese when taking Celexa to prevent a rise in my blood pressure."

B. "I will not get as dizzy when I change positions after I switch medications." Citalopram, an SSRI, produces minimal anticholinergic and cardiovascular side effects.

Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine (Clozaril)? A. Renal panel B. Complete blood count C. Liver function tests D. Immunoglobulin levels

B. Complete blood count Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.

What is another approved and indicated use for bupropion (Zyban), a second-generation antidepressant? A. Orthostatic hypotension B. Smoking cessation C. Anorexia in patients undergoing chemotherapy D. Nocturnal enuresis in children

B. Smoking cessation Zyban is a sustained-release form of bupropion that is useful in helping patients quit smoking.

A patient currently prescribed duloxetine (Cymbalta) comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? A. ibuprofen B. St. John's wort C. vitamin E supplements D. glucosamine chondroitin

B. St. John's wort Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as ginseng and St. John's wort.

A patient diagnosed with an anxiety disorder has been using lorazepam (Ativan) but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient? A. alprazolam (Xanax) B. buspirone (BuSpar) C. chlordiazepoxide (Librium) D. hydroxyzine hydrochloride salt (Vistaril)

B. buspirone (BuSpar) Buspirone (BuSpar) is a third-generation anxiolytic that has the advantage of being both nonsedating and non-habit-forming. All the other options are sedatives as well as anxiolytics.

barbiturates indications for use

Barbiturates are classified into 4 categories: -Ultra short acting: most often used for anesthesia -Short acting: used to help people go to sleep -Intermediate acting: used to keep people asleep -Long acting: used as anticonvulsants - treatment of seizures

Nursing Implications

Before beginning therapy, obtain a thorough history regarding allergies, use of other medications, health history, and medical history. Obtain baseline vital signs and I&O, including supine and erect blood pressure. Assess for potential disorders and conditions that may be contraindications and for potential drug interactions.

This class of drugs is one of the first-line drugs used to treat status epilepticus

Benzodiazepines

Nondepolarizing NMBDs

Bind to Ach receptors at the nueromuscular junction but block its actions. These drugs are competitive antagonists of Ach.

buspirone

BuSpar side effects include: • Dizziness • Headache • Drowsiness physical and psychological dependence is not as great with this drug. drug interactions with other CNS depressants, alcohol is not as great. Buspirone (BuSpar) mechanism of action is not clear. It is thought that the drug interacts with serotonin and dopamine receptors in the brain. drug does not produce the CNS depression. patient less likely to feel lethargic or sleepy. Delayed onset buspirone (BuSpar) only-----lag time of 10 days to 2 weeks before subsiding anxiety.

A patient who is experiencing neuropathic pain tells the nurse that the physician is going to start him on a new medication that is generally used to treat seizures. The nurse anticipates that which drug will be ordered? A. Phenobarbital (Luminal) B. Phenytoin (Dilantin) C. Gabapentin (Neurontin) D. Tiagabine (Gabatril)

C

The nurse is administering phenobarbital (Luminal) and will monitor the patient for which possible adverse effect? A. Constipation B. Gingival hyperplasia C. Drowsiness D. Dysrhythmias

C

The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patient A. is unaware of his own disease history. B. has been taking his wife's medication by mistake. C. may be taking this drug for neuropathic pain. D. is reluctant to admit to having a seizure disorder.

C

Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy? A. If you feel sleepy when taking the drug, decrease the dose by half. B. Take the drug on an empty stomach. C. Call your health care provider if you experience a sore throat or fever. D. Patients with epilepsy are not able to hold a job and work, so you should apply for benefits.

C

Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy? A. "I need to change positions slowly to prevent dizziness." B. "I will need to wear sunscreen and protective clothing when outdoors." C. "It is okay to take this drug with a small glass of wine to help relax me." D. "I should call my doctor if I notice any uncontrollable movements of my tongue."

C. "It is okay to take this drug with a small glass of wine to help relax me." Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression.

The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with? A. Obsessive-compulsive disorder B. Absence seizures C. Bipolar disorder D. Paranoid schizophrenia

C. Bipolar disorder Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorders.

Which activity should the patient be cautioned to avoid while taking an MAO inhibitor? A. Participating in a bowling league B. Sunbathing at the pool C. Eating aged cheese D. Smoking a low-nicotine cigarette

C. Eating aged cheese Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors.

CNS depressants sedative-hynotics mechanisms of action for barbiturates

CNS depressant acting on the reticular formation area of the brain stem Potentiate the effect of GABA phentobarbital (Luminal) Prototype thiopental (Pentothal) - ultra short acting pentobarbital (Nembutal) - short acting butabarbital (Butisol) - Intermediate acting

barbiturates mechanism of action

CNS depression GABA potentiation

Stimulants: Adverse Effects - CV and GI

CV: ´Headache, pallor or flushing, palpitations, tachycardia, cardiac dysrhythmias, hypertension or hypotension, excessive sweating, circulatory collapse GI: ´Dry mouth, anorexia, nausea, vomiting, diarrhea, abdominal cramps

Benzodiazepines: Drug Effects

Calming effect on the CNS Useful in controlling agitation and anxiety Reduce excessive sensory stimulation, inducing sleep Induce skeletal muscle relaxation

Adjunct drugs

Can be thought of "helper drugs". Can be used wtih general anesthetics for anesthesia initiation, sedation, reduction of anxiety, and amnesia.

Barbiturates: Adverse Effects

Cardiovascular: Vasodilation & hypertension CNS: Drowsiness, lethargy, vertigo Respiratory: Respiratory depression & cough GI: Nausea, vomiting, diarrhea, constipation Hematologic: Agranulocytosis & thrombocytopenia Other: Hypersensitivity reactions. Stevens-Johnson syndrome

What are hypnotics?

Cause sleep Much more potent effect on CNS than sedatives A sedative can become a hypnotic if it is given in large enough doses.

Interactions with muscle relaxants

Caution with other CNS depressants Benzodiazepines Alcohol

Spasmolytics

Class C Centrally acting baclofen (P - prototype) tizanidine gabapentin Class C Peripherally acting dantrolene (P - prototype) botulinum toxin type A Diazepam (Valium), a benzodiazepine, used in managing both muscle spasms and spasticity

muscle relaxants centrally acting

Class C cyclobenzaprine (P - prototype) carisoprodol chlorzoxazone metaxalone methocarbamol orphenadrine diazepam

What can Benzodiazepines be classified as?

Classified as either: ´Sedative-hypnotic ´Anxiolytic (medication that relieves anxiety)

Cluster Headache

Cluster headaches Unilateral, non-throbbing, occur in "clusters" over days

Second-Generation Antidepressants: Serotonin Syndrome

Common symptoms ´Delirium ´Agitation ´Tachycardia ´Sweating ´Myoclonus (muscle spasms) ´Hyperreflexia ´Shivering ´Course tremors ´Extensor plantar muscles (sole of foot) response

synergism

Concomitant use with other drugs that depress the central nervous system (CNS) can increase the effects of benzodiazepines, more than the sum of the two drugs individually

Moderate Sedation

Conscious sedation and procedural sedation are synonymous terms for anesthesia that does not cause complete loss of consciousness and does not normally cause respiratory arrest.

Neuromuscular Blocking Drugs: Contraindications

Contraindications Malignant hyperthermia Adverse effects Drug interactions Toxicity and management of overdose Antidotes: anticholinesterase drugs such as neostigmine, pyridostigmine, and edrophonium

An involuntary spasmodic contraction of voluntary muscles throughout the body

Convulsion

A patient has been taking antiepileptic drugs for 1 year. The nurse is reviewing his recent history and will monitor for which condition that may develop during this time? A. Loss of appetite B. Jaundice C. Weight loss D. Suicidal thoughts or behaviors

D

The nurse is assessing a newly admitted patient who has a history of seizures. During the assessment, the patient has a generalized seizure that does not stop for several minutes. The nurse expects that which drug will be ordered for this condition? A. valproic acid (Depakote) B. neurontin (Gabapentin) C. carbamazepine (Tegretol) D. diazepam (Valium)

D

The nurse is providing education for a patient who will be taking an antiepileptic drug for the first time. Which statement by the patient indicates that further teaching is indicated? A. "I will take the medicine at the same time every day" B. "I will check with my doctor before taking any over-the-counter drugs" C. "I will keep the appointments to check my bloodwork" D. "I can drive to work again once my drug levels are normal"

D

A patient diagnosed with depression is started on a TCA after failure to improve symptoms on an SSRI. The nurse should include which teaching point when educating the patient about the new medication? A. There are no contraindications to this medication. B. The medication is safe; it has been used longer than many others. C. This class of medications has no other use and is only for depression. D. There is a risk of toxicity when this medication is taken with alcohol.

D. There is a risk of toxicity when this medication is taken with alcohol. There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.

What atypical antipsychotic medication would the nurse anticipate a provider prescribing for treatment of refractory schizophrenia? A. trazodone (Desyrel) B. phenelzine (Nardil) C. amoxapine (Asendin) D. risperidone (Risperdal)

D. risperidone (Risperdal) Risperidone is effective for refractory schizophrenia, including negative symptoms. The other medications listed are antidepressants.

Ach

Depolarizing NMBDs work similarly to the neurotransmitter _____ . They bind in place of ____ to cholinergic receptors at the motor endplates of muscle nerves or neuromuscular junctions. Competitive agonists.

Benzodiazepines: Mechanism of Action

Depress CNS activity Affect hypothalamic, thalamic, and limbic systems of the brain Benzodiazepine receptors Gamma-aminobutyric acid (GABA) Do not suppress rapid eye movement (REM) sleep as much as barbiturates do Do not increase metabolism of other drugs

CNS depressants sedative-hynotics mechanisms of action for benzodiazepines

Depress CNS activity Bind to gamma-aminobutyric acid (GABA receptor) and enhances the GABA response of inhibiting overstimulation of the brain Do not suppress REM sleep Do not produce respiratory depression The drugs differ in how quickly they work -Long acting -Short acting diazepam (Valium) Prototype alprazolam(Xanax) chlordiazepoxide (Librium) lorazepam (Ativan) temazepam (Restoril)

All IV solutions contain solutes and electrolytes for specific therapies Common solutions are:

Dextrose (D) Sodium chloride (NaCl)

Common commercial solutions

Dextrose in water (D5W) Dextrose with one-half normal saline solution (D5 0.45%) Normal saline solution (0.9% NaCl) One-half normal saline solution (0.45% NaCl) Lactated Ringer's solution (LR)

Half-Life and Elderly Patients

Diazepam (Valium) = long half-life. generally avoided in elderly patients or those w/ renal impairment. Lorazepam (Ativan) is usually preferred = shorter half-life. associated w/ less risks of falls and associated issues such as hip fractures.

Three methods are used to administer IV therapy

Direct IV drug injection Continuous IV infusion Intermittent IV infusion

Why are drugs administered intravenously?

Direct absorption; many drugs cannot be absorbed through the gastrointestinal tract. Direct access also produces fast action.)

Treatment for Alcoholism

Disulfiram (Antabuse) ´Acetaldehyde syndrome ´Naltrexone ´Acamprosate (Campral) ´Newest treatment ´Counseling ´Individual ´Alcoholics anonymous

Local Anesthesia

Does not involve paralysis of respiratory function but does involve elimination of pain sensation in the tissues innervated by anesthetized nerves.

antiparkinson adverse effects dopamine replacement

Drowsiness / dizziness Hypotension Nausea and vomiting Involuntary movements Hallucinations

CNS depressants adverse effects of benzos, nonbenzos

Drowsiness, confusion Orthostatic hypotension Ataxia Tolerance and physical/psychological dependence Abrupt withdrawal signs and symptoms (if taking prolonged time) Nausea and vomiting, increased anxiety, insomnia, tremors, abdominal and muscle cramps, sweating, convulsions

muscle relaxant adverse effects

Drowsiness, dizziness, lightedness are the most common Nausea, vomiting, headache, muscle weakness

Benzodiazepines: Contraindications

Drug allergy Narrow-angle glaucoma Pregnancy

Barbiturates: Contraindications

Drug allergy Pregnancy Significant respiratory difficulties Severe kidney or liver disease Caution in older adults

What is adjunct anesthetics?

Drug that enhances clinical therapy when used simultaneously with another drug

benzodiazepine interactions

Drug-drug interactions, drug-food interactions and drug-herb interactions can occur with this class of drugs. drugs should be used cautiously with other CNS depressants since they potentiate CNS depression. Kava is a herbal supplement that has claims to suppress anxiety and produce euphoria. There have been some studies that suggest it functions similar to benzodiazepines (attaching to the GABA receptors). Grapefruit juice interacts with some benzodiazepines such as Xanax and actually increases the level of the drug in the blood. Grapefruit juice interferes with the enzymes that are involved in the metabolism of drugs - so if it is not metabolized, there is more drug circulating.

Adjuvant analgesic drugs

Drugs that are added for combined therapy with a primary drug and may have additive or independent analgesic properties, or both.

What are sedatives?

Drugs that have an inhibitory effect on the CNS to the degree that they reduce: ´Nervousness ´Excitability ´Irritability

General Anesthetics

Drugs that induce general anesthesia and are most commonly used to induce anesthesia during surgical procedures. Given only in controlled situations. Often a synergistic combination of drugs is used.

Anesthetics

Drugs that reduce or eliminate pain by depressing nerve function in the CNS and/or the PNS.

What is anesthetics?

Drugs that reduce or eliminate pain by depressing nerve function in the central nervous system (CNS) and peripheral nervous system

The muscles twitch (fasciculate)

During phase 1 of the depolarizing block, what is happening?

Muscles are no longer responsive to Ach release and muscle becomes paralyzed.

During phase 2 of the depolarizing block, what is happening?

CRITICAL THINKING AND PRIORITIZATION QUESTIONS Ch.13 p.217 1. The parents of a 10-year-old boy are concerned about the effects of the medication their son is taking for ADHD. They ask, "What should we be looking for when he starts this medicine?" What is the nurse's best response?

During therapy for attention deficit hyperactivity disorder (ADHD), the following need to be monitored: • Nutritional status because these drugs often cause weight loss • Sleep patterns because these drugs may interfere with sleep • Behavior, attention span, and social interactions while at school and at home to determine whether this therapy is effective • Suicidal thoughts because they may occur with drug therapy for ADHD in adolescents. This child is 10 years old, but the concern ought to be mentioned.

Textbook Case Studies Lilley Ch.13 pg. 208 3. At the 2-month checkup, the physician suggests that N.'s mother hold the medication on weekends, giving the drug only during the weekdays while N. is at school. In addition, careful height and weight measurements are taken. What is the reason for this "drug holiday", as described by the physician? What is the purpose of the height and weight measurements?

During therapy, the patient will also be monitored for continued physical growth with specific attention to weight and height. For a school-aged child, the physician may order "medication-free" times on weekends, holidays, or vacations, meaning that the drug may be held periodically so that the need for the medication can be reassessed and sensitivity increased. In addition, these medication-free periods may help to diminish the addictive tendencies of the stimulant drugs.

Adverse Effects: Antipsychotic Drugs - EPS

EPS ´Involuntary muscle symptoms similar to those of Parkinson's disease ´Akathisia (distressing muscle restlessness) ´Acute dystonia (painful muscle spasms) ´Treated with benztropine (Cogentin)

Ergot Alkaloid

Ergot Alkaloids (for migraine) Ertotamine tartrate (Ergostat) Action: Vasoconstricts

nursing process related to drug therapy (evaluation) for sedative drug class

Evaluate the effectiveness of promoting sleep Evaluate the effectiveness of decreasing manifestations of anxiety

Muscle Relaxants: Adverse Effects

Extension of effects on CNS and skeletal muscles Euphoria Lightheadedness Dizziness Drowsiness Fatigue Muscle weakness

Narcolepsy

Falling asleep at normally waking hours While driving While talking to someone

Effects of Chronic Ethanol Ingestion: Fetal alcohol syndrome (FAS)

Fetal alcohol syndrome (FAS) ´Craniofacial abnormalities ´CNS dysfunction ´Prenatal and postnatal growth retardation

What is diazepam (Valium)?

First clinically available benzodiazepine drug. It has varied uses Treatment of anxiety Procedural sedation and anesthesia adjunct Skeletal muscle relaxation

What is Nonbenzodiazepine: Eszopiclone (Lunesta)?

First hypnotic to be FDA approved for long-term use Designed to provide a full 8 hours of sleep Considered a short- to intermediate-acting agent Patients should allot 8 hours of sleep time and should avoid taking hypnotics when they must awaken in less than 6 to 8 hours.

What are Barbiturates?

First introduced in 1903; were the standard drugs for insomnia and sedation Habit forming; low therapeutic index Only a handful commonly used today partly because of the safety and efficacy of benzodiazepines

Drug Effects: Paralysis

First, autonomic activity is lost. Then pain and other sensory functions are lost. Last, motor activity is lost. As local drugs wear off, recovery occurs in reverse order (motor, sensory, then autonomic activity are restored).

Commonly Abused Substances: Flunitrazepam

Flunitrazepam ´Not legal in US ´"Roofies" ´Cause relaxed, drunken feeling ´Used with alcohol to produce disinhibition and amnesia ´"Date-Rape" drug

Mechanism of Action of General Anesthetics: Overton-Meyer Theory

For all anesthetics, potency varies directly with lipid solubility. Fat-soluble drugs are stronger anesthetics than water-soluble drugs. Nerve cell membranes have high lipid content, as does the blood-brain barrier. Lipid-soluble anesthetic drugs can therefore easily cross the blood-brain barrier to concentrate in nerve cell membranes.

What are Benzodiazepines?

Formerly the most commonly prescribed sedative-hypnotic drugs Nonbenzodiazepines are currently more frequently prescribed. Favorable adverse effect profiles, efficacy, and safety when used appropriately *have potential for abuse*

What are the indications of general anesthesia?

General anesthetics are used during surgical procedures to produce: Unconsciousness Skeletal muscular relaxation Visceral smooth muscle relaxation Rapid onset; quickly metabolized Also used in electroconvulsive therapy treatments for depression

Parenteral Anestheics

Given intravenously and are used for induction and/or maintenance of general anesthesia, induction of amnesia, and as adjuncts to inhalation-type anesthetics.

CNS stimulants anorexiants adverse effects

Headache Insomnia Life threatening = seizures

A potential adverse effect of valproic acid

Hepatotoxicity

Making it more difficult for these ions to move in and out of the nerve fiber

How do local anesthetics block the movement of certain ions?

Cardiorespiratory supportive care

How is malignant hyperthermia treated?

antiparkinson contraindications dopamine replacement

Hypersensitivity Angle closure glaucoma (increases pressure) Malignant melanoma (can activate malignant disease)

IV solutions are divided into three categories:

Hypertonic Hypotonic Isotonic IV solutions produce tonicity, which causes movement into or out of body cells

Teamwork and Collaboration

Important for nurse to understand pharmacokinetic properties of anesthetic agents Onset of action Peak effect Elimination

Anesthetics

In large doses, ____________ are potentially life threatening, with cardiac and respiratory arrest as the ultimate causes of death.

general anesthesia: Toxicity and management of overdose

In large doses, anesthetics are potentially life threatening. Cardiac and respiratory arrest ultimate causes of death in an overdose. Administered in a controlled environment

World Health Organization Three-Step Analgesic Ladder: Step 2

In this step these are weak opioids - codeine - oxycodone (combination, low dose) - tramadol + non-opioid + adjuvant

CNS stimulants ADHD mechanism of action for amphetamines

Increase the release of norepinephrine and dopamine in the brain.

Second-Generation Antidepressants: Indications

Indications ´Depression ´BPD, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, PTSD, premenstrual dysphoric disorder, the neurologic disorder myoclonus, and various substance abuse problems such as alcoholism

Local anesthetics are given by:

Infiltration anesthesia Nerve block anesthesia

Electronic Intravenous Infusion Pumps

Infusion pumps are used for accurate fluid and drug administration

What is parenteral local anesthetics?

Injected intravenously or into the CNS by various spinal injection techniques

Textbook Case Studies Lilley Ch.13 pg. 208 2. After 3 weeks, N.'s mother calls the physician's office to say that N. has been doing better at school, as reported by her morning teacher, but the band teacher has reported that N. gets restless during after-school rehersals. N.'s mother also reports that N. seems unable to get to sleep at night and has been staying up too late. What should the nurse suggest?

Insomnia may be an adverse effect of drug therapy with methylphenidate. To help decrease the occurrence of insomnia, the last daily dose needs to be taken 4 to 6 hours before bedtime. However, dosing will be individualized and based on the patient's needs at different times during the school day (e.g., an afternoon dose for activities later in the afternoon). Scheduling of these medications and close communication between the school/teachers/school nurse with the family and patient is very important to successful treatment. It is also important to time the dosing of medications—but as ordered—for periods in which symptom control is most needed but without leading to alterations in sleep patterns. The use of once-a-day dosing with extended-release or long-acting preparations avoids the need for dosing during school hours.

CNS stimulants anti migraine nursing implications

Instruct the patient to take the medication at the first sign of a migraine headache. Monitor for increased heart rate and blood pressure. Teach patient to monitor Ergotamine nstruct the patient not to smoke and avoid exposure to cold while taking the medications (further peripheral vasoconstriction)

CNS stimulants ADHD patient teaching

Instruct to report signs of heart racing, heart palpitations, dizziness Notify the physician immediately if behavioral changes occur, nervousness Check weight 2 times a week and report weight loss. If anorexia happens, take after the meal Avoid caffeine containing drinks Patient guide http://www.parentsmedguide.org/ParentGuide_English.pdf Take 30- 40 minutes before a eating (methylphenidate) Teach the patient not to take more than the prescribed amount. If a dose is missed, taking remaining doses at regular times. Do not double doses. Sustained tablets must be swallowed whole- do not crush or chew. Transdermal patch: apply to hip area (not under waistline) Take last dose by 4-6 pm to reduce risk of insomnia Do not stop drug abruptly Teach the patient/family there may be "drug holidays" and their purpose Report signs of palpitations, weight loss, nervousness, skin rash or fever. Report signs of liver injury

What is Ketamine?

Intravenous administration use for both general anesthesia and moderate sedation Can be given IM or subcutaneously Rapid onset of action Low incidence of reduction of cardiovascular, respiratory, and bowel function Adverse effects: disturbing psychomimetic effects, including hallucinations

General Anesthesia

Involves complete loss of consciousness, loss of body reflexes, elimination of pain and other sensations throughout the entire body, and skeletal and smooth muscle paralysis, including paralysis of respiratory muscles.

Infiltration Anesthesia

Involves multiple small injections to produce a more limited or "local" anesthetic field.

What are some of the advantages of intermittent intravenous route?

It can be used on an outpatient basis and can ensure compliance with drug therapy, it allows for rapid correction of electrolyte imbalance, and medications can be given at intervals.

Nurse's functions and responsibilities with IV therapy

Knowledge of IV sets and their drop factors Calculating IV flow rates Verifying compatibilities of the IV solution and the drug Mixing and diluting drugs in IV solution Regulating IV infusion devices Maintaining patency of IV accesses Monitoring for signs and symptoms of infiltration or other complications

muscle relaxant contraindications

Known allergy to the specific drug. Some drugs may have contraindications for individuals with renal or liver impairment These drugs need to be used cautiously in patients "spasticity maintains posture and balance."

What are the contraindications of general anesthesia?

Known drug allergy Depending on drug type: Pregnancy Narrow-angle glaucoma Acute porphyria Malignant hyperthermia

CNS depressants sedative-hypnotics contraindications barbiturates

Known drug allergy Individuals with respiratory difficulties or respiratory depression Severe kidney or liver disease Used with caution in older adults

CNS depressants sedative-hypnotics contraindications benzos, nonbenzos

Known drug allergy Pregnancy and nursing mothers (Ambien = Class C) Narrow angle glaucoma (b/c produce changes in intraocular pressure Severe kidney or liver disease

Types of Local Anesthesia

LIDOCAINE Spinal or intraspinal Intrathecal Epidural Infiltration Nerve block Topical Peripheral nerve catheter attached to a pump containing the local anesthetic: Pain Buster and On-Q pump

CNS depressants adverse effects of barbiturates

Lethargy Drowsiness Dizziness Paradoxical excitement (especially in older adults) Drug dependence and tolerance

bipolar tx lithium

Like any drug, individuals who are allergic to lithium should not take it. small therapeutic index If you read about the metabolism and excretion of lithium in a drug book, you will notice that lithium is not metabolized in the body - it is excreted unchanged in the urine. A majority of the lithium is reabsorbed in the proximal tubule of the kidney. It can be eliminated or retained based on the serum sodium levels. if the serum sodium is high, more lithium is excreted. It can also be affected by drugs that inhibit reabsorption in the proximal tubule. individuals with renal disease might not be good candidates for this therapy.

Sympathetic blockade

Local anesthetics also produce ___________ ___________; that s they block the action of the two neurotransmitters of the SNS (norep and ep).

antiparkinson drug interactions dopamine replacement

MAO inhibitors (hypertension) Anticholinergics (reduce absorption) Benzodiazepines (decrease levodopa effect) Pyridoxine foods (decrease levodopa effect)

Neuromuscular Blocking Drugs: Indications

Main use: facilitating controlled ventilation during surgical procedures Endotracheal intubation (short acting) To reduce muscle contraction in an area that needs surgery Diagnostic drugs for myasthenia gravis Other uses

antianxiety drugs

Major Drug Classifications Used to Manage Anxiety Antidepressants: Monoamine oxidase inhibitors (MAOIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and combination agents Barbiturates Benzodiazepines

What is the cause of incorrect fluid administration via electronic IV delivery devices?

Mechanical problems or incorrect settings

Direct Intravenous Injections

Medications given by IV injection route have a rapid onset of action, and calculation errors can have serious, even fatal, consequences The amount of time needed to infuse a drug given by direct IV infusion can be determined through the ratio and proportion method When giving drugs by direct IV infusion, always verify compatibility of the IV solution and the drug If the type of fluid used for infusion is not compatible with the drug, precipitation can result Incompatibilities can be avoided if IV tubing is flushed with a drug-compatible solution before and after administration

Textbook Case Studies Lilley Ch.13 pg. 208 4. When it is time for a refil, N.'s mother calls the pharmacy. However, the pharmacist tells her, "I can't refill this medication by phone. You will need to bring in a new prescription." What is the reason for this?

Methylphenidate is classified as a Schedule II drug under the Controlled Substance Act. Therefore, a written prescription is needed for refills once the original prescription has expired.

Benzodiazepines: Adverse Effects

Mild and infrequent: Headache Drowsiness Dizziness Cognitive impairment Vertigo Lethargy Fall hazard for older adults "Hangover" effect or daytime sleepiness

Psychotherapeutic Drugs: Nursing Implications - Monitor for therapeutic effects

Monitor for therapeutic effects ´Monitor mental alertness, cognition, affect, mood, ability to carry out activities of daily living, appetite, and sleep patterns. ´Monitor potential for self-injury during the delay between the start of therapy and symptomatic improvement.

Psychotherapeutic Drugs: Nursing Implications - Monitor for therapeutic effects (part 2)

Monitor for therapeutic effects—part 2 ´For anxiolytics ´Improved mental alertness, cognition, and mood ´Fewer anxiety and panic attacks ´Improved sleep patterns and appetite ´Less tension and irritability; fewer feelings of fear, impending doom, and stress ´More interest in self and others

Psychotherapeutic Drugs: Nursing Implications - Monitor for therapeutic effects (part 3)

Monitor for therapeutic effects—part 3 ´For antidepressants ´Improved sleep patterns and nutrition ´Increased feelings of self-esteem ´Decreased feelings of hopelessness ´Increased interest in self and appearance ´Increased interest in daily activities ´Fewer depressive manifestations or suicidal thoughts or ideations

Psychotherapeutic Drugs: Nursing Implications - Monitor for therapeutic effects (part 4)

Monitor for therapeutic effects—part 4 ´For antipsychotics ´Improved mood and affect ´Alleviation of psychotic symptoms and episodes ´Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope ´For lithium ´Less mania ´Therapeutic lithium levels of 0.6 to 1.2 mEq/L

CNS depressants sedative-hynotics nursing interventions

Monitor vital signs (watching for orthostatic hypotension) monitor neurological status, flumazenil might be used to reverse benzo effects Assess for changes in the patient's mood or affect Safety measures: side rails, monitor for confusion, instruct the patient not to drive or operate dangerous machinery Monitor other medications, OTC, herbal supplements and drinks the patient is using Monitor for signs or withdrawal and be sure that the drug is not abruptly stopped.

CNS stimulants ADHD nursing interventions

Monitor vital signs specifically for tachycardia and hypertension Monitor for behavioral changes, drowsiness, agitation, and anxiety Monitor height and weight Provide nutritional guidance to prevent weight loss Administer drug accurately Monitor for side effects atomoxetine: monitor for suicidal thoughts and hepatic impairment Assess attention span, concentration and social interaction if prescribed for ADHD

CNS stimulants nursing implications

Monitor weight loss Monitor vital signs. Increases in pulse may require a decrease in dose Assess for hepatotoxicity (orlistat)

Second-Generation Antidepressants: Serotonin Syndrome - More Severe Symptoms

More severe symptoms ´Hyperthermia ´Seizures ´Rhabdomyolysis ´Renal failure ´Cardiac dysrhythmias ´Disseminated intravascular coagulation

morphine

Morphine-like drugs class: opiate analgesic, opium alkaloid (Schedule II controlled substance) indications: relief of chronic pain, opioid detoxification, opioid analgesia

codeine

Morphine-like drugs class: opiate analgesic; opium alkaloid (Schedule II) indications: opioid analgesia, relief of cough; ceiling effect; causes GI upset; contraindicated for pets and pregnant/breast feeding mothers

hydrocodone

Morphine-like drugs class: opiate analgesics (Schedule II) indications: severe pain of a prolonged duration, if other measures are not sufficient. cough suppressant

hydromorphone

Morphine-like drugs class: opioid analgesic (schedule II) indications: 7x more potent than morphine; relief of chronic pain, opioid detoxification, opioid analgesia

oxycodone

Morphine-like drugs class: opioid, synthetic (schedule II) indications: relief of moderate to severe pain

heroin

Morphine-like drugs class: opioids (schedule I)

Parenteral Injections

Most commonly given intravenously may also be administered by various spinal injection techniques.

What is Midazolam (Versed)?

Most commonly used preoperatively and for moderate sedation Causes amnesia and anxiolysis (reduced anxiety) as well as sedation Normally administered by injection in adults Liquid oral dosage form is also available for children.

Esters and Amides

Most local anesthetics belong to one of two major groups of organic compounds called _______ and _______. Also called parenteral or topical anesthetics.

Three types of infusion pumps:

Multichannel pumps Ambulatory pumps Patient-controlled analgesia (PCA)

What would happen if a patient required multiple infusions?

Multichanneled pumps are available and can be programmed for different drug infusions at different infusion rates

muscle relaxant indications of use

Muscle injury resulting in painful muscle spasms. Muscle relaxants are effective when combined with physical therapy Spasticity due to severe chronic neuromuscular disorders such as multiple sclerosis, cerebral palsy, spinal cord lesions and in some cases stroke.

Depolarizing, nondepolarizing

NMBDs are classified into two groups based on mechanism of action:____________ and _____________.

Adverse Effects: Antipsychotic Drugs - NMS

NMS ´Potentially life threatening ´High fever, unstable blood pressure (BP), myoglobinemia

Respiratory CNS Stimulant

Name: Doxapram (Dopram) Action Low dose: Stimulates carotid receptors Higher dose: stimulates respiratory center in medulla, produces generalized CNS stimulation Indications --Respiratory depression --Overdose (although mechanical ventilation is more effective) NOTE: Narcan is more specifically used for opiates but this can be used for overdose as well. --Pre-and post anesthetic COPD Contraindications/Cautions Head Trauma Seizures Severe respiratory illness (acute asthma, mechanical ventilation, flail chest, pulmonary embolism) Cautiously used for neonatal apnea Adverse Reactions/Side Effects (with overdose) Hypertension Tachycardia Seizures Phlebitis at IV site Lasryngospasm (RARE..but deadly) Nursing implications Constant monitoring of vital signs, especially respirations. Monitor for signs of overdose Frequently assess IV site Patient Teaching Instruct patient to notify physician immediately if respiratory problems worsen

Amphetamine-like drugs

Names --Methylphenidate (Ritalin) --Atomoxetine (Strattera) --Modafinil (Provigil) Action: Produces CNS and respiratory stimulation with weak sympathomimetic activity Indications: ADHD (1st 2) (b/c this makes the person more alert), narcolepsy (#3) Contraindications/Cautions Hyperexcitable states Adverse Reactions/Side Effects Hyperactivity Insomnia Restlessness Tremors Anorexia Sudden death Nursing Considerations/Patient Teaching Same as for amphetamines

Anorexiant

Names --OTC-Benzphetamine (Dexadrine) (over-the-counter) --RX-Silbutramine (Meridian) (prescription) Action Stimulates CNS activity, suppresses appetite Contraindications Children younger than 12 years Self-medication (don't do this...) Adverse Reactions/Side Effects Associated with long-term use Nervousness Restlessness Irritability Insomnia Heart palpitations Hypertension Nursing Indications Monitor vital signs Monitor length of time being treated Teach patient diet management Encourage exercise

Amphetamine

Names: Amphetamine (Adderall) Dextroamphetamine (Dexidrine) Methamphetamine (Desoxyn) Action: Stimulate release of neurotransmitters (dopamine andnorepinephrinne) causing euphoria and alertness Indications: ADHD, narcolepsy Contraindications/Cautions: Symptomatic CV disease (The heat speeds up), Hyperthyroidism (increased HR/ everything) Agitated states (stress response), History of drug abuse Adverse Reactions/Side Effects: CNS: Restlessness CNS: Insomnia CV: Tachycardia CV: Hypertension CV: Heart palpitations GI: Dry mouth GI: Anorexia GI/Endocrine: Weight loss GI: Diarrhea GI: Constipation Endocrine: Impotence Nursing Indications/Patient Teaching Monitor vital signs Monitor weight Offer fluids Provide reassurance Report extreme restlessness/insomnia Monitor for withdrawal No caffeine Alternative therapies to help sleep

Analeptic

Names: Caffeine and theophylline Action --Affects brainstem, spinal cord, and cerebral cortex --Relaxes bronchial smooth muscle --Increases heart rate and blood pressure --Stimulates respirations Indications Used for newborns with apnea --Contraindications/Cautions Seizure (orderly activity) disorder CV disease Impaired hepatic or renal function Adverse Reactions/Side Effects (same as other CNS stimulants except necrotizing) Nervousness Restlessness Tremors Twitching Palpitations Insomnia Diuresis GI irritation Tinnitus (rarely) Psychological dependence Necrotizing enterocolitis (rare but deadly) Nursing Implications/Patient teaching Do not take before bedtime Consider regarding Cardiac rhythm Increased urine output Sleeplessness Etc.

What is melatonin?

Naturally occurring hormone released by the pineal gland at night (due to darkness) Considered a dietary supplement (OTC) Synthetic (majority), some from animals and microorganisms Contraindicated with epilepsy Interaction with blood thinners A 2017 study tested 31 OTC brands. Amount of melatonin did not match what was listed on label. 26% of these contained serotonin, harmful, even at low levels.

Opioid Withdrawal Symptoms

Nausea, Dysphoria, Muscle aches, Lacrimation, Rhinorrhea, Pupillary dilation, Piloerection Sweating, Diarrhea, Yawning, Fever, Insomnia

Intercostal muscles, diaphragm

Neuromuscular blocking drugs also paralyze the skeletal muscles required for breathing: ____________ muscles, __________.

Over-the-Counter Hypnotics

Nonprescription sleeping aids often contain antihistamines, which have CNS depressant effect. Doxylamine (Unisom) and diphenhydramine (Sominex, Benadryl), acetaminophen/diphenhydramine (Extra Strength Tylenol PM) As with other CNS depressants, concurrent use of alcohol can cause respiratory depression or arrest

barbiturates overdose management

OD effects: possible coma/death, CNS depression treatment is symptomatic and supportive maintain adequate airway, assist ventilation, oxygen administration if needed, fluid and pressor support activated charcoal to bind to drug molecules forced diuresis using diuretics (furosemide)

Adverse Effects general anesthesia: Malignant Hyperthermia

Occurs during or after volatile inhaled general anesthesia or use of the neuromuscular blocking drug (NMBD) succinylcholine Sudden elevation in body temperature (greater than 104° F) Tachypnea, tachycardia, muscle rigidity Life-threatening emergency Treated with cardiorespiratory supportive care and dantrolene (skeletal muscle relaxant)

acute pain

Onset: sudden (minutes to hours) usually sharp, localized, physiologic response (SNS tachycardia, sweating, pallor, increased blood pressure) Duration: limited (has an end) Examples: myocardial infarction, appendicitis, dental procedures, kidney stones, surgical procedures

What is Cyclobenzaprine (Flexeril)?

Oral and extended release oral form (Amrix) Centrally acting muscle relaxer Most common used muscle relaxer Can cause marked sedation On the BEERS List

What is Baclofen (Lioresal)?

Oral and injectable forms Treat chronic spastic muscular conditions Implantable baclofen pump device

CNS stimulants anorexiants drug interactions

Other appetite suppressants MOA inhibitors and SSRI - Cause Serotonin syndrome

Barbiturates: Toxicity and Overdose

Overdose frequently leads to respiratory depression and subsequent respiratory arrest. Overdose produces CNS depression (sleep to coma and death). Can be therapeutic Anesthesia induction Uncontrollable seizures: "phenobarbital coma"

General Anesthesia: ´Drugs that induce a state in which the CNS is altered to produce varying degrees of:

Pain relief Depression of consciousness Skeletal muscle relaxation Reflex reduction

Allergic

Para-aminobenzoic acid compound is responsible for _________ reaction.

What is Porpofol (Diprivan)

Parenteral general anesthetic Used for the induction and maintenance of general anesthesia Sedation for mechanical ventilation in ICU settings Lower doses: sedative-hypnotic for moderate sedation Monitor triglycerides if administered with total parenteral nutrition Some states prohibit administration by nurses.

nursing process related to drug therapy (Planning - goals) for sedative drug class

Patient will remain asleep for 6 -8 hours

What is chronic pain?

Persistent or recurring Lasts 3-6 months Often difficult to treat Tolerance Physical dependence

A barbiturate used primarily to control tonic-clonic and partial seizures

Phenobarbital

CNS stimulants anorexiants

Phentermine (Ionamin) Prototype other drugs: orlistat (Xenical) - not a CNS stimulant

Generic name of a first line antiepileptic drug which can cause gingival hyperplasia with long term use

Phenytoin

Neuromuscular Blocking Drugs

Prevent nerve transmission in skeletal and smooth muscles leading to paralysis. Often used as adjuncts with general anesthetics for surgical procedures.

Toxicity and Management of Overdose

Primarily involve the CNS No specific antidote or reversal Best treated with conservative supportive measures If taken along with other CNS depressants Adequate airway must be maintained EKG monitoring Fluid management to avoid crystalluria

A type of epilepsy with an unknown cause

Primary

Advantages of IV drug therapy

Rapid drug distribution into the bloodstream Rapid onset of action No drug loss to tissues

Nondepolarizing Neuromuscular Blocking Drugs: Rocuronium (Zemuron) - FYI

Rapid-to-intermediate acting Adjunct to general anesthesia Facilitates tracheal intubation Provides skeletal muscle relaxation

Barbiturates: Adverse Effects: Sleep

Reduced REM sleep, resulting in: ´Agitation ´Inability to deal with normal stress

Muscle Relaxants: Indications

Relief of painful musculoskeletal conditions Muscle spasms Management of spasticity of severe chronic disorders (multiple sclerosis, cerebral palsy) Work best when used along with physical therapy

CNS depressants sedative-hynotics patient teaching

Report side effects of dizziness Instruct patient to get up slowly from a lying position or to a standing position Teach the patient / family to report signs of confusion, ataxia, lethargy Instruct patient/family to report changes in mood or affect Avoid alcohol and other antidepressant drugs because antidepressant effects of both will be potentiated Avoid driving or using heavy machinery until the effects of the drugs are known Instruct the patient not to take OTC drugs, herbal supplements or caffeine or alcohol until talking with physician or nurse Instruct the patient who is long term therapy not to suddenly stop taking the drug Take the drug before bedtime Take with meals / snack to avoid gastric discomfort Inform physician if planning to become pregnant or become pregnant

Neuromuscular Blocking Drugs: Safety

Respiratory muscle paralysis occurs with these drugs. Emergency ventilation equipment must be immediately available.

Pregabalin (Lyrica)

Schedule V controlled substance Indication: adjunct therapy for partial seizures Most common uses: neuropathic pain, postherpetic neuralgia, and fibromyalgia Contraindication: known drug allergy Adverse drug reactions: primarily CNS related

A type of epilepsy with a distinct cause

Secondary

Three sets are available for administering IV drugs

Secondary set, similar to regular IV tubing, except shorter, that is inserted or piggybacked into the primary IV line port Calibrated cylinder (chamber) with tubing also inserted into the primary IV port Regular set used with infusion pump and piggybacked into the primary set at a port closer to the patient

Benzodiazepines: Indications

Sedation Sleep induction Skeletal muscle relaxation Anxiety relief Anxiety-related depression

Selective Serotonin Receptor Agonists (Triptans)

Selective Serotonin Receptor Agonists (Triptans) Drugs: -Sumatriptan (Imitrex), -Zolmitriptan (Zomig), -Eletriptan (Relpax) Indication: For migraine and cluster headaches**Most effective (given sq [this one hurts, but works the fastest], PO, and nasal spray) Action: Vasoconstricts Contraindications: Severe hypertension, heart disease (B/C it does inc your BP) Adverse Side Effects -Common: --injection site reaction , paresthesias, --hot or cold sensation, --malaise/fatigue, --chest pain, --dizziness, --flushing -Uncommon: Peripheral vascular ischemia, loss of vision, MI, cardiac arrest Nursing Implications/Patient Teaching Know patient history Discuss potential side effects (hot and cold sensation.. Etc.) Monitor for extreme adverse effects

selective MAO-B inhibitors

Selegiline and rasagiline

Complications of IV drug therapy

Sepsis Thrombosis, phlebitis Air emboli Infiltration, extravasation

What is Nonbenzodiazepine: Zolpidem (Ambien)?

Short-acting nonbenzodiazepine hypnotic Lower incidence of daytime sleepiness compared with benzodiazepine hypnotics Ambien CR is a longer acting form with two separate drug reservoirs. Somnambulation Not as much daytime sleepiness. Should be 30mins before you go to bed. Like when you take it, get in bed ha ha.

Intubation with an endotracheal tube

Shorter-acting NMBDs are often used to facilitate....?

Ethanol Withdrawal

Signs and symptoms ´Elevated blood pressure, pulse rate, and temperature ´Insomnia ´Tremors ´Agitation ´Classified as mild, moderate, and severe

Adjunct Anesthetics

Simply adjuncts are also used. Drugs used in combination with anesthetic drugs to control the adverse effects of anesthetics or to help maintain the anesthetic state in the patient.

Barbiturates: Mechanism of Action

Site of action: brainstem (reticular formation) By potentiating the action of GABA, nerve impulses traveling in the cerebral cortex are inhibited.

nursing process related to drug therapy (diagnoses) for sedative drug class

Sleep deprivation related to anxiety Risk for Injury related to dizziness

Intravenously administered antiepileptic drugs are given _____ to avoid serious adverse effects

Slowly

Antihypertensives, beta blockers

Some of the common drugs that interact with general anesthetics are ______________ and ______ __________, which have additive affects when combined with general anesthetics.

Benzodiazepines: Toxicity and Overdose

Somnolence Confusion (common with overdose) Coma Diminished reflexes Do not cause hypotension and respiratory depression unless taken with other CNS depressants Treatment symptomatic and supportive Flumazenil as an antidote

Block all peripheral nerves

Spinal or intraspinal anesthesia is generally given to....?

Anesthesia

State of reduced neurologic function. Further classified as general or local.

Infusion sets

Sterile spike for entry into the IV bag or bottle A drip chamber A roller clamp that controls flow Tubing length from drip chamber to IV site Y-site for a secondary set or giving IV drugs Needleless adapter

Commonly Abused Substances: Stimulants

Stimulants ´Racemic amphetamine ´Dextroamphetamine ´Methamphetamine ´Cocaine, methylphenidate, dextroamphetamine, phenmetrazine, and methamphetamine, "Ecstasy" Abuse is related to ability to elevate mood, reduce fatigue, increase alertness, and invigorate aggressiveness.

CNS depressants sedative-hynotics mechanisms of action for nonbenzodiazepines

Structurally different from benzodiazepines but produce similar effects. Buspirone Has not been determined but not thought to bind to GABA receptor sites zolpidem (Ambien) Prototype eszopiclone (Lunesta) ramelteon (Rozerem) buspirone (BuSpar)

Neuromuscular Blocking Drugs: Depolarizing Drugs

Succinylcholine Works similarly to neurotransmitter acetylcholine (ACh), causing depolarization Metabolism is slower than ACh, so as long as succinylcholine is present, repolarization cannot occur. Result: flaccid muscle paralysis

What is acute pain?

Sudden onset Usually subsides once treated

Local anesthetics are used for:

Surgical, dental, and diagnostic procedures Treatment of certain types of chronic pain Spinal anesthesia: to control pain during surgical procedures and childbirth

CNS stimulants anorexiants patient teaching

Take the drug first thing in the morning Avoid CNS depressants including alcohol Consult physician or nurse before taking OTC or herbal drugs Follow-up appointments are necessary Orlistat: Omit dose if you skip a meal or there is no fat in the meal Common GI side effects include excessive flatus, oily spotting, increased bowel movements, etc. Report signs of hepatotoxicity

Adverse Effects: Antipsychotic Drugs - Tardive dyskinesia (TD)

Tardive dyskinesia (TD) ´Involuntary contractions of oral and facial muscles ´Choreoathetosis (wavelike movements of extremities) ´Occurs with continuous long-term antipsychotic therapy

Oral

The ______ route of drug administration is commonly used in pediatric patients.

Amine type

The _______ _______ of anesthetics is metabolized to active and inactive metabolites in the liver by other enzymes.

Medullary

The _____________ center which governs the vital functions, is the last area of the brain to be affected by anesthetics and the first to regain function.

Schedule 2

The drug has a high potential for abuse. The drug has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Abuse of the drug may lead to severe psychological or physical dependence.

Schedule 1

The drug has a high potential for abuse. The drug has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use of the drug under medical supervision. No prescriptions may be written for Schedule I substances, and they are not readily available for clinical use. NOTE: Tetrahydrocannabinol (THC, marijuana) is still considered a Schedule 1 drug by the DEA, even though some U.S. states have legalized marijuana for personal, recreational use or for medical use

Schedule 4

The drug has a low potential for abuse relative to the drugs in schedule 3 The drug has a currently accepted medical use in treatment in the United States. Abuse of the drug may lead to limited physical dependence or psychological dependence relative to the drugs in schedule 3.

Schedule 3

The drug has a potential for abuse less than the drugs in schedules 1 and 2. The drug has a currently accepted medical use in treatment in the United States. Abuse of the drug may lead to moderate or low physical dependence or high psychological dependence.

How to recognize Benzos

The generic names of Benzos end in "am." Since this drug class causes sedative effects, think of patients who take Benzos as not wanting to get up in the morning (the "am").

It is necessary to know the drop factor of the IV set to calculate the hourly infusion rate.

a.The drop factor usually is printed on the package of the infusion set. b.Macrodrip sets deliver large drops (10, 15, or 20 gtt/mL). c.Microdrip sets deliver small drops (60 gtt/mL).

REM rebound

abnormal amounts of REM sleep after discontinuance of sedative-hypnotics

Nerves releasing ________________ are called _____________ so the receptors in the target tissues are called cholinergic receptors

acetylcholine (ACh); cholinergic

ACh

acetylcholine is the neurotransmitter at the end of the postganglionic neuron in the parasympathetic nervous system

Sympathetic Nervous System

activated during times of stress and is known as the "fight or flight" response. The effects on the body tissues and organs are for the most part opposite of the parasympathetic response

Parasympathetic nervous system

activated during times when the body is not stressed and is conserving or restoring energy

benzos adverse effects

after prolonged use, abruptly quitting may cause: vomiting nausea tremors abdominal, muscle cramps sweating convulsions increased anxiety

barbiturates adverse effects hematologic

agranulocytosis thrombocytopenia

barbiturates indications

all barbiturates have same sedative hypnotic effects differ in potency, onset, duration of action therapeutic purpose: short acting - surg procedures-anesthesia, induction short acting sedation, control of convulsives intermediate sedation and control of convulsives long acting epileptic seizure prophylaxis

benzos as antianxiety meds

alprazolam (Xanax) chlordiazepoxide (Librium) diazepam (Valium) lorazepam (Ativan)

Antidepressants

alters levels of two important neurotransmitters in the brain, norepinephrine and serotonin, to reduce depression and anxiety

antiparkinsons drug amantadine presynaptic dopamine release enhancer

amantadine indirecting drug also an antiviral used in the treatment of influenza A. also used in the beginning stages of Parkinsons The mechanism of action is not totally understood, but it is thought that this drug increases the release of dopamine from the vesicles in the presynaptic neuron and then also slows the reuptake of dopamine. Both actions would result in more dopamine being available to attach to the receptors.

nonbenzo z-hypnotics

ambien (often used for short term insomnia tx) lunesta (long term insomnia therapy-no tolerance) sonata (often used for short term insomnia tx) bind w/GABA receptor, inhibit CNS response

CNS stimulants ADHD contraindications

amphetamines: Hypersenstivity Anxiety and agitation Tourette syndrome Glaucoma Use cautiously in cardiac disease non-stimulants: atomoxetine (Strattera) - Hypersensitivity, Glaucoma Guanfacine (INTUVINA) - Hypersensitivity, Children with preexisting cardiac conditions

CNS stimulants ADHD adverse effects

amphetamines: Insomina Anorexia; weight loss Tachycardia Decrease in growth non-stimulants: atomoxetine (Strattera): Suicidal ideation Hepatic impairment Other adverse effects similar to amphetamines Guanfacine (INTUVINA): Drowsiness Headache Fatigue Dry mouth Constipation Hypotension bradycardia

Tranquilizer

an older term sometimes used to describe a drug that produces a calm or tranquil feeling

SSRIs and SNRIs are prescribed more than older _______________

antidepressants

OTC hypnotics

antihistimines: doxylamine (Unisom) diphenhydramine (Sominex) analgesics: acetaminophen *caution: use w/alcohol can cause respiratory depression or arrest

CNS depressants sedative-hynotics indications

anxiety (nonbenzo, buspirone) insomnia

Panic disorder

anxiety disorder characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity

Situational anxiety

anxiety experienced by people faced with a stressful environment

primary indications for use of benzodiazepines

anxiety, insomnia, anticonvulsants wide therapeutic index = less likely overdose issues. short term treatment of insomnia caused by anxiety. allow an individual to quickly fall asleep decrease waking freq. during night midazolam (Verded) are used during anesthesia - especially conscious sedation - to reduce the memory of the discomfort of the procedure. used for treatment of acute alcohol withdrawal. benzodiazepines function: to inhibit/depress GABA neuron function in the CNS.

beta blocker

any of a class of drugs that prevent the stimulation of the adrenergic receptors responsible for increased cardiac action. Beta blockers are used to control heart rhythm, treat angina, and reduce high blood pressure

nonbenzodiazepines

are all the drugs that are used for anxiety and insomnia that are not chemically similar to benzodiazepines or barbiturates but produce similar effects.

MAO enzymes

are throughout the body. primary function is to breakdown catecholamines like dopamine, epinephrine and norepinephrine. If you give a MAO inhibitor, it will influence MAO enzymes throughout the body. there are 2 subglasses of MAO enzymes, MAO 1 and MAO-B. MAO-B is found mostly in the brain.

Limbic system

area in the brain responsible for emotion, learning, memory, motivation, and mood

CNS stimulants ADHD indications for non-stimulants

atomoxetine (Strattera) ADHD Guanfacine (INTUVINA) ADHD, Hypertension

CNS stimulants ADHD mechanisms of action for non-stimulants

atomoxetine (Strattera) Selectively inhibits the presynaptic transporter of norepinephrine so the reuptake does not occur Guanfacine (INTUVINA) Selective alpha-2 adrenergic which decreases the sympathetic outflow to heart

Autonomic nervous system

autonomic nervous system is composed of two subdivisions; sympathetic and parasympathetic nervous systems. Some tissues and organs are stimulated by only one of the systems; a few are stimulated by both

antipsychotic teaching tips

avoid hot baths, saunas, hot climates (drops BP) don't stop abruptly, may induce psychosis (withdrawal interactions: alcohol, CNS depressants, levodopa, antihypertensives WBC drop: report malaise, fever, bleeding to prescriber

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 1. A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see within adverse effect? a. Bradycardia b. Nervousness c. Mental clouding d. Drowsiness at night

b

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 4. A patient has a new prescription for sumatriptan (Imitrex). The nurse providing patient teaching on self-administration will include which information? a. Correct technique for intramuscular injections b. Take the medication before a headache worsens. c. Allow at least 30 minutes between injections d. Take no more than 4 doses in a 24-hour period

b

Preparation for the NCLEX® Examination Questions - Chapter 13 2. A child is prescribed methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD). The parent expresses concern about using a controlled substance to treat ADHD and asks the nurse about using a noncontrolled substance. The nurse knows ADHD can be treated with which noncontrolled substance? a. Methylphenidate (Concerta) b. Atomoxetine (Strattera) c. Amphetamine aspartate (Adderall) d. Dextroamphetamine sulfate (Dexedrine)

b Atomoxetine (Strattera) Atomoxetine (Strattera) is not a controlled substance because it lacks drug addictive (psychological dependence) properties, unlike amphetamines and phenidates.

Preparation for the NCLEX® Examination Questions - Chapter 13 7. A nurse working with patients who are diagnosed with ADHD is aware that such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified? a. Schedule IV b. Schedule II c. Schedule I d. Schedule III

b Schedule II CNS stimulants are the first-line drugs of choice for both ADHD and narcolepsy. They are potent drugs with a strong potential for tolerance and psychological dependence and are therefore classified as Schedule II drugs under the Controlled Substances Act.

muscle relaxants (drugs)

baclofen (Lisoreal) (C) cyclobenzaprine (Flexeril) (B) chlorzoxazone (Paraflex) carisoprodol (Soma) *abuse potential metaxalone (Skelaxin) methocarbamol (Robaxin) tizanidine (Zanaflex) dantrolene (Dantrium) *direct action on skeletal muscle

half-life

benzos characterized by long or short acting long is >12 hours short is <12 hours Drugs with long half lives take 5-7 days to reach a sustained therapeutic effect. They linger longer in the body. could cause problems for older adults, people w/ liver disease.

antiepileptics adverse effects

birth defects each drug has own set of adverse effects (many) suicidal behavior/thoughts depression mood changes p. 224 table 14-4: dizziness, lethargy, drowsiness etc. depends on drug used

BP low

blood pressure varies from person to person, a blood pressure reading of 90 millimeters of mercury (mm Hg) or less systolic blood pressure (the top number in a blood pressure reading) or 60 mm Hg or less diastolic blood pressure (the bottom number) is generally considered low blood pressure

What does isotonic mean?

both solutions have an equal concentration

seizure

brief episode of abnormal electrical activity in nerve cells of the brain which may or may not lead to convulsion 3 categories: - tonic-clonic (start w/muscular contraction, progress to alternating contraction/relaxation - clonic), atonic (drop attacks - sudden global muscle weakness) - myoclonic seizures: brief muscular jerks - absence seizures: brief loss of awareness

barbiturates intermediate acting

butabarbital (Butisol)

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 8. A patient with narcolepsy is having problems with excessive daytime sleepiness. The nurse expects which drug to be prescribed to improve the patient's wakefulness? a. Phentermine (Ionamin) b. almotriptan (Axert) c. Modafinil (Provigil) d. Methyphenidate (Ritalin)

c

Preparation for the NCLEX® Examination Questions - Chapter 13 3. A patient diagnosed with narcolepsy is prescribed a central nervous system (CNS) stimulant. Which statement best describes the action of CNS stimulants? a. CNS stimulants activate cyclic adenosine monophosphate. b. CNS stimulants block or reduce the activity of inhibitory neurons. c. CNS stimulants increase release of and block reuptake of neurotransmitters. d. CNS stimulants decrease the production of excitatory neurotransmitters.

c CNS stimulants increase release of and block reuptake of neurotransmitters. CNS stimulation occurs when the amount of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased.

Preparation for the NCLEX® Examination Questions - Chapter 13 5. Which instructions should the nurse discuss to reduce the gastrointestinal (GI) adverse effects of orlistat (Xenical)? a. Advise to take vitamin C supplement. b. Take the medication with an antacid. c. Limit dietary intake of fat. d. Increase fluid and fiber in the diet.

c Limit dietary intake of fat. Orlistat is an anorexiant that works by blocking the absorption of fat from the GI tract. Restricting dietary intake of fat reduces the GI adverse effects associated with increased fat content in stool (flatulence, oily spotting, and fecal incontinence).

Preparation for the NCLEX® Examination Questions - Chapter 13 6. Ergot alkaloids exert their therapeutic effect by which action? a. Simulation of the alpha receptors. b. Vasodilation. c. Vasoconstriction. d. Blockade of the beta2 receptors.

c Vasoconstriction Ergot alkaloids narrow or constrict blood vessels in the brain. They are useful in the treatment of migraine headache caused by vasodilation of vessels in the brain. Ergot alkaloids were the mainstay of treatment of migraine headaches but have been replaced by the triptans for first-line therapy.

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 6. The nurse is reviewing medication therapy with the parents of an adolescent with ADHD. Which statement is correct? (Select all that apply.) a. "Be sure to have your child blow his nose before administering the nasal spray." b. "This medication is used only when symptoms of ADHD are severe." c. "The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep." d. "Be sure to contact the physician right away if you notice the expression of suicidal thoughts." e. "We will need to check your child's height and weight periodically to monitor physical growth." f. "If adverse effects become severe, stop the medication for 3 to 4 days."

c,d,e

CNS stimulants assessment pediatric

cautious continuous assessment gather info: baseline weight height vitals sleep habits, patterns atypical behavior loss in attn. span history of social probs probs in school social supports/parentals nutrition and dietary assessment cardiac assess. BP, pulse rate, heart sounds, history of chest pain or palpitations use of any prescriptions, OTC, herbals, ginseng, caffeine

muscle relaxant drug interactions

central acting: CNS depressants including alcohol and kava Use of MAO inhibitors direct acting: alcohol and kava antihistimines

Fight-or-flight response

characteristic set of signs and symptoms produced when the sympathetic nervous system is activated

Bipolar disorder

characterized by periods of depression that alternate with episodes of mania. the individual will be deeply depressed for a period of time and then swing to a period of being excessively elated or irritable (known as mania) . It is thought that bipolar disorders occur due a interaction of several variable including genetics, neurobiology, psychological factors and environmental factors.

epilepsy

chronic recurrent pattern of seizures excessive electrical discharges detected by EEG

Catecholamines

class of agents secreted in response to stress that includes epinephrine, norepinephrine and dopamine

tramadol

class: nonopijoid analgesic (with opioid like activity; class CIV narcotic) indications: relief of moderate to severe pain; should not be used with tricyclic antidepressants, SSRIs, drugs that reduce seizure threshold.

acetaminophen

class: nonopioid analgesic, antipyretic indications: relief of mild to moderate pain.

lidocaine (transdermal)

class: topical anesthetic indications: postherpetic neuralgia, (pain relief)

Ganglion

collection of neuron cell bodies located outside the CNS

What is general anesthesia?

complete loss of consciousness and loss of body reflexes, including paralysis of respiratory muscles

Physical dependence

condition of experiencing unpleasant withdrawal symptoms when a substance is discontinued

clonic spasm

contractions of the affected muscles occur repeatedly, forcibly, and in quick succession, with equally sudden and frequent relaxations

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 2. A patient at a weight management clinic who was given a prescription for orlistat (Xenical) calls the clinic hotline complaining of a "terrible side effect." The nurse suspects that the patient is referring to which problem? a. Nausea b. Sexual dysfunction c. Urinary incontinence d. Fecal incontinence

d

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 3. The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate? a. Deficient fluid volume b. Sleep deprivation c. Impaired memory d. Imbalanced nutrition, less than body requirements

d

____________ is the only muscle relaxant that works directly at the muscle site.

dantrolene It decreases the muscle's response to stimuli. It does this by interfering with calcium ions release into the skeletal muscle.

diuretics

decrease the amount of sodium and water the body reabsorbs. results in increased urine output reduction of edema decreased blood pressure do not give diuretics to an individual that already has low blood pressure - it would only lower it more and cause more signs and symptoms. do not give to a patient who has low potassium or sodium. (You would not want to further lower their electrolytes)

opioid naive

describes patients who are receiving opioid analgesics for the first time and who therefore are not accustomed to their effects

Succinylcholine

description: depolarizing neuromuscular blocking drug (NMBD); like Ach. flaccid muscle paralysis results. Intubation Risk: muscular fasciculations.

ketamine

description: general anesthesia and moderate sedation. Risk: disturbing psychomimetic effects including hallucinations.

nitrous oxide

description: laughing gas, weakest of general anesthetics. Risk: postoperative nausea and vomiting (PONV)

Propofol

description: parenteral general anesthetic used for the induction and maintenance of general anesthesia and sedation in ICU. lower dose for sedative-hypnotic for moderate sedation Risk: monitor serum lipids

Generalized anxiety disorder (GAD)

difficult to control, excessive anxiety that lasts 6 months or more, focuses on a variety of life events, and interferes with normal day-to-day functions

Central nervous system (CNS)

division of the nervous system consisting of the brain and spinal cord

Peripheral nervous system

division of the nervous system containing all nervous tissue outside the CNS, including the autonomic nervous system

antiepileptics nursing process evaluation

document patient responses to meds assess for MSE changes, level of consciousness monitor CBC affect, eye probs, visual disorders measure serum levels to keep in therapeutic range

muscle relaxants action on CNS

does not work directly on the muscle to make it relax -- sends signal from brain to tell the muscle to relax. unclear what the exact mechanism of action is for many of the central acting muscle relaxants. Others are known: example, baclofen (Lioresal) potentates the GABA inhibitory effect on the CNS. cyclobenzaprine (Flexeril) is pharmacologically similar to tricyclic antidepressants. blocks reuptake of norepinephrine in brain increased amount of norepinephrine circulating. This drug has anticholinergic effects. This drug is usually only given for 2-3 weeks.

antiparkinsons drug mechanism of action

dopamine replacement: Converted to dopamine in the brain dopamine agonists: Stimulates dopamine receptors in the brain

antiparkinsons drug adverse effects

dopamine replacement: Drowsiness / dizziness Hypotension Nausea and vomiting Involuntary movements Hallucinations dopamine agonists: Drowsiness / dizziness Hypotension Nausea and vomiting Hallucinations

antiparkinsons drug contraindications

dopamine replacement: Hypersensitivity Angle closure glaucoma (increases pressure) Malignant melanoma (can activate malignant disease) dopamine agonists: Hypersensitivity

antiparkinsons drug interactions

dopamine replacement: MAO inhibitors (hypertension) Anticholinergics (reduce absorption) Benzodiazepines (decrease levodopa effect) Pyridoxine foods (decrease levodopa effect) dopamine agonists: Concurrent use with levodopa

antiparkinsons drug indications

dopamine replacement: Parkinson's Disease dopamine agonists: This group of drugs is used both the early and later stages of Parkinson's disease. Restless Leg Syndrome

antiparkinsons drug

dopamine replacement: carbidopa - levodopa (Sinemet) prototype dopamine agonists: pramipexole (Mirapex) - nonergot prototype

What is a Sedative-hypnotic?

dose dependent At low doses, calm the CNS without inducing sleep. At high doses, calm the CNS to the point of causing sleep. Classified into three main groups: ´Barbiturates ´Benzodiazepines ´Miscellaneous drugs

barbiturates adverse effects

drowsiness lethargy dizziness hangover paradoxical restlessness excitement prolonged drowsiness, lethargy, dizziness deprivation of REM sleep enzyme inducers respiratory depression

barbiturates adverse effects nervous

drowsiness lethargy vertigo

barbiturates contraindications

drug allergy pregnancy respiratory difficulties severe kidney/liver disease caution use with elderly, increase fall risk, sedative props

synergistic effects

drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone. For example, 1 + 1 is greater than 2. ex. hydrocodone with acetaminophen. Amoxicillin.

Anticholinergic

drug that blocks the actions of the parasympathetic nervous system

Adrenergic antagonist

drug that blocks the actions of the sympathetic nervous system

Hypnotic

drug that causes sleep

Sympathomimetic

drug that stimulates or mimics the sympathetic nervous system

Sedative-hypnotic

drug with the ability to produce a calming effect at lower doses while having the ability to induce sleep at higher doses

Anxiolytics

drugs that relieve anxiety

lithium mild side effects

dry mouth, thirst polyuria fine hand tremors mild nausea

affective disorder

emotional disorders characterized by mood changes mania to depression include anxiety pathology when moods become life altering

psychotherapeutic nursing assessment

emphasize past, present medical history, physical exam, medication history and profile

Catechol O-methyltransferase (COMT)

enzyme that destroys levodopa in the blood stream. COMT inhibitors work like carbidopa. they prevent levodopa from being destroyed in the blood before it gets to the brain. COMT inhibitors work on a different enzyme. COMT inhibitors are used in conjunction with levodopa to help with the "wearing off" portions of the drug therapy. So for the hour or so as the levodopa wears off before the next dose (bridge gap between next dose). There is a combination drug called Stalevo which combines entacapone, levodpa and carbidopa into one pill making it eaiser for patients to take. side effects: Discoloration of urine But pretty well tolerated

Monoamine oxidase (MAO)

enzyme that destroys norepinephrine in the nerve terminal

benzos used for insomnia

estazolam (Prosom) furazepam (Dalmane)

antiepileptics mechanism of action and drug effects

exact mechanism uncertain evidence indicates drugs alter movement of sodicum, potassium, calcium, and magnesium ions (movement stabilizes and makes cell membranes less excitable) stabilize neurons keep them from being hyperexcited/generating excessive nerve impulses to adjacent neurons increase threshold of activity in motor cortex limit the spread of seizure discharge from origins decrease the speed of nerve impulses conduction w/in a given neuron some drugs may indirectly affect seizure foci (locations) in brain by altering blood supply to the areas

Respiration

exchange of oxygen and carbon dioxide in the lungs; also the process of deriving energy from metabolic reactions

Acetylcholine

excitatory neurotransmitter while dopamine is an inhibitory neurotransmitter in the brain. a delicate balance between acetylcholine (a neurotransmitter that carries messages along the nerves) and dopamine must be maintained. Acetylcholine inhibits motor activity, while dopamine facilitates motor activity.

Phobias

fearful feelings attached to situations or objects such as snakes, spiders, crowds, or heights

ramelteon (Rozerem)

first rx. hyptotic in 35 yrs. w/new mechanism of action structurally similar to melatonin agonist at melatonin receptors in CNS not a CNS depressant hypnotic lack of observed dependency risk used for those with difficult sleep onset contraindicated for those w/severe liver dysfunction avoid use if taking: flovoxamine, fluconazole, ketoconazole

antiepileptics nursing process planning

goals 1) patient demonstrates knowledge about diagnosis, drug therapy 2) compliant w/therapy regimen, avoid adverse effects 3) maintains positive self esteem, body image 4) free of injury during drug therapy

autonomic nervous system

has 2 neurons w/synapse in between sympathetic and parasympathetic nervous systems

Rasagiline

has been approved as a monotherapy meaning it can be used by itself in the early stages of treatment. often used in the early stages of Parkinson's disease

Sonata

helpful for patients who go to sleep but wake up and can not get back to sleep. short half-life (1 hour) so a patient can take the drug at 1 or 2 am to get back to sleep. • used for short term insomnia treatment - usually less than 10 days.

barbiturates adverse effects other

hypersensitivity reactions: urticaria angioedema rash fever Stevens-Johnson syndrome

Local anesthetics i. Types - general ii. Effects iii. Indications iv. Adverse effects

i. Types - general ii. Effects- progressive reduction of sensory and motor CNS functions. iii. Indications- used to produce unconsciousness and relaxation for surgical procedures and in electroconvulsive therapy for severe depression. Contraindications are drug allergy and possibly pregnancy, narrow angle glaucoma, acute porphyria, and known susceptibility to malignant hyperthermia. iv. Adverse effects- Heart, peripheral circulation, liver, kidneys, and respiratory tract are primarily affected. hypotension, post nausea, vomiting, confusion, malignant hyperthermia

primary epilepsy

idiopathic epilepsy epilepsy without identifiable cause

benzo contraindications

if there's a known drug allergy Pregnancy and nursing mothers can cross the placenta and be excreted in breast milk • Category D drugs Narrow angle glaucoma • drugs produce changes in intraocular pressure Severe kidney or liver disease • Most of the drugs in this group are mainly metabolized in the liver. if liver function is impaired, there's a greater risk of higher blood levels of the drug.

nursing process psychotherapeutic drugs diagnoses

imbalanced nutrition, related to mental health/drugs urinary retention related to psychotherapeutic drugs constipation related to psychotherapeutic drugs sexual dysfunction related to psych drugs sleep deprivation related to mental health/drug therapy deficient knowledge lack of info about psych drugs impaired social interaction related to illness situational low self esteem related to mental health/psych drugs risk for self injury related to mental health

Postsynaptic neuron

in a synapse, the nerve that has receptors for the neurotransmitter

Long-term insomnia

inability to sleep for more than a few nights, often caused by depression, manic disorders, and chronic pain

Short-term or behavioral insomnia

inability to sleep that is often attributed to stress caused by a hectic lifestyle or the inability to resolve day-to-day conflicts within the home or workplace

enzyme induction

increased activity of hepatic microsomal or cytochrome P-450 enzymes (increased drug metabolism/breakdown) if two drugs are competing for the same enzyme system, the result is inhibited drug metabolism and possibly increased toxicity of metabolized drugs by this enzyme

Rebound insomnia

increased sleeplessness that occurs when long-term antianxiety or hypnotic medication is discontinued

Psychological dependence

intense craving for a drug that drives people to continue drug abuse withdrawn

temazepam (Restoril)

intermediate acting benzo metabolite of diazepam induces sleep within 20-40 mins long onset recommended dose 1 hr. before bed effective hypnotic, but is less freq. prescribed

antiepileptics nursing process implementation

interventions aimed at monitoring patient while providing safety measures, securing airway, breathing, circulation tongue can relax during a seizure and fall into airway, blocking it rescue breathing if there's no breath 1 in every 5 secs. keep suction equip handy keep patient secure in bed, guardrails up side lying position if necessary drugs administered at the same time, if orally, with fluid reduce GI upset by taking with meals avoid: juice, carbonation, milk beverages w/meds do not crush, open/chew med capsules oral suspensions are shaken, solution mixed thoroughly

Spasticity

is a condition in which certain muscles are continuously contracted.

Eszopiclone (Lunesta)

is a hypnotic that can be used for long term therapy. It does not produce tolerance

Selegiline

is used as an adjunct therapy with carbidopa-levodopa. often used in the early stages of Parkinson's disease

Synapse

junction between two neurons consisting of a presynaptic nerve, a synaptic cleft, and a postsynaptic nerve

antiepileptics contraindications

known drug allergy pregnancy (risks considered/weighed benefit/harm to mother/child) newer antiepileptics safer for mother and child

Sleep debt

lack of sleep

What does hypotonic mean?

less solute, more water

where are benzodiazepines metabolized

liver

What is monitored anesthesia care (MAC)?

local anesthesia along with sedation and analgesia

Anorexia

loss of appetite

Benzodiazepines

major class of drugs used to treat anxiety disorders

psychosis

major emotional disorder, impairs mental function individual experiencing psychosis loses contact w/reality

analgesics (painkillers)

medications that relieve pain without causing loss of consciousness

Meperidine

meperidine-like drug class: opioid analgesic (Schedule II) indications: acute migraine headaches, immediate post op period to reduce shivering. Not recommended, risk of seizures

fentanyl

meperidine-like drug class: opioid analgesic (Schedule II) indications: procedural sedation or adjunct to general anesthesia; relief of moderate to severe acute pain; relief of chronic pain, including cancer pain

methadone

methodone-like drug class: opioid analgesic (Schedule II) indications: relief of chronic pain, opioid detoxification, opioid analgesia

barbiturates ultra short acting

methohexital (Brevital) thiopental (Pentothal)

The nurse is administering an antiepileptic drug and will follow which guidelines?

monitor the patient for drowsiness give the medication at the same time every day notify the prescriber if the patient is unable to take the medication

phenobarbital

most commonly prescribed barbiturate prototypical barbiturate long acting used to prevent tonic-clonic seizures fever induced convulsions oral and injectable forms tx of hyperbilirubinemia in neonates rarely used as a sedative no longer recommended as a hypnotic

muscle relaxants

mostly centrally acting skeletal muscle relaxants (site of action is CNS) similar in structure and action to CNS depressants like diazepam *dantrolene act directly on skeletal muscle, GABA resemblance sedative effects decreases calcium release from storage sites in sarcoplasmic reticula of muscle fiber

Myasthenia gravis

motor disorder caused by a destruction of nicotinic receptors on skeletal muscles and characterized by profound muscular fatigue

status epilepticus

multiple seizures w/no recovery between them if appropriate therapy doesn't begin quickly, hypotension, hypoxia, brain damage, death ensue

cyclobenzaprine (Flexeril)

muscle relaxant pharmacologically similar to tricyclic antidepressants It blocks reuptake of norepinephrine in the brain increased amount of norepinephrine circulating has anticholinergic effects usually only given for 2-3 weeks.

antiepileptics dosage

narrow therapeutic range monitor plasma levels to maintain therapeutic range

barbiturates adverse effects GI

nausea vomiting diarrhea constipation

lithium toxicity

nausea vomiting diarrhea muscle weakness Severe toxicity is usually treated with gastric lavage - there is no drug antidote. early signs of toxicity, lithium is stopped until the serum blood levels can be determined. The dose then will be adjusted. Dealing with conditions such as dehydration that may have contributed to the problem will also be addressed. Even with advanced signs of toxicity, the patient may not be hospitalized. It will depend on the signs and symptoms. However, as the patient begins to experience severe toxicity (such as seizures and severe hypotension), the patient will be hospitalized to help eliminate the excess lithium.

Somatic nervous system

nerve division that provides voluntary control over skeletal muscle

preganglionic neuron

neuron originating in the CNS

What is local anesthesia?

no paralysis of respiratory function; elimination of pain sensation in the tissues innervated by anesthetized nerves

NREM

non-REM element of sleep, cycled with REM

Nerves releasing ______________ are called ____________ and the receptors in the organs are called adrenergic receptors

norepinephrine (NE); adrenergic

NE

norepinephrine is the neurotransmitter released at the end of the postganglionic neuron in sympathetic nervous system

antiepileptics interactions

numerous drug interactions many antiepileptics induce hepatic metabolism which reduces efficacy of other drugs potential need for alt. birth control grapefruit caution w/carbamazepine (toxicity)

Analgesic ceiling effect

occurs when a given pain drug no longer effectively controls pain despite the administration of the highest safe dosages

chronic pain

onset: slow (days to months) long duration, dull, persistent aching Duration: persistent or recurring (endless) Examples: arthritis, cancer, lower back pain, peripheral neuropathy

sleep architecture

patterns of sleep: consists of RE and non-REM sleep

barbiturates short acting

pentobarbital (Nembutal) secobarbital (Seconal)

barbiturates long acting

phenobarbital (Generic) mephobarbital (Mebaral)

antiepileptics nursing process assessment

physical assessment health and med history identify allergies, drug interactions, adverse reactions, cautions, contraindications inquire about panic attacks, stress levels note any type of seizure disorder, precipitating events seizure duration, freq, intensity problems before, during, after seizure autonomic nervous system responses assoc. w/anxiety neurologic assessment baseline CNS functioning (before giving antiepileptic drugs) review lab results RBC, WBC counts clotting studies renal/liver function urinary output assess potential of other conditions causing altered consciousness: syncope, breath holding, transient ischemic attacks, drug use, metabolic disorders, infections, head trauma, tumors, psychogenic probs

nursing process psychotherapeutic drugs assessment

physical exam (est. baseline) assess neurologic function MMSE mini mental status exam Blessed Orientation Memory Concentration Test dementia: Functional activities questionnaire alzheimer's disease assessment scale mattis dementia rating scale for depression altered autonomic nervous system response suicidal ideations/tendencies suicide assessment scale assess sleep habits BPs (supine and standing) drug allergies nutritional intake, appetite addictive behaviors elimination difficulties

Reticular formation

portion of the brain affecting awareness and wakefulness

benzo indications

pre op insomnia anxiety anticonvulsants acute alcohol withdrawal

midazolam (Versed)

pre-op, IV, or oral liquid - (for children) cause amnesia, sedation anxiolysis - anxiety reducer patients can avoid remembering med procedures

Norepinephrine

primary neurotransmitter in the sympathetic nervous system

Acetylcholine

primary neurotransmitter of the parasympathetic nervous system; also present at somatic neuromuscular junctions and at sympathetic preganglionic nerves

Tolerance

process of adapting to a drug over a period of time, and subsequently requiring higher doses to achieve the same effect

Dopamine

produced from levodopa (L-DOPA). inhibitory neurotransmitter. produced in the substantia nigra, area inside the basal ganglia. basal ganglia is involved with the controlling movement, coordination, and affecting voluntary movement. As an action potential comes down the axon, the vesicles move to the membrane and release the dopamine into the synaptic space. The dopamine then crosses the synapse and attaches to the specific dopamine receptors on the postsynaptic cleft. The dopamine causes an inhibitory response in the post synaptic neuron. After the dopamine performs its function, it releases from the receptor site and then one of 3 things happen. 1. It moves back into the presynaptic neuron through reuptake and is recycled/destroyed 2. It diffuses out into the extracellular fluid 3. It is destroyed by enzymes in the synaptic space.

REM interference

prolonged use of sedative hypnotics can reduce cumulative amount of REM sleep

CNS stimulants

prototype drug: phentermine (Ionamin) orlistat (Xenical) - not a CNS stimulant anorexiants - weight control appetite suppression

nonbenzodiazepine drugs

prototype: zolpidem (Ambien) ramelteon (Rozerem) buspirone (BuSpar) zaleplon (Sonata) eszoplicone (Lunesta)

benzo adverse effects

psychomotor impairment, drowsiness as it inhibits the signals in the hippocampus and cerebral cortex.

Ambien

quick onset (20 minutes). This has implications for patient teaching. The patient should be taught to take the medication just before they are ready to go to sleep. The hypnotic effect lasts 6-8 hours

postganglionic neuron

receives impulse from preganglionic neuron

Obsessive-compulsive disorder

recurrent, intrusive thoughts or repetitive behaviors that interfere with normal activities or relationships

Cholinergic

relating to nerves that release acetylcholine

Adrenergic

relating to nerves that release norepinephrine or epinephrine

muscle relaxant effects

relaxation of striated muscle mild skeletal muscle weakness generalized CNS depression sedation somnolence ataxia respiratory and cardiac depression

barbiturates adverse effects respiratory

respiratory depression cough

situational anxiety

response to specific life events nursing assessment key to identifying patients at risk

Reticular activating system (RAS)

responsible for sleeping and wakefulness and performs an alerting function for the cerebral cortex; includes the reticular formation, hypothalamus and part of the thalamus

Substance abuse

self-administration of a drug that does not conform to the medical or social norms within the patient's given culture or society

convulsion

severe seizure involuntary spasmodic contractions of any/all of voluntary muscles, including skeletal, facial, ocular

pentobarbital (Nembutal)

short acting barbiturate sedative hypnotic for insomnia uses: pre-op alcohol withdrawal acute seizure episodes resulting from: tetanus chorea meningitis poison eclampsia

zolpidem (Ambien)

short acting nonbenzo hypnotic relatively short half life 1.4 - 4.5 hrs. lacks active metabolites potential for somnambulation (sleepwalking) approved for long term use like (Lunesta) eszopiclone

zaleplon (Sonata)

short acting nonbenzo short half life 1 hr. can be taken 4 hours prior to needing to wake up (can be taken in the middle of the night)

Rest-and-digest response

signs and symptoms produced when the parasympathetic nervous system is activated

barbiturate contraindications

similar to benzodiazepines as are most of the adverse effects. Barbiturates are enzyme inducers they decrease the concentration of other drugs the patient is taking. Barbiturates can cause respiratory depression w/out influence of other CNS depressants.

ramelteon (Rozerem)

similar to melatonin structurally best used for those who have trouble going to sleep

stevens johnson syndrome

skin condition, genetic predisposition form of toxic epidermal necrolysis, is a life-threatening skin condition

benzo overdose symptoms

somnolence confusion coma diminished reflexes rarely: hypotension, respiratory depression, death

REM Rapid eye movement sleep

stage of sleep characterized by quick, scanning movements of the eyes

Anxiety

state of apprehension and autonomic nervous system activation resulting from exposure to a nonspecific or unknown cause

Agonists

substance that binds to a receptor and causes a response

Sedative

substance that depresses the CNS to cause drowsiness or sleep

Designer drugs

substances produced in a laboratory and intended to mimic the effects of other psychoactive controlled substances

Psychedelics

substances that alter perception and reality

agonists-antagonists (also called partial agonists)

substances that bind to a receptor and cause a partial response that is not as strong as that caused by an agonist

secondary epilepsy

symptomatic epilepsy epilepsy has a distinct cause

Withdrawal syndrome

symptoms that result when a patient discontinues taking a substance upon which he or she was dependent

opioid analgesics

synthetic drugs that bind to opiate receptors to relieve pain

cholinergic

the abbreviated term referring to acetylcholine. The parasympathetic nervous system, which uses acetylcholine almost exclusively to send its messages, is said to be almost entirely cholinergic

Tetrahydrocannabinol (THC)

the active chemical in marijuana

pain tolerance

the amount of pain a patient can endure without its interfering with normal function

Addiction

the continued use of a substance despite its negative health and social consequences

Insomnia

the inability to fall asleep or stay asleep

Gate theory

the most well-described theory of pain transmission and pain relief. It uses a gate model to explain how impulses from damaged tissues are sensed in the brain

Synaptic transmission

the process by which a neurotransmitter reaches receptors to regenerate the action potential

Digestion

the process by which the body breaks down ingested food into small molecules that can be absorbed

Opioid withdrawal

the signs and symptoms associated with abstinence from or withdrawal of an opioid analgesic when the body has become physically dependent on the substance

lithium bipolar tx mechanism of action

thought to alter sodium transport in nerve and muscle cells. inhibits the release and the reuptake of neurotransmitters.

What does osmolarity mean?

total concentration of solutes in solution

acute muscle spasms (conditions associated with)

trauma inflammation anxiety pain

other drugs frequently prescribed for sleep

trazodone diphenhydramine amitriptyline

CNS stimulants anti migraine mechanism of action

triptans: Act as a serotonin agonist stimulating 5-HT receptor to cause vasoconstriction ergot alkaloids: Act directly on alpha adrenergic receptors to cause vasoconstriction.

CNS stimulants anti migraine drug interactions

triptans: Concurent use or ergot alkaloids MOA inhibitors SSRI antidepressants St John's Wort ergot alkaloids: Beta blockers Hormonal contraceptives Use of triptans

CNS stimulants anti migraine adverse effects

triptans: Dizziness, vertigo Warm sensation Tingling ergot alkaloids: Abdominal pain; nausea and vomiting Hypertension

CNS stimulants anti migraine contraindications

triptans: Hypersensitivity Presence of ischemic heart disease, peripheral vascular disease and uncontrolled hypertension ergot alkaloids: Hypersensitivity Presence of ischemic heart disease, peripheral vascular disease and uncontrolled hypertension Renal or liver disease

muscle relaxants mechanisms of action

two ways muscle relaxants work - 1) by causing a sedative effect in the CNS (central acting muscle relaxants) 2) working directly at the muscle site (direct acting).

Posttraumatic stress disorder

type of anxiety that develops in response to reexperiencing a previous life event that was psychologically traumatic

Nicotinic

type of cholinergic receptor found in ganglia of both the sympathetic and parasympathetic nervous systems

Muscarinic

type of cholinergic receptor found in smooth muscle, cardiac muscle, and glands

Alpha-receptor

type of subreceptor found in the sympathetic nervous system

Beta-receptor

type of subreceptor found in the sympathetic nervous system

nonbenzodiazepine drugs

used for both anxiety and insomnia though the dosages for insomnia are higher. ramelteon (Rozerem)

lithium carbonate bipolar disorder tx

used to treat and prevent manic episodes. It is not a cure, but is helpful in controlling the signs and symptoms of bipolar disorder. Antipsychotics and benzodiazepines are often used at the beginning of treatment for bipolar disorders to help control the mania and calm the patient until lithium has reached its therapeutic levels Indications of effectiveness of the drug include: • Decreased elation and grandiosity • Decreased flight of ideas • Decreased irritability • Decreased anxiety

antiepileptic adverse effects

valporic acid (Depakene) P: Drowsiness, agitation, headache, GI upset, weight gain Bruising / bleeding Hepatotoxicity, Life threatening Suicidal thoughts Succinimides - ethosuximide (Zarontin) : Drowsiness Increased frequency of tonic-clonic seizures GI symptoms: anorexia, cramping, diarrhea, gastric upset, weight loss, Life threatening, Suicidal thoughts Stevens Johnson syndrome Misc. levetiracetam (Keppra), gabapentin (Neurontin) Dizziness, Weakness, Life threatening Suicidal thoughts, Stevens Johnson syndrome

antiepileptics indication

vary among drugs specific seizures/seizure type have specific drug uses used for long term maintenance and tx of epilepsy also useful for acute tx of status epilepticus brain surgery/head injuries may receive prophylactic antiepileptics

barbiturates adverse effects cardiovascular

vasodilation, hypotension (esp. if rapidly given)

lithium adverse effects unrelated

weight gain metallic taste in mouth pruritis headache hypothyroidism

barbiturates

were very common in years past not used as much presently this older pharmacologic drug class produces many side effects have a narrow (low) therapeutic index

Cross-tolerance

when tolerance to one drug makes the patient tolerant to another drug

Benzodiazepines

´ Largest and most commonly prescribed anxiolytic ´Used to treat alcohol withdrawal, insomnia, and muscle spasms as well as adjunct for depression ´Alprazolam (Xanax) ´Diazepam (Valium) ´Lorazepam (Ativan)

Opioid Analgesics: Mechanism of Action- Classifications

´ Three classifications based on their actions ´Agonists ´Agonists-antagonists ´Antagonists (nonanalgesic)

What is opioid tolerance?

´A common physiologic result of chronic opioid treatment ´Result: larger dose is required to maintain the same level of analgesia

Parkinson's Disease: Progressive Condition

´A progressive condition ´Rapid swings in response to levodopa occur ("on-off phenomenon") ´PD worsens when too little dopamine is present. ´Dyskinesia occurs when too much dopamine is present. ´"Wearing-off phenomenon" ´PD-associated dementia

What is equianalgesia?

´Ability to provide equivalent pain relief by calculating dosages of different drugs or routes of administration that provide comparable analgesia ´Hydromorphone (Dilaudid): seven times more potent than morphine ´Example: if morphine 10 mg was given to a patient followed 1 hour later by hydromorphone 1 mg, then the patient would have received an equivalent of 17 mg of morphine. Ex. Slowly taper them off morphine

Obesity

´According to the National Institutes of Health and the Centers for Disease Control and Prevention, approximately 35% of Americans are obese, and nearly two thirds (64.5%) are overweight. ´More than 78 million obese adults ´Many associated health risks

Atypical Antipsychotics: Mechanism of Action

´Advantageous properties over conventional drugs ´Block specific dopamine receptors: dopamine-2 (D2) receptors ´Also block specific serotonin receptors: serotonin 2 (5-HT2) receptors ´This is responsible for their improved efficacy and safety profiles.

Substance Abuse can affect who?

´Affects people of all ages, sexes, ethnic, and socioeconomic groups ´Leads to: ´Physical dependence ´Psychologic dependence ´Habituation ´Addiction

Adverse Effects: Antipsychotic Drugs

´Agranulocytosis and hemolytic anemia ´CNS effects ´Drowsiness ´Neuroleptic malignant syndrome (NMS) ´Extrapyramidal symptoms (EPS): pseudoparkinsonism-akathisia, acute dystonia ´Tardive dyskinesia

Opioid Analgesics: Interactions

´Alcohol ´Antihistamines ´Barbiturates ´Benzodiazepines ´Monoamine oxidase inhibitors ´Others

Benzodiazepines: Interactions

´Alcohol and CNS depressants can result in additive CNS depression and even death. ´More likely to occur in patients with renal or hepatic compromise

Antiepileptic Drugs (AEDs)

´Also known as anticonvulsants ´Goals of therapy ´To control or prevent seizures while maintaining a reasonable quality of life ´To minimize adverse effects and drug-induced toxicity ´AED therapy is usually lifelong. ´Combination of drugs may be used.

Dopamine Modulator

´Amantadine (Symmetrel) ´Antiviral drug used for treatment of influenza ´Indirect acting ´Causes release of dopamine and other catecholamines from their storage sites in the presynaptic fibers of nerve cells within the basal ganglia that have not yet been destroyed by the disease process ´Blocks the reuptake of dopamine into the nerve fibers ´Result: higher levels of dopamine in the synapses between nerves and improved dopamine neurotransmission between neurons

Principal Drugs Used to Treat ADHD and Narcolepsy

´Amphetamines ´Nonamphetamine stimulants ´Atomoxetine: nonstimulant drug also used for ADHD

Mechanism of Action and Drug Effects: Amphetamines

´Amphetamines ´Stimulate areas of the brain associated with mental alertness ´CNS effects ´Mood elevation or euphoria ´Increased mental alertness and capacity for work ´Decreased fatigue and drowsiness ´Prolonged wakefulness

What is pain?

´An unpleasant sensory and emotional experience associated with actual or potential tissue damage ´A personal and individual experience "pain is pain" ´Whatever the patient says it is "pain is pain" ´Exists when the patient says it exists "pain is pain" ´Pain involves: ´Physical factors - trauma or injuries ´Psychologic factors - how experienced pain in past (were they supported?) ´Cultural factors

What is Oxycodone hydrochloride?

´Analgesic agent structurally related to morphine ´Schedule II ´Comparable analgesic activity to morphine ´Often combined with acetaminophen (Percocet) or with aspirin (Percodan) ´IR and SR HYDROCODONE - Hydrocodone (weaker) often combined with acetaminophen (Vicodin, Norco)

Nonopioid Analgesics: Acetaminophen (Tylenol)

´Analgesic and antipyretic effects ´Little to no antiinflammatory effects ´Available over-the-counter (OTC) and in combination products with opioids ´Mechanism of Action: ´Similar to salicylates ´Blocks pain impulses peripherally by inhibiting prostaglandin synthesis

Benztropine (Cogentin)

´Anticholinergic drug used for PD and extrapyramidal symptoms from antipsychotic drugs ´Caution during hot weather or exercise because it may cause hyperthermia ´Adverse effects: tachycardia, confusion, disorientation, toxic psychosis, urinary retention, dry throat, constipation, nausea, and vomiting ´Anticholinergic syndrome ´Avoid alcohol

Anticholinergic Therapy

´Anticholinergics block the effects of Ach. ´Used to treat muscle tremors and muscle rigidity associated with PD ´These two symptoms are caused by excessive cholinergic activity. Does not relieve bradykinesia (extremely slow movements

Psychotherapeutic Drugs: Nursing Implications - Antidepressants (part 2)

´Antidepressants—part 2 ´Tricyclics may need to be weaned and discontinued before undergoing surgery to avoid interactions with anesthetic drugs. ´Monitor for adverse effects and discuss with patients. ´Encourage patients to wear medication ID badges naming the drugs being taken. ´Caffeine and cigarette smoking may decrease effectiveness of medication therapy. ´With MAOIs, instruct patients and family regarding tyramine-containing foods and signs and symptoms of hypertensive crisis.

Antimigraine Drugs

´Antimigraine (serotonin agonists; also called triptans) ´Sumatriptan (Imitrex) ´Almotriptan (Axert) ´Eletriptan (Relpax) ´Naratriptan (Amerge) ´Rizatriptan (Maxalt) ´Zolmitriptan (Zomig) ´Frovatriptan (Frova)

Three main emotional and mental disorders

´Anxiety ´Affective disorders ´Psychoses

Types of psychotherapeutic drugs

´Anxiolytic drugs ´ Mood-stabilizing drugs ´ Antidepressant drugs ´ Antipsychotic drugs

Anorexiants

´Any substance that suppresses appetite ´Used to treat obesity ´Anorexiants ´Phentermine (Ionamin) ´Benzphetamine (Regimex)* ´Methamphetamine (Desoxyn)* ´Diethylpropion (Tenuate) ´ *Only ones approved for treatment of obesity.

Atomoxetine (Strattera)

´Approved for treating ADHD in children older than 6 years of age and in adults In September 2005, the FDA issued a warning describing cases of suicidal thinking and behavior in small numbers of adolescent patients receiving this medication

Nursing Implications: Assess for signs and symptoms of PD

´Assess for signs and symptoms of PD ´Masklike expression ´Speech problems ´Dysphagia ´Rigidity of arms, legs, and neck ´Assess for conditions that may be contraindications. ´Administer drugs as directed by manufacturer. ´Provide patient education regarding PD and the medication therapy.

Nursing Implications of Analeptics

´Assess for: ´Potential contraindications ´Potential interactions, including herbal therapies ´Conditions such as abnormal cardiac rhythms, seizures, palpitations, liver problems ´For children, assess baseline height and weight. ´Ergot alkaloids ´Chest pain, confusion, slurred speech, and vision changes need immediate medical attention. ´Analeptics ´Pay close attention to the ABCs because of the patient's diminished sensorium.

Nursing Implications of Antiepileptic Drugs: Assessment

´Assessment ´Health history, including current medications ´Drug allergies ´Liver function studies, complete blood count, renal, WBCs ´Baseline: vital signs, CNS function, neurological status

Nursing Implications

´Assessments should include nonjudgmental and open-ended questions about substance abuse. ´Be observant for clues to substance abuse so as to avoid withdrawal symptoms. ´The most dangerous substances in terms of withdrawal are CNS depressants such as barbiturates, benzodiazepines, and alcohol. ´Establish therapeutic rapport and use empathy toward the patient.

What are adjuvant drugs?

´Assist primary drugs in relieving pain ´NSAIDs ´Antidepressants ´Anticonvulsants ´Corticosteroids ´Example: adjuvant drugs for neuropathic pain ´Amitriptyline (antidepressant) ´Gabapentin or pregabalin (anticonvulsants)

Stimulants: Indications

´Attention deficit hyperactivity disorder ´Narcolepsy ´Obesity treatment

Safety: Look-Alike/Sound-Alike Drugs

´Be careful with drug names! ´When using trade names, Cerebyx and Celebrex sound and look very much alike ... but they are quite different! ´Use both trade and generic names when ordering medications.

Analgesics: Nursing Implications

´Be sure to medicate patients before the pain becomes severe so as to provide adequate analgesia and pain control. ´Pain management includes pharmacologic and nonpharmacologic approaches; be sure to include other interventions as indicated. ´Patients should not take other medications or OTC preparations without checking with their physicians. ´Instruct patients to notify physician about signs of allergic reaction or adverse effects.

Psychotherapeutic Drugs: Nursing Implications

´Before beginning therapy, assess the physical and emotional status of patients. ´Obtain baseline vital signs, including postural BP readings. ´Obtain liver and renal function tests. ´Complete Suicide Assessment Scale

Depressants: Mechanism of Action and Drug Effects

´Benzodiazepines and barbiturates work by increasing the action of GABA. ´Active ingredient in marijuana is cannabinoids (THC) which bind to and stimulate cannabinoid receptors in CNS.

Ethanol Withdrawal Treatment

´Benzodiazepines are the treatment of choice ´Diazepam (Valium), lorazepam (Ativan), or chlordiazepoxide (Korsakoff's psychosis) ´Dosage and frequency depend on severity ´For severe withdrawal, monitoring in an intensive care unit is recommended.

Benzodiazepines: Adverse Effects

´Benzodiazepines' adverse effects are an overexpression of their therapeutic effects ´Decreased CNS activity, sedation ´Hypotension ´Drowsiness, loss of coordination, dizziness, headaches ´Nausea, vomiting, dry mouth, constipation ´Others

Depressants: Withdrawal, Toxicity, and Overdose

´Benzodiazepines: ´Fatality is unusual when taken alone. ´When combined with alcohol or other drugs (esp. other CNS depressants), combination can be lethal. ´Withdrawal sx: seizures, delirium, rebound anxiety, myoclonus, myalgia, sleep disturbances ´Reversal: flumazenil

What are agonists-antagonists?

´Bind to a pain receptor ´Cause a weaker neurologic response than a full agonist ´Also called partial agonist or mixed agonist

What is an agonist?

´Bind to an opioid pain receptor in the brain ´Cause an analgesic response (reduction of pain sensation)

Orlistat (Xenical)

´Binds to gastric and pancreatic enzymes called lipase ´Reduces fat absorption by roughly 30% ´Restricting dietary intake of fat to less than 30% of total calories can help reduce GI adverse effects. ´Oily spotting, flatulence, fecal incontinence ´Supplement with fat-soluble vitamins

Antipsychotics: Mechanism of Action

´Block dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion, cognitive function, motor function ´Dopamine levels in the CNS are decreased. ´Result: tranquilizing effect in psychotic patients

Tricyclic Antidepressants: Mechanism of Action

´Block reuptake of neurotransmitters, causing accumulation at the nerve endings ´It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression.

Nicotine Withdrawal Treatment: Bupropion (Zyban)

´Bupropion (Zyban): may be prescribed to aid in smoking cessation ´First nicotine-free prescription medicine to treat nicotine dependence ´Varenicline (Chantix) ´Stimulates nicotine receptors

Nursing Implications: Assessment tools for substance abuse

´CAGE Alcoholism Screening Test Adapted to Include Drugs (CAGE-AID) ´Substance Abuse Subtle Screening Inventory (SASSI) ´Michigan Alcoholism Screening Test Geriatric version (MAST-G) ´Problem Oriented Screening Instrument for Teenagers (POSIT)

Opioid Analgesics: Adverse Effects

´CNS depression ´Leads to respiratory depression ´Most serious adverse effect ´Nausea and vomiting ´Urinary retention ´Diaphoresis and flushing ´Pupil constriction (miosis) ´Constipation (OIC) ´Itching

Ethanol: Drug Effects

´CNS depression ´Respiratory stimulation or depression ´Vasodilation, producing warm, flushed skin ´Increased sweating ´Diuretic effects

Drugs for Attention Deficit Hyperactivity Disorder (ADHD) and Narcolepsy

´CNS stimulants are first line drugs. ´Amphetamines: methylphenidate ´Nonamphetamine stimulants ´Pemoline and modafinil ´Atomoxetine: nonstimulant drug that is also used to treat ADHD ´Lisdexamfetamine (Vyvanse) prodrug for dextroamphetamine

Opioids: Adverse Effects

´CNS: ´Diuresis ´Miosis ´Convulsions ´Nausea, vomiting ´Respiratory depress ´Non-CNS: ´Hypotension ´Constipation ´Urinary retention ´Flushing ´Urticaria/pruritus

Analeptics

´Caffeine ´Found in: •Over-the-counter drugs: NoDoz •Combination prescription drugs: Fioricet, Fiorinal •Foods and beverages ´Use with caution in patients with a history of: •Peptic ulcer •Recent myocardial infarction •Dysrhythmias ´Intravenous: caffeine citrate and caffeine sodium benzoate

Carbidopa-Levodopa (Sinemet)

´Carbidopa (Lodosyn): adjunct to treat nausea associated with Sinemet ´Sinemet CR: increases "on" time and decreases "off" time ´Drug interactions occur with tricyclic antidepressants and other drugs. ´Carbidopa-levodopa: best taken on an empty stomach; to minimize GI side effects, it can be taken with food

Affective Disorders (Mood Disorders)

´Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions) ´Some patients may exhibit both mania and depression: bipolar disorder (BPD)

Parkinson's Disease (PD)

´Chronic, progressive, degenerative disorder ´Affects dopamine-producing neurons in the brain ´Caused by an imbalance of two neurotransmitters ´Dopamine ´Acetylcholine (ACh)

Classification of CNS stimulants

´Classified according to ´Chemical structural similarities: amphetamines, serotonin agonists, sympathomimetics, and xanthines ´Site of therapeutic action in the central nervous system (CNS) ´Major therapeutic uses: anti-attention deficit disorder, antinarcoleptic, anorexiant, antimigraine, and analeptic drugs

Migraine

´Common type of recurring headache, usually lasting from 4 to 72 hours ´Typical features: pulsatile quality with pain that worsens with each pulse ´Most commonly unilateral but may occur on both sides of the head ´Associated symptoms: nausea, vomiting, photophobia (avoidance of light), and phonophobia (avoidance of sounds) ´Aura

Stimulants: Adverse Effects

´Commonly an extension of their therapeutic effects ´CNS: ´Restlessness, syncope, dizziness, tremor, hyperactive reflexes, talkativeness, tenseness, irritability, weakness, insomnia, fever, euphoria ´Confusion, aggression, increased libido, anxiety, delirium, paranoid hallucinations, panic states, suicidal, and homicidal tendencies ´Fatigue and depression follow CNS stimulation.

Levodopa, Carbidopa Therapy

´Contraindicated in cases of angle-closure glaucoma ´Use cautiously in patients with open-angle glaucoma ´Adverse effects: cardiac dysrhythmias, hypotension, chorea, muscle cramps, and GI distress ´Interactions: pyridoxine and dietary protein

Antipsychotics: Types

´Conventional, or first-generation: phenothiazines ´Second-generation ´Atypical antipsychotics

Commonly Abused Substances: Depressants

´Depressants: drugs that relieve anxiety, irritability, and tension when used as intended. ´Also used to treat seizure disorders and induce anesthesia ´Depressants ´Benzodiazepines ´Barbiturates ´Marijuana

Amphetamines

´Dextroamphetamine sulfate (Dexedrine) ´Amphetamine aspartate (Adderall): one of the most commonly prescribed drugs for ADHD

Dyskinesia

´Difficulty in performing voluntary movements ´Two common types: ´Chorea: irregular, spasmodic, involuntary movements of the limbs or facial muscles ´Dystonia: abnormal muscle tone leading to impaired or abnormal movements

Nursing Implications for Selective Serotonin Receptor Agonists (SSRAs)

´Dissolvable wafers, nasal spray, and self-injectable forms ´Provide specific teaching about correct administration. ´Instruct patients to keep a journal to monitor response to therapy.

Antiepileptic Drugs: Interactions

´Drug interactions are numerous. ´Many antiepileptic drugs interact with each other. ´Induce hepatic metabolism resulting in reduction of effects of other drugs. ´Interfere with birth control. ´Avoid grapefruit with carbamazepine.

Lithium

´Drug of choice for the treatment of mania ´It is thought to potentiate serotonergic neurotransmission ´Narrow therapeutic range: acute mania—lithium serum level of 1 to 1.5 mEq/L; maintenance serum levels should range between 0.6 and 1.2 mEq/L. ´Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity, including gastrointestinal (GI) discomfort, tremor, confusion, somnolence, seizures, and possibly death. ´Keeping the sodium level in the normal range (135 to 145 mEq/L) helps to maintain therapeutic lithium levels. If hyponatremic, toxicity may occur.

What are CNS stimulants?

´Drugs that stimulate a specific area of the brain or spinal cord ´Neurons contain receptors for excitatory neurotransmitters, including dopamine (dopaminergic drugs), norepinephrine (adrenergic drugs), and serotonin (serotonergic drugs). ´Sympathomimetic drugs

Antipsychotics

´Drugs used to treat serious mental illness ´Drug-induced psychoses, schizophrenia, and autism ´Also used to treat extreme mania (as an adjunct to lithium), BPD, depression that is resistant to other therapy, certain movement disorders (e.g., Tourette's syndrome), and certain other medical conditions (e.g., nausea, intractable hiccups) ´Have been known as tranquilizers or neuroleptics

Antimigraine Drugs: Ergot alkaloids

´Ergot alkaloids ´Were the mainstay of treatment of migraine headaches but have been replaced by the triptans for first-line therapy

Acetaminophen: Toxicity and Managing Overdose

´Even though available OTC, lethal when overdosed ´Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity ´Long-term ingestion of large doses also causes nephropathy. ´Recommended antidote: acetylcysteine regimen

Psychotherapeutic Drugs: Exact Cause...

´Exact cause of mental disorders not fully understood ´Many theories ´Thought to arise from abnormal levels or imbalance of neurotransmitters ´Dopamine and epinephrine ´Serotonin and histamine ´Gamma-aminobutyric acid and acetylcholine

Antiepileptic: Mechanism of Action and Drug Effects

´Exact mechanism of action is not known. ´Pharmacologic effects: ´Reduce nerve's ability to be stimulated ´Suppress transmission of impulses from one nerve to the next ´Decrease speed of nerve impulse conduction within a neuron

Second-Generation Antidepressants

´Fewer adverse effects than TCAs and MAOIs ´Very few drug-drug or drug-food interactions ´Still take about 4 to 6 weeks to reach maximum clinical effectiveness ´Now considered first-line drugs for depression ´Mechanism of action: inhibition of serotonin reuptake and possible effects on norepinephrine and dopamine reuptake

Methylphenidate (Ritalin)

´First prescription drug indicated for ADHD ´Also used for narcolepsy ´Extended-release dosage forms ´Ritalin SR ´Concerta ´Metadate CD

Nursing Implications for Anorexiants

´Follow instructions for diet and exercise. ´Take in the morning. ´Avoid caffeine ´Fat-soluble vitamin supplementation may be needed.

Cocaine

´From the leaves of the coca plant ´Snorted or injected intravenously ´Highly addictive—physical and psychologic dependence ´Powdered form ´Also called "dust," "coke," "snow," "flake," "blow," "girl" ´Crystallized form (smoked) ´Also called "crack," "freebase rocks," "rock"

Treatment of Parkinson's Disease

´Full explanation of disease to the patient ´Treatment centers on drug therapy ´PT, OT, speech therapy important ´Severe cases: ´Deep brain stimulation

Tricyclic Antidepressants (TCA)

´Have largely been replaced by SSRIs as first-line antidepressant drugs ´Considered second line ´For patients who fail with SSRIs or other newer generation antidepressants ´As adjunct therapy with newer generation antidepressants

Second-Generation Antidepressants: Interactions

´Highly protein bound ´Need 2- to 5-week "washout" when changing classes of antidepressants that include MAOIs ´Avoid herbal products, particularly St. John's wort

What is hydromorphone (Dilaudid)

´Hydromorphone (Dilaudid): very potent opioid analgesic; Schedule II drug ´One milligram of IV or IM hydromorphone is equivalent to 7 mg of morphine ´Exalgo: ´Osmotic extended release oral deliver ´Difficult to crush or extract for injection which aids in reducing abuse potential

Pain Management

´Important aspect of nursing care ´Pain one of the most common reasons for seeking health care ´Pain can lead to: ´Suffering ´Recent MN event ´Economic burden

Antidepressants increase levels of what?

´Increase the levels of neurotransmitter concentration in CNS ´Based on several hypotheses

Narcolepsy

´Incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities. These "sleep attacks" are reported to cause car accidents or near-misses in 70% or more of patients. ´Cataplexy: sudden acute skeletal muscle weakness. Associated symptom in at least 70% of narcolepsy cases. It involves sudden acute skeletal muscle weakness.

Antidepressant Drugs

´Indicated for major depressive disorders ´Other indications: ´Dysthymia (chronic low-grade depression) ´As adjunct for schizophrenia ´Eating disorders ´Personality disorders ´Various medical conditions ´Migraine headaches ´Chronic pain/sleep disorders ´Premenstrual syndrome ´Hot flashes associated with menopause

Indications/Contraindications of Anorexiants

´Indications ´Used to treat obesity along with behavior modifications (diet, exercise) ´Most often used in higher-risk patients ´Contraindications ´Drug allergy ´Severe cardiovascular disease ´Uncontrolled HTN ´Hyperthyroidism ´Eating disorders ´MAOI usage

Indications/Contraindications of CNS stimulants

´Indications: ´ADHD ´Narcolepsy ´Obesity ´Contraindications: ´Known drug allergy ´Cardiac structural abnormalities ´Recent MAOI usage

Haloperidol (Haldol)

´Indications: long-term treatment of psychosis ´Contraindications: hypersensitivity, Parkinson's disease, and in patients taking large amounts of CNS depressants ´Oral, intramuscular, intravenous ´Useful in treating patients with schizophrenia who were nonadherent with their drug regimen

Nursing Implications: Inform patient..

´Inform patient not to take other medications, herbals, or dietary supplements with PD drugs unless he or she checks with physician ´When starting dopaminergic drugs, assist patient with walking because dizziness may occur. ´Administer oral doses with food to minimize GI upset. ´Encourage patient to force fluids to at least3000 mL/day (unless contraindicated).

MAOIs and Tyramine

´Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death ´Avoid foods that contain tyramine! ´Aged, mature cheeses (cheddar, bleu, Swiss) ´Smoked, pickled, or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté) ´Yeast extracts ´Red wines (Chianti, burgundy, sherry, vermouth) ´Italian broad beans (fava beans)

Hydantoins: Fosphenytoin (Cerebyx)

´Injectable prodrug of phenytoin ´Water-soluble phenytoin derivative that can be given intramuscularly or intravenously—by IV push or continuous infusion—without causing burning on injection associated with phenytoin

Opioids: Indications

´Intended drug effects of opioids: ´Relieve pain ´Reduce cough ´Relieve diarrhea ´Induce anesthesia ´Certain opioid drugs are used to treat opioid dependence. ´Methadone ´Goal: reduce the patient's dosage gradually so that eventually the patient can live permanently drug free ´Relapse rates are often high; the drug can be abused.

Alcohol Interactions

´Intensifies sedative effects of medications that work in the CNS ´Interacts with antibiotic metronidazole ´Hepatotoxicity with acetaminophen ´Increase bioavailability of blood thinner warfarin

Hydantoins: Phenytoin (Dilantin) - Intravenous (IV) Admin

´Intravenous (IV) administration ´Very irritating to veins ´Slow IV directly into a large vein through a large-gauge (20-gauge or larger) venous catheter ´Diluted in normal saline (NS) for IV infusion

Nursing Implications of Antiepileptic Drugs

´Intravenous forms ´Follow manufacturer's recommendations for IV delivery—usually given slowly. ´Monitor vital signs during administration. ´Avoid extravasation of fluids. ´Use only normal saline with IV phenytoin (Dilantin).

Opioid Analgesics: Contraindications

´Known drug allergy ´Severe asthma ´Use with extreme caution in patients with: ´Respiratory insufficiency ´Elevated intracranial pressure ´Morbid obesity or sleep apnea ´Paralytic ileus ´Pregnancy

Nursing Implications for ADHD Drugs

´Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia. ´Take on an empty stomach 30 to 45 minutes before meals. ´Drug "holidays" may be ordered. ´Instruct parents to keep a journal to monitor the child's response to therapy. ´Monitor the child for continued physical growth, including height and weight.

Tricyclic Antidepressants: Overdose

´Lethal: 70% to 80% die before reaching the hospital. ´CNS and cardiovascular systems are mainly affected. ´No specific antidote ´Decrease drug absorption with activated charcoal. ´Speed elimination by alkalinizing urine. ´Manage seizures and dysrhythmias. ´Provide basic life support. ´Death results from seizures or dysrhythmias.

What is pain threshold?

´Level of stimulus needed to produce the perception of pain ´A measure of the physiologic response of the nervous system When you are more sensitive to pain, your threshold is decreased.

Levodopa Therapy

´Levodopa is taken up by the dopaminergic terminal, converted into dopamine, and then released as needed. ´As a result, neurotransmitter imbalance is controlled in patients with early PD who still have functioning nerve terminals. ´As PD progresses, it becomes more difficult to control it with levodopa. ´Ultimately, levodopa no longer controls the PD, and the patient is seriously debilitated. ´This generally occurs between 5 and 10 years after the start of levodopa therapy. ´Adverse effects: confusion, involuntary movements, GI distress, hypotension, and cardiac dysrhythmias

Indirect-Acting Dopaminergic Drugs: Monoamine Oxidase Inhibitors

´MAOIs break down catecholamines in the CNS, primarily in the brain. ´MAO-B inhibitors. ´Cause an increase in levels of dopaminergic stimulation in the CNS ´Do not elicit the "cheese effect" of the nonselective MAOIs used to treat depression

Opioid Analgesics: Indications

´Main use: to alleviate moderate to severe pain ´Often given with adjuvant analgesic drugs to assist primary drugs with pain relief ´Opioids are also used for: ´Cough center suppression ´Treatment of diarrhea ´Balanced anesthesia

Nicotine: Withdrawal

´Manifested by cigarette craving ´Irritability, restlessness, decreased heart rate, and BP ´Cardiac symptoms resolve in 3 to 4 weeks, but cigarette craving may persist for months or years.

Management of Withdrawal, Toxicity, and Overdose

´Many patients require a formal detoxification program. ´Most common cause of death with opioids is respiratory depression. ´Naloxone is an opioid antagonist used in opioid overdose. ´Now standard with first responders

Herbal Products

´Many potential drug interactions ´Herb commonly used for anxiety or depression: ´St. John's wort ´"Herbal Prozac"

Nicotine

´Many smoke to "calm nerves." ´Releases epinephrine, which creates physiologic stress rather than relaxation ´Tolerance develops ´Physical and psychologic dependency ´Withdrawal symptoms occur if stopped ´No therapeutic uses 200 known poisons present in cigarette smoke.

Acetaminophen: Dosage

´Maximum daily dose for healthy adults is being lowered to 3000 mg/day. ´2000 mg for older adults and those with liver disease ´Inadvertent excessive doses may occur when different combination drug products are taken together. ´Examples: Vicodin or Percocet ´Be aware of the acetaminophen content of all medications taken by the patient (OTC and prescription).

What are analgesics (narcotics)

´Medications that relieve pain without causing loss of consciousness ´"Painkillers" ´Opioid analgesics ´Adjuvant analgesic drugs

Acetaminophen: Indications

´Mild to moderate pain ´Fever ´Alternative for those who cannot take aspirin products

Nursing Implications: Monitor for response to drug therapy

´Monitor for response to drug therapy: ´Improved sense of well-being and mental status ´Increased appetite ´Increased ability to perform ADLs, to concentrate, and to think clearly ´Less intense parkinsonian manifestations, such as less tremor, shuffling gait, muscle rigidity, and involuntary movements

Alcohol (Ethanol)

´More accurately known as ethanol (ETOH) ´Causes CNS depression by dissolving in lipid membranes in the CNS ´Few legitimate uses of ethanol and alcoholic beverages ´Used as a solvent for many drugs ´Systemic uses of ethanol: treatment of methyl alcohol and ethylene glycol intoxication (e.g., from drinking automotive antifreeze solution)

What is the gate way theory of pain transmission?

´Most common and well-described theory ´Uses the analogy of a gate to describe how impulses from damaged tissues are sensed in the brain ´Many current pain management strategies are aimed at altering this system.

Attention Deficit Hyperactivity Disorder (ADHD)

´Most common psychiatric disorder in children, affecting 4% to 10% of school-age children of which approximately 6% are treated with medication ´Boys are affected three times more often than girls. ´Primary symptoms of ADHD are inappropriate ability to maintain attention span or the presence of hyperactivity and impulsivity. ´Drug therapy for both childhood and adult ADHD is the same.

Alprazolam (Xanax)

´Most commonly used as an anxiolytic ´Indicated for GAD, short-term relief of anxiety symptoms, panic disorder, and anxiety associated with depression ´Adverse effects: confusion, ataxia, headache, and others ´Interactions: alcohol, oral contraceptives, and others

Lithium: Adverse effects

´Most serious adverse effect is cardiac dysrhythmia. ´Other effects: drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension ´Long-term treatment may cause hypothyroidism

Status Epilepticus

´Multiple seizures occur with no recovery between them. ´Result: hypotension, hypoxia, brain damage, and death ´True medical emergency

Opioids: Toxicity and Management of Overdose

´Naloxone (Narcan) ´Naltrexone (ReVia) ´Regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an opioid antagonist should be given. ´Opioid withdrawal or opioid abstinence syndrome ´Manifested as: ´Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, confusion

What are opioid antagonists?

´Naloxone now available without a prescription and is being used by 1st responders for opioid/illegal drug overdoses ´Naltrexone ´Opioid antagonist ´Oral form ´Used for alcohol and opioid addiction

Relapse Prevention

´Naltrexone ´Works by blocking the opioid receptors so that the use of opioid drugs do not produce euphoria ´Must be 1 week free from opioids to begin this therapy ´Opioid naïve and tolerance - dangerous

What is Morphine Sulfate?

´Naturally occurring alkaloid derived from the opium poppy ´Drug prototype for all opioid drugs; Schedule II controlled substance ´Indication: severe pain ´High abuse potential ´Oral, injectable, and rectal dosage forms; also extended-release forms ´Embeda (morphine and naltrexone) is the newest morphine product.

Analeptic-Responsive Respiratory Depression Syndromes

´Neonatal apnea ´Common in about 25% of premature infants ´Bronchopulmonary dysplasia ´Postanesthetic respiratory depression ´Drugs: analeptic drugs such as theophylline, aminophylline, caffeine, and doxapram

Nicotine: Drug Effects

´Nicotine found in nature (i.e., tobacco plants) has no known therapeutic uses. ´Nicotine is medically significant because of its addictive and toxic properties.

What are some ways to approach pain management?

´No single approach to effective pain management ´Tailored to each patient's needs ´Consider: ´Cause of pain ´Existence of concurrent medical conditions ´Characteristics of pain ´Psychological and cultural characteristics ´Requires ongoing reassessment of pain and the effectiveness of treatment

Pramipexole (Mirapex)

´Nonergot NDDRA ´More specific antiparkinson effects with fewer adverse effects ´Used in both early- and late-stage PD ´May delay the need for levodopa ´Monotherapy or adjunctive therapy ´Also used for Restless Leg Syndrome

Antiepileptic Drugs: Adverse Effects

´Numerous adverse effects; vary per drug ´Adverse effects often necessitate a change in medication. ´Black box warning as of 2008 ´Suicidal thoughts and behavior ´Long-term therapy with phenytoin (Dilantin) may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies.

Effects of Chronic Ethanol Ingestion

´Nutritional and vitamin deficiencies (especially B vitamins) ´Wernicke's encephalopathy ´Korsakoff's psychosis ´Polyneuritis ´Nicotinic acid deficiency encephalopathy ´Seizures ´Alcoholic hepatitis, progressing to cirrhosis ´Cardiomyopathy

Six major anxiety disorders (persistent anxiety)

´Obsessive-compulsive disorder (OCD) ´Posttraumatic stress disorder (PTSD) ´Generalized anxiety disorder (GAD) ´Panic disorder ´Social phobia (social anxiety disorder) ´Simple phobia

Citalopram (Celexa)

´One of the most commonly used SSRIs ´Treatment of depression and OCD ´Discontinuation syndrome ´Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

What is codeine sulfate?

´Opioid agonist ´Natural opiate alkaloid (Schedule II) obtained from opium ´Less effective ´Often combined with acetaminophen ´Schedule III ´More commonly used as an antitussive drug ´Most common adverse effect: GI disturbance

Commonly Abused Substances

´Opioids: Synthetic versions of pain-relieving substances ´Heroin: One of the most commonly abused opioids ´Codeine ´Hydrocodone ´Hydromorphone ´Morphine ´Oxycodone

Nursing Implications of Antiepileptic Drugs: Oral Drugs

´Oral drugs ´Take regularly, same time each day. ´Take with meals to reduce GI upset. ´Do not crush, chew, or open extended-release forms. ´If patient is NPO for a procedure, contact prescriber regarding AED dosage.

Other Drugs to Treat Obesity

´Orlistat (Xenical): related nonstimulant drug used to treat obesity ´Mechanism of action: works locally in the small and large intestines, where it inhibits absorption of caloric intake from fatty foods. ´Inhibits enzyme lipase

Depressants: Adverse Effects

´Overexpression of their therapeutic effects ´CNS: ´Drowsiness, sedation, lack of coordination, dizziness, blurred vision, headaches, paradoxical reactions ´GI: ´Nausea, vomiting, constipation, dry mouth, abdominal cramping ´Misc: ´Chronic respiratory symptoms for marijuana smokers; memory and attention deficit problems; chronic depressive amotivational syndrome

Treatment of Pain in Special Situations

´PCA and "PCA by proxy" (patient-controlled analgesia) ´Patient comfort vs. fear of drug addiction ´Opioid tolerance - Occurs especially with cancer patients ´Use of placebos - don't do it b/c ethical issues ´Recognizing patients who are opioid tolerant ´Breakthrough pain - Scheduled opioid every 8hrs and after 5 hrs pain level goes up again. They will add something else on to minimize pain. ´Synergistic effect - Use one drug to get more beneficial effect

Pharmacology Overview of Parkinson's

´PD is thought to be caused by an imbalance of dopamine and Ach, with a deficiency of dopamine in certain areas of the brain. ´Drug therapies are aimed at increasing the levels of dopamine or antagonizing the effects of Ach. ´Unfortunately, current drug therapy does not slow the progression of the disease but rather is used to slow the progression of symptoms.

Nursing Implications: Patient safety

´Patient safety is of utmost importance at all times during patient care but especially when the patient is experiencing the signs and symptoms of withdrawal. ´Provide monitoring and support as needed throughout the withdrawal process. ´Educate the patient and family members or significant others about the recovery process. ´Emphasize that recovery is lifelong.

Depressants Withdrawal

´Peak period ´2 to 4 days for short-acting drugs ´4 to 7 days for long-acting drugs ´Duration ´4 to 7 days for short-acting drugs ´7 to 12 days for long-acting drugs ´Signs ´Increased psychomotor activity; agitation; hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature; others

Opioid: Drug Withdrawal

´Peak period: 1 to 3 days ´Duration: 5 to 7 days ´Signs ´Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated blood pressure (BP), and pulse ´Symptoms ´Intense desire for drug, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise

Stimulant Withdrawal

´Peak period: 1 to 3 days ´Duration: 5 to 7 days ´Signs ´Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia ´Symptoms ´Depression, suicidal thoughts and behavior, paranoid delusions ´No specific pharmacologic treatments

Nursing Implications

´Perform a thorough assessment, nursing history, and medication history. ´Include questions about the patient's: ´CNS ´GI and GU tracts ´Psychologic and emotional status

Hydantoins: Phenytoin (Dilantin)

´Phenytoin (Dilantin) has been used as a first-line drug for many years and is the prototypical drug. ´Adverse effects: gingival hyperplasia, acne, hirsutism, Dilantin facies, and osteoporosis ´Highly protein bound

What is physical dependence?

´Physiologic adaptation of the body to the presence of an opioid ´Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with psychologic dependence (addiction).

Adverse Effects of Anorexiants

´Possible elevated blood pressure and heart palpitations ´Anxiety ´Agitation ´Dizziness ´Headache ´Orlistat: fecal incontinence with oily stools

Antiepileptic Drugs: Indications

´Prevention or control of seizure activity ´Long-term maintenance therapy for chronic, recurring seizures ´Acute treatment of convulsions and status epilepticus

Fluoxetine (Prozac)

´Prototypical SSRI ´Indications: depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder ´Contraindications: known drug allergy and concurrent MAOI therapy ´Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

Indications: Antipsychotic Drugs

´Psychotic illness, most commonly schizophrenia ´Anxiety and mood disorders

Pharmacology Overview: psychotherapeutic drugs

´Psychotropic drugs are widely prescribed in the US. ´Drug selection is often trial-and-error processes. ´Nonadherence is a common problem.

What is Naloxone Hydrochloride (Narcan)?

´Pure opioid antagonist ´Drug of choice for the complete or partial reversal of opioid-induced respiratory depression ´Indicated in cases of suspected acute opioid overdose ´Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.

Anxiolytic Drugs

´Reduce anxiety by reducing overactivity in central nervous system (CNS). ´Benzodiazepines ´Depress activity in the brainstem and limbic system. ´Miscellaneous drug: buspirone (Buspar) ´Nonsedating and nonhabit forming ´May have drug interaction with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome) ´Do not administer with MAOIs

Herbal Products: Feverfew

´Related to the marigold family ´Antiinflammatory properties ´Used to treat migraine headaches, menstrual cramps, inflammation, and fever ´May cause GI distress, altered taste, muscle stiffness ´May interact with aspirin and other NSAIDs, as well as anticoagulants

Dopamine Replacement Drugs

´Replacement drugs (presynaptic) ´Levodopa: biologic precursor of dopamine required by the brain for dopamine synthesis ´Work presynaptically to increase brain levels of dopamine ´Levodopa is able to cross the blood-brain barrier, and then it is converted to dopamine. ´However, large doses of levodopa needed to get dopamine to the brain also cause adverse effects.

Antidepressants: Length of time to be fully effective

´Requires at least 6 weeks of therapy with adequate doses to be able to fully evaluate results ´May require upward titration of dosages over several weeks ´Should be used in conjunction with psychotherapy Higher risk of suicide among both adult and pediatric population (esp. in first few weeks

What are antagonists?

´Reverse the effects of these drugs on pain receptors ´Bind to a pain receptor and exert no response ´Also known as competitive antagonists

Anticholinergic Therapy: SLUDGE

´SLUDGE: Ach is responsible for causing increased salivation, lacrimation (tearing of the eyes), urination, diarrhea, increased GI motility, and possibly emesis (vomiting). ´Anticholinergics have the opposite effects: dry mouth or decreased salivation, urinary retention, decreased GI motility (constipation), dilated pupils (mydriasis), and smooth muscle relaxation.

Iminostilbenes: Carbamazepine (Tegretol)

´Second most commonly prescribed antiepileptic drug in the United States after phenytoin ´Autoinduction of hepatic enzymes ´Adverse reactions ´Pharmacogenetics: Chinese ancestry ´Stevens-Johnson syndrome

Tricyclic Antidepressants: Adverse Effects

´Sedation ´Impotence ´Orthostatic hypotension ´Others ´Older patients ´Dizziness, postural hypotension, constipation, delayed micturition, edema, muscle tremors

Monoamine Oxidase Inhibitors (MAOIs)

´Selective and Non-selective ´Rarely used for depression ´Used for Parkinson's disease ´Disadvantage: potential to cause hypertensive crisis when taken with tyramine

Psychosis

´Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living ´Hallmark: loss of contact with reality ´Examples ´Schizophrenia ´Depressive and drug-induced psychoses

Acetaminophen: Contraindications and Interactions

´Should not be taken in the presence of: ´Drug allergy ´Liver dysfunction ´Possible liver failure ´G6PD deficiency ´Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic.

Classification (Types) of Pain

´Somatic - skeletal muscles and bones ´Visceral - organs ´Superficial - skin ´Deep - below skin ´Vascular - Varicose veins peripheral vascular diseases ´Referred - pain that runs along a nerve ´Neuropathic - along nerve pathways (neuropathy) ´Phantom - due to amputation ´Cancer - depends on if tumor, spread, what type cancer ´Central - R/t CNS damage

Mechanism of Action of Analeptics

´Stimulate areas of CNS that control respiration ´Methylxanthines ´Inhibit phosphodiesterase, leading to buildup of cyclic adenosine monophosphate (cAMP) ´Caffeine ´Antagonizes adenosine receptors

Methamphetamine

´Stronger effects than other amphetamines ´Pill form ´Powder form: snorted or injected ´Crystallized form ´Also known as "ice," "crystal," "glass," "crystal meth" ´Smokable ´More powerful Sales of over-the-counter (OTC) pseudoephedrine are now regulated

Mechanism of Action: Anorexiants

´Suppress appetite control centers in the brain ´Increase the body's basal metabolic rate ´Mobilization of adipose tissue stores ´Enhanced cellular glucose uptake ´Reduce dietary fat absorption

Parkinson's Disease: Symptoms

´Symptoms occur when about 80% of the dopamine stored in the substantia nigra of the basal ganglia is depleted. ´Symptoms can be partially controlled as long as there are functioning nerve terminals that can take up dopamine. ´Classic symptoms include: Tremor, Rigidity, Akinesia, Postural instability, TRAP acronym, Staggering gait, Drooling

Epilepsy

´Syndrome of CNS dysfunction ´Most common chronic neurologic illness ´Results from excessive electrical activity of neurons located in superficial area of brain (gray matter)

What are opioid drugs?

´Synthetic drugs that bind to the opiate receptors to relieve pain ´Mild agonists: codeine, hydrocodone ´Strong agonists: morphine, hydromorphone, oxycodone, meperidine, fentanyl, and methadone ´Meperidine: not recommended for long-term use because of the accumulation of a neurotoxic metabolite, normeperidine, which can cause seizures

What is fentanyl?

´Synthetic opioid (Schedule II) used to treat moderate to severe pain ´Parenteral injections, transdermal patches (Duragesic), buccal lozenges (Fentora), and buccal lozenges on a stick (Actiq) ´Fentanyl in a dose of 0.1 mg intravenously is roughly equivalent to 10 mg of morphine intravenously. ´Fentanyl patch for chronic, long-term pain management

What is Meperidine?

´Synthetic opioid analgesic (Schedule II) ´Caution with use in elderly or those with kidney dysfunction ´Active metabolite (normeperidine) can accumulate to toxic levels and cause seizures ´Rarely used and not recommended for long-term pain treatment ´Use: ´Migraine treatment ´Post-op shivering

What is Methadone Hydrochloride (Dolophine)?

´Synthetic opioid analgesic (Schedule II) ´Opioid of choice for the detoxification treatment of opioid addicts in methadone maintenance programs ´Prolonged half-life of the drug: cause of unintentional overdoses and deaths ´Cardiac dysrhythmias

Nursing Implications: Taking levodopa w/ MAOIs

´Taking levodopa with MAOIs may result in hypertensive crisis. ´Patient should be taught not to discontinue antiparkinson drugs suddenly. ´Teach patient about expected therapeutic and adverse effects with antiparkinson drug therapy.

What is pain tolerance?

´The amount of pain a person can endure without it interfering with normal function ´Varies from person to person ´Subjective response to pain, not a physiologic function ´Varies by attitude, environment, culture, ethnicity

What is Lidocaine, transdermal?

´Topical anesthetic ´OTC - 4% ´Prescription - 5% ´Indications: postherpetic neuralgia, other neuralgias ´Left in place no longer than 12 hours ´Minimal adverse effects ´Skin irritation may occur

What is Tramadol Hydrochloride?

´Trade name: Ultram ´Centrally acting analgesic with a dual mechanism of action ´Weak bond to mu opioid receptors ´Inhibits the reuptake of norepinephrine and serotonin ´Not classified as a controlled substance (CIV) ´Is being considered for Schedule IV ´Indicated for moderate to moderately severe pain ´Adverse effects similar to those of opioids ´Careful use in patients taking SSRIs, MAOIs, neuroleptics

Gabapentin (Neurontin)

´Treatment of partial seizures ´Most often used for treatment of neuropathy ´Contraindication: known drug allergy

Antidepressants: Types

´Tricyclic antidepressants ´Monoamine oxidase inhibitors (MAOIs) ´Second-generation antidepressants ´SSRIs ´Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Mechanism of Action and Drug Effects: Antimigraine

´Triptans ´Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms ´Reduce the production of inflammatory neuropeptides ´Abortive therapy for migraines ´Ergot alkaloids ´Narrow or constrict blood vessels in the brain

Adverse Effects of Antimigraine Drugs

´Triptans ´Vasoconstriction ´Irritation at injection site ´Tingling, flushing ´Ergot alkaloids ´Nausea and vomiting ´Cold or clammy hands and feet ´Muscle pain ´Dizziness ´Others

Anxiety

´Unpleasant state of mind characterized by a sense of dread and fear ´May be based on actual anticipated experiences or past experiences ´May be exaggerated responses to imaginary negative situations

Modafinil (Provigil)

´Use: improvement of wakefulness in patients with excessive daytime sleepiness associated with narcolepsy and with shift work sleep disorder ´Less abuse potential than amphetamines and methylphenidate ´Schedule IV drug ´Armodafinil (Nuvigil): similar to modafinil

When are psychotherapeutic drugs used?

´Used in the treatment of emotional and mental disorders ´Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress ´When emotions significantly affect an individual's ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option.

Drugs for Specific Respiratory Depression Syndrome: Analeptics

´Used less frequently ´Still used for neonatal apnea ´Examples ´Doxapram (Dopram) ´Methylxanthines, such as aminophylline, theophylline, and caffeine

Body Mass Index (BMI)

´Used to classify weight ´Overweight: BMI 25 to 29.9 ´Obesity: BMI 30 and above

Mood-Stabilizing Drugs

´Used to treat bipolar illness ´Lithium carbonate and lithium citrate ´Other drugs may be used in combination with lithium ´Benzodiazepines ´Antipsychotic drugs ´Antiepileptic drugs ´Dopamine receptor agonists

Serotonin Receptor Agonists

´Used to treat migraine headaches ´Relief from moderate to severe migraines within 2 hours in vast majority of patients ´Action: ´Stimulate 5-HT1 receptors in the brain ´"Triptans" ´Available in oral, sublingual tablets, subcutaneous self-injections, and nasal sprays

Methylenedioxymethamphetamine(MDMA, "Ecstasy," or "E")

´Usually prepared in secret home laboratories ´More calming effects than other amphetamine drugs ´Usually taken by pill ´"Raves"

Adverse Effects of Analeptics

´Vagal ´Stimulation of gastric secretions, diarrhea, and reflex tachycardia ´Vasomotor ´Flushing, sweating ´Respiratory ´Elevated respiratory rate ´Musculoskeletal ´Muscular tension and tremors

What is the CNS?

´Very complex system in the human body ´Many drugs work in the CNS or cause adverse effects in the CNS. ´CNS activity is regulated by a "checks-and-balances system." ´Excitatory and inhibitory neurotransmitters ´Receptors in the CNS

Adverse effects of CNS Stimulants

´Wide range; dose related ´Tend to "speed up" body systems ´Common adverse effects include: ´Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others

Withdrawal, Toxicity, Overdose: Stimulants

´Withdrawal symptoms are common. ´Treatment of overdose is supportive. ´Death due to poisoning or toxic levels ´Convulsions ´Coma ´Cerebral hemorrhage

Stimulants work by releasing what?

´Work by releasing biogenic amine, norepinephrine from its storage sites ´Results in CNS stimulation as well as cardiovascular stimulation ´Increases blood pressure, heart rate ´Possible cardiac dysrhythmias ´Smooth muscle effects ´Contraction of urinary sphincter

4 groups of drugs that are used to treat Parkinson's Disease

• Dopamine Replacement Drugs • Dopamine Receptor Agonists • Indirect acting • Direct acting • Anticholinergic • Antihistamines

patient teaching for sedative hypnotics

• Instructing the patient not to increase or decrease the dosage on their own. • Do not abruptly stop taking the drug especially if they have been taking it for an extended time 3-4 months • Do not operate heavy machinery until they know the effect on them • Do not take the drug with alcohol or other CNS depressant medication - tell other physicians they are on this drug. -Inform the physician if they become pregnant. -can be taken with food to decrease gastric upset.

nursing process related to drug therapy (assessment) for sedative drug class

• Obtain drug history including OTC, alcohol and herbal supplements especially Kava • Baseline vital signs and lab values (liver and renal) • Assess sleep disturbance • Assess for factors that produce anxiety • Observe for behaviors indicative of anxiety

pain threshold

The level of a stimulus that results in the sensation of pain.

Muscle spasms

The muscle paralysis induced by depolarizing NMBDs is sometimes preceded by _________ _________ which may damage muscles could result in hyperkalemia.

Respirations

The neuromuscular blocking drugs temporarily inactivate the body's natural drive to control _____________.

1 Red wine and beer contain tyramine. MAOI medications interact with tyramine, increasing catecholamine concentrations and inhibiting the activity of the drug. This is called the "cheese effect." Therefore the patient must be advised to avoid drinking red wine and beer. Red wine and beer increase the concentration of serotonin and dopamine; they may also cause hypertensive crisis and increase blood pressure.

The nurse is assessing a patient who is receiving a nonselective monoamine oxidase inhibitor (MAOI). The nurse advises the patient to avoid drinking red wine and beer. What is the reason for this instruction? 1 Red wine and beer interact with selegiline. 2 Red wine and beer decrease blood pressure. 3 Red wine and beer decrease dopamine levels. 4 Red wine and beer decrease the efficiency of levodopa.

3 Amantadine is generally indicated during the initial stage of Parkinson disease. It is usually effective for only 6 to 12 months, after which it becomes ineffective in relieving hypokinesia and muscle rigidity. Bromocriptine, an ergot alkaloid, should be prescribed to the patient to provide relief from the symptoms. Meperidine is an analgesic drug used to reduce severe pain. Benztropine and pilocarpine hydrochloride are anticholinergic drugs that interact with amantadine and result in anticholinergic poisoning. These medications do not help reduce muscle stiffness.

The nurse is caring for a patient who has Parkinson disease who has been taking amantadine for more than a year. The nurse observes that despite taking the medication, the patient has muscle stiffness and slowed movements. Which drug may help this patient? 1 Meperidine 2 Benztropine 3 Bromocriptine 4 Pilocarpine hydrochloride

2 When administered along with selegiline, entacapone exposes the patient to cardiovascular risks due to reduced catecholamine metabolism. The patient may develop cardiac side effects such as cardiomyopathy. These medications should not be administered together. The nurse should hold the medication and notify the health care provider.

The nurse is caring for a patient who has Parkinson disease. The primary health care provider has prescribed selegiline to the patient. While doing a medication review, the nurse finds the patient has been receiving entacapone. What is the nurse's best action? 1 Monitor the patient for additive effects. 2 Hold the selegiline and notify the health care provider. 3 Make certain the selegiline is given before the entacapone. 4 Make certain both medications are on the same schedule for the best action.

4 Entacapone is a drug that should be taken with a meal to minimize gastrointestinal upset. Therefore the caregiver should not give the drug when the patient has an empty stomach. Milk products do not interfere with entacapone, so it is safe to administer them. A patient with Parkinson disease needs to exercise because his motor abilities are diminished. Grains contain a high amount of fiber, which helps to prevent constipation. Therefore cereals should be included in the patient's diet.

The nurse is teaching the patient's caregiver about the administration of entacapone. Which statement made by the caregiver indicates the need for additional education? 1 "I may give milk and yogurt to the patient daily." 2 "I will encourage the patient to exercise regularly." 3 "I will include a high amount of cereals in the patient's diet." 4 "I will administer the drug when the patient has an empty stomach."

1 Carbidopa-levodopa with selegiline is prescribed to patients with Parkinson's disease. Selegiline and meperidine together are contraindicated because they may cause delirium and disorientation. Therefore the nurse would hold the meperidine and call the health care provider to possibly prescribe another intervention for pain control or adjust the patient's medications temporarily in the postoperative period.

The nurse reviews the medication history of a postoperative patient, which shows carbidopa-levodopa with selegiline, along with meperidine for pain, with instructions to begin taking entacapone with each dose of carbidopa-levodopa after 10 days. What is the appropriate nursing action? 1 Hold the meperidine and call the health care provider. 2 Administer all medications and monitor blood pressure hourly. 3 Administer the meperidine as ordered and hold the entacapone. 4 Administer the meperidine as ordered and hold the carbidopa-levodopa through the postoperative period.

opioid tolerant

The opposite of opioid naive; describes patients who have been receiving opioid analgesics (legally or otherwise) for a period of time (1 week or longer) and who are therefore at greater risk of opioid withdrawal syndrome upon sudden discontinuation of opioid use.

Paralysis

The primary concern when NMBDs are overdosed is prolonged __________ requiring prolonged mechanical ventilation.

CRITICAL THINKING AND PRIORITIZATION QUESTIONS Ch.13. p.217 2. A patient calls the headache clinic because she is unhappy about her medication. She says, "I've been taking zolmitriptan (Zomig) to prevent headache, but I am still having them." What is the nurse's priority action at this time?

The priority action is to educate the patient on the purpose of triptans for migraine therapy. These drugs are intended for the relief of migraine headaches, not their prevention. The term abortive therapy means that the medication treats the headache once it has started. It needs to be taken at the first sign (aura) of the headache and repeated as indicated in the instructions. The nurse can also help the patient assess whether she has addressed any possible precipitating factors, such as stress; hypoglycemia; menses; endogenous estrogen (including oral contraceptives); exercise; and intake of alcohol, caffeine, cocaine, nitroglycerin, aspartame, and the food additive MSG.

Balanced Anesthesia

The simultaneous use of both general anesthetics and adjuncts.

Textbook Case Studies Lilley Ch.13 pg. 208 N., a 13-year-old girl, has been diagnosed with attention deficit hyperactivity disorder. she is in the seventh grade at a local middle school and plays the clarinet in the school's after-school band. Her parents have noticed that she has had trouble focusing on assignments and music practice for the last year and have discussed her problems with N.'s pediatrician. The physician has prescribed methylphenidate (Ritalin) 5 mg twice a day for 2 weeks, and then increasing the dose to 10 mg twice a day if no improvement is noted. 1. What are the therapeutic effects of methylphenidate?

Therapeutic responses to drugs used in the management of attention deficit and related disorders include decreased hyperactivity, increased attention span and concentration, and improved behavior and/or academic achievement.

Intermittent Intravenous Administration

This IV route allows for rapid therapeutic concentration of the drug and control over onset of action and peak concentrations A separate delivery set or a secondary set is used for intermittent therapy if the patient is also receiving continuous infusion through the same IV site

ADHD

Thought to be caused by a disregulation of --Serotonin --Norepinephrine --Dopamine Characteristics: Inattentiveness, Inability to concentrate, Restlessness, Hyperactivity, Inability to complete tasks, Impulsivity

Attention-Deficit Hyperactivity Disorder (ADHD)

Thought to be caused by a disregulation of Serotonin Norepinephrine Dopamine Characteristics: Inattentiveness, Inability to concentrate, Restlessness, Hyperactivity, Inability to complete tasks, Impulsivity

Tonicity of IV Solutions

Tonicity refers to the concentration of solute particles (osmoles) in IV solution Osmolality is total concentration of solutes in body fluids

What is nociception?

Transmit all pain signals to spinal cord ´Pain results from stimulation of sensory nerve fibers called nociceptors. ´These receptors transmit pain signals from various body regions to the spinal cord and brain.

Barbiturates: Treatment for Toxicity and Overdose

Treatment of overdose Symptomatic and supportive Maintain adequate airway Assisted ventilation or oxygen therapy Fluids Pressor support Activated charcoal

Nicotine: Withdrawal Treatment

Treatments provide nicotine without the carcinogens in tobacco. ´Nicotine transdermal system (patch) ´Nicotine polacrilex (gum) ´Inhalers ´Nasal spray

CNS stimulatnts anti migraine

Triptans: sumatriptan (Imitrex) Ergot Alkaloids: ergotamine tartrate (Ergostat)

Direct-Acting Dopamine Receptor Agonists

Two subclasses: ´Nondopamine dopamine receptor agonists (NDDRAs) ´Ergot derivatives ´Nonergot drugs: pramipexole (Mirapex) ´All of the NDDRAs work by direct stimulation of presynaptic and/or postsynaptic dopamine receptors in the brain.

CNS depressants sedative-hynotics indications for barbiturates

Ultra short acting: anesthesia Short acting: used to induce sleep for individuals having problems going to sleep Intermediate acting: used to help maintain sleep Long acting: used to control seizures

Barbiturates: Indications

Ultrashort acting ´Anesthesia induction and for short surgical procedures ´Control of seizures ´Reduction of intracranial pressure in neurologic patients Short acting ´Sedation and control of seizures Intermediate acting ´Sedation and control of seizures Long acting ´Seizure prophylaxis

Migraine Headache

Unilateral throbbing (usually temporal), Nausea, Vomiting, Photophobia Caused by inflammation and dilation of cranial blood vessels (constriction precedes the migraine which is the blow out of the vessels) Preventive treatments(prevent vasoconstriction) for migraine: --Beta blockers: 1. Propranolol (Inderal) 2. Atenolol (Tenormin) --Anticonvulsants 1. Gabapentin (Neurontin) 2. Topiramate (Topamax) 3. Valproic acid (Depakote) --Tricyclic antidepressents 1. Amitriptyline (Elavil) 2. Imipramine (Tofranil) *** BUT ONCE THE HEADACHE IS THERE YOUR TREATMENT IS JUST THE OPPOSITE- YOU WANT TO CONSTICT THE VESSELS Treatment for cessation --Analgesics (for migraine and cluster) 1. Opiod 2. NSAIDS 3. Combinations (hydrocodone with ibprofen) --Ergot Alkaloids (for migraine) 1. Ertotamine tartrate (Ergostat) >>>Action: Vasoconstricts *** YOU WANT TO AVOID HABIT FORMING DRUGS BECAUSE CLUSTER HEADACHES HAPPEN OFTEN

Spinal Anesthesia

Used in childbirth.

OvertonMeyer theory

Used to explain some of the properties of anesthetic drugs since the early days of anesthesiology.

General Anesthetics

Used to produce unconsciousness as well as relaxation of skeletal and visceral smooth muscles for surgical procedures.

What are Herbal Products: Valerian?

Used to relieve anxiety, restlessness, and sleep disorders May cause CNS depression, hepatotoxicity, nausea, vomiting, anorexia, restlessness, insomnia Many interactions, including with CNS depressants, MAOIs, phenytoin, warfarin, and alcohol Contraindicated in cardiac and liver disease ´Patient should not operate heavy machinery during use.

What are Herbal Products: Kava?

Used to relieve anxiety, stress, and restlessness and to promote sleep May cause temporary yellow skin discoloration (extended, continued intake) and visual disturbances Potential interactions with alcohol, barbiturates, and psychoactive drugs Contraindicated in liver disease, alcoholism, other conditions Patient should not operate heavy machinery during use.

Vasoconstrictor

Usually a ______________ such as epinephrine is often coadministered with the local anesthetic to maintain localized drug activity.

Local Anesthetic: Adverse Effects

Usually limited Adverse effects result if: Inadvertent intravascular injection Excessive dose or rate of injection Slow metabolic breakdown Injection into highly vascular tissue Allergy Generally limited Most common with "ester type" anesthetics

antiepileptic drug interactions

Valporic acid: CNS depressants including alcohol, antihistamines, opioid analgesics, kava Aspirin, cimetidine, chlorpromazine, erythromycin increase Valproic toxicity Succinimides: CNS depressants including alcohol, antihistamines, opioid analgesics, kava May increase phenytoin levels May decrease phenobarbital levels

Mechanism of Action of General Anesthetics

Varies according to drug Classical "stages" of anesthesia Overall effect Orderly and systematic reduction of sensory and motor CNS functions Progressive depression of cerebral and spinal cord functions

What are the adverse effects of general anesthesia?

Vary according to dosage and drug used Sites primarily affected Heart, peripheral circulation, liver, kidneys, respiratory tract Myocardial depression is commonly seen.

IV sets are either vented or unvented

Vented sets are used for IV bottles without vents so that fluid will flow out Unvented sets are used for bottles or bags with their own venting system or no need for venting

What are inhalation anesthetics?

Volatile liquids or gases that are vaporized in oxygen and inhaled

Inhalational anesthetics

Volatile liquids or gases that are vaporized or mixed with oxygen to induce anesthesia.

IV therapy is used for administering fluids that contain

Water Dextrose Fat emulsions Vitamins Electrolytes Drugs

Surgical, dental, or diagnostic procedures, chronic pain

What are local anesthetics used for?

Drug Allergy

What are the contraindications to local anesthetics?

1 Benzodiazepines interact with levodopa to cause reduced levodopa effects and an increase in the symptoms of Parkinson disease.

What does the nurse teach the patient about the use of benzodiazepines when taking levodopa? 1 Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson disease. 2 Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson disease. 3 Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson disease. 4 Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson disease.

Drug Allergy

What is a contraindication to the use of anesthetic drugs?

Spinal headache

What is one notable complication of spinal anesthesia?

2 Ropinirole is a newer antiparkinson drug that directly stimulates specific dopamine receptors. It is more specific for the receptors associated with parkinsonian symptoms, the D2 family. This, in turn, may have more specific antiparkinson effects, with fewer adverse effects associated with generalized dopaminergic stimulation.

What is the difference between carbidopa-levodopa and ropinirole? 1 Both drugs have the same pharmacodynamic and side effect profiles. 2 Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. 3 Carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine. 4 Carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson disease.

4 The substantia nigra is a part of the extrapyramidal system, which is involved in motor function, including posture, muscle tone, and smooth muscle activity. Dopamine depletion in this area causes Parkinson disease. The thalamus is the relay station for brain impulses. The cerebellum is the area of the brain involved in the regulation of muscle coordination. The globus pallidus is a structure adjacent to the substantia nigra and is not affected in patients with Parkinson disease.

What is the main anatomic area of the brain that is affected in a patient with Parkinson disease? 1 Thalamus 2 Cerebellum 3 Globus pallidus 4 Substantia nigra

Maintaining skeletal muscle paralysis to controlled ventilation during surgical procedures.

What is the main therapeutic use of NMBDs?

2 Selegiline is a monoamine oxidase-B inhibitor used for the treatment of Parkinson disease. Meperidine is an opioid analgesic. Severe hypertension is caused by a drug-drug interaction between selegiline and buspirone. Concomitant administration of selegiline and meperidine may result in serotonin syndrome. Potential selegiline toxicity is the result of an interaction between selegiline and carbamazepine or oral contraceptives. Increased anticholinergic effects are the result of an interaction between dopamine modulators and anticholinergics.

What is the potential complication of a drug-drug interaction between selegiline and meperidine? 1 Severe hypertension 2 Serotonin syndrome 3 Potential selegiline toxicity 4 Increased anticholinergic effects

Continuous Intravenous Administration

When IV solutions are required, the health care provider orders the amount of solution per liter or milliliter to be administered over a specific time The nurse calculates the IV flow rate according to the drop factor, the amount of fluid to be administered, and the infusion time

4 Bromocriptine is the antiparkinson drug that also inhibits the production of the hormone prolactin. Hence it is useful for treating prolactin-secreting tumors. Selegiline, ropinirole, and entacapone are antiparkinson drugs that have no action on the prolactin hormone. Therefore they are not useful in the treatment of prolactin-secreting tumors.

Which antiparkinson drug is useful in the treatment of prolactin-secreting tumors? 1 Selegiline 2 Ropinirole 3 Entacapone 4 Bromocriptine

1, 3, 5 Parkinson disease is a slowly progressive, degenerative, neurologic disorder. It is characterized by resting tremors, pill rolling of the fingers, masklike face, shuffling gait and forward flexion of the trunk, muscle rigidity, loss of postural reflexes, and weakness. Chorea is irregular, spasmodic, involuntary movements of the limbs and facial muscles. Chorea and dystonia are symptoms of antiparkinson therapy, but not Parkinson disease.

Which are the most common symptoms of Parkinson disease? Select all that apply. 1 Tremor 2 Chorea 3 Rigidity 4 Dystonia 5 Postural instability

3 Catechol-ortho-methyltransferase drugs are useful for treating the on-off phenomenon in Parkinson disease, which is caused by fluctuations in dopamine concentrations. These drugs inhibit the enzyme catalyzing the breakdown of catecholamines, thereby maintaining uniform concentrations of dopamine. Dopamine modulators are useful in case of depleted dopamine concentrations. Anticholinergic drugs enhance the dopaminergic effects of the central nervous system, thus reducing the symptoms of Parkinson disease. They do not affect dopamine concentrations. Indirect-acting dopamine receptor agonists bind to the dopaminergic receptors, irrespective of the concentrations of dopamine.

Which class of drugs is administered to treat on-off phenomenon in a patient with Parkinson disease? 1 Anticholinergic drugs 2 Dopamine modulators 3 Catechol-ortho-methyltransferase 4 Indirect-acting dopamine receptor agonists

3 The combined use of COMT inhibitors with MAOIs results in decreased metabolism of catecholamines, which leads to increased cardiovascular risk. Concomitant use of COMT inhibitors and MAOIs does not result in renal toxicity. COMT inhibitors and MAOIs do not cause any increase in muscular rigidity because they do not overstimulate cholinergic excitatory pathways. Intake of COMT inhibitors on an empty stomach results in gastrointestinal (GI) upset. However, GI upset is not related to the concomitant use of COMT inhibitors and MAOIs.

Which complication is observed because of the concomitant use of catechol-O-methyl transferase (COMT) inhibitors and monoamine oxidase inhibitors (MAOIs)? 1 Increased renal toxicity 2 Increased muscular rigidity 3 Increased cardiovascular risk 4 Increased gastrointestinal upset

4 Carbidopa-levodopa is the drug combination contraindicated in patients with angle-closure glaucoma. The medication tends to cause an increase in intraocular pressure, and it may worsen glaucoma, resulting in blindness. Galactorrhea is a condition in which excessive milk production occurs in nursing mothers. These patients can safely take carbidopa-levodopa because the drug does not alter prolactin levels. Carbidopa-levodopa is used to replace dopamine and is beneficial in the treatment of low blood pressure. Myasthenia gravis is a muscular disorder for which the drug combination can be used if recommended.

Which condition is a contraindication for administration of carbidopa-levodopa? 1 Galactorrhea 2 Myasthenia gravis 3 Low blood pressure 4 Angle-closure glaucoma

3 Amantadine is a dopamine modulator that acts by releasing dopamine and blocking the reuptake of dopamine into nerve fibers. It is indicated in the early stages of Parkinson's disease. Selegiline is a selective monoamine oxidase-B inhibitor, which is indicated for Parkinson's disease. Entacapone is a catechol-O-methyl transferase (COMT) inhibitor indicated for the adjunctive treatment of Parkinson's disease. It acts by blocking the COMT receptors. Bromocriptine is a direct-acting dopamine receptor agonist that is used to treat Parkinson's disease. These directly stimulate the release of dopamine from the pre- and postsynaptic dopamine receptors in the brain.

Which drug indicated for Parkinson's disease acts by releasing dopamine and blocking the reuptake of dopamine into nerve fibers? 1 Selegiline 2 Entacapone 3 Amantadine 4 Bromocriptine

2 Tolcapone is an antiparkinson drug that is contraindicated in patients with liver failure. It is rarely used. Tolcapone is a catechol-ortho-methyltransferase inhibitor and gets metabolized in the liver and may cause liver toxicity. Ropinirole is a nondopamine receptor agonist and is not contraindicated in liver failure. Pramipexole is a direct-acting dopamine receptor agonist. It does not affect liver function and is not contraindicated in liver failure. Amantadine is an antiviral drug that is used in the treatment of moderate Parkinson's disease but is not contraindicated in liver failure.

Which drug is contraindicated in the patient with liver failure who needs an antiparkinson drug? 1 Ropinirole 2 Tolcapone 3 Pramipexole 4 Amantadine

1, 3, 5 Levodopa and a combination of levodopa and carbidopa are the available dopamine replacement drugs. Large doses of dopamine replacement drugs may result in undesired effects that include dyskinesia (difficulty performing voluntary movements), palpitations caused by cardiac involvement, and urinary retention as a result of decreased elimination of the drug by the kidneys. Somnolence is an adverse effect associated with the use of ropinirole, which is a nonergot alkaloid. Hypotension is the most common adverse effect caused by dopamine replacement drugs.

Which possible adverse effects are associated with the use of dopamine replacement drugs? Select all that apply. 1 Dyskinesia 2 Somnolence 3 Palpitations 4 Hypertension 5 Urinary retention

1, 2, 4 Bradykinesia, or slowing down of movements, is a prominent symptom of Parkinson disease. Tremors occur because of involuntary contractions of the muscles. Rigidity occurs as a result of resistance to passive movement. Seizures and tachycardia are not symptoms of Parkinson's disease. Tachycardia may not be caused by the degeneration of the substantia nigra because this brain area does not regulate heart function. Seizures are not associated with depleting concentrations of dopamine.

Which symptoms are associated with Parkinson disease? Select all that apply. 1 Rigidity 2 Tremors 3 Seizures 4 Bradykinesia 5 Tachycardia

Children, adolescents, and individuals with muscular and/or skeletal abnormalities

Who is at a greater risk for malignant hyperthermia?

Local Anesthetics

Work by rendering a specific portion of the body insensitive to pain by interfering with nerve transmission.

Mild Amnesia

______ _________ is also a common effect, due to midazolam.

Fat-soluble

______-__________ drugs are stronger anesthetics than water-soluble drugs.

Local

________ anesthetics are the second major class of anesthetics. They reduce pain sensations at the level of peripheral nerves, although this can involve intraspinal anesthesia, also called regional anesthetics bc they render a specific portion of the body insensitive to pain.

Curare

________ can be considered the grandfather of modern NMBDs.

Topical

__________ meds are applied directly to the skin and mucous membranes.

Cardiac, Pulmonary

___________ and ______________ functions are usually the last to be interrupted, bc they are controlled by the medulla of the brainstem.

Membrane-stabilizing

___________-____________ drugs that alter the cell membrane of the nerve so that the free movement of ions is inhibited.

Mechanical

_____________ ventilatory support is absolute necessary.

Anticholinesterase drugs

_______________ _____ are antidotes and are used to reverse muscle paralysis.

NCLEX EXAMINATION REVIEW QUESTIONS Lilley Ch.13 pg. 217 5. The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of a treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy? a. Cardiovascular disease b. Chronic bronchitis c. History of renal calculi d. Diabetes mellitus type 2

a

Preparation for the NCLEX® Examination Questions - Chapter 13 4. The nurse explains to a patient that using caffeine may exacerbate which health condition? a. Cardiac dysrhythmias b. Constipation c. Heart block d. Myelin degeneration

a Cardiac dysrhythmias Caffeine is a CNS stimulant. It should be used with caution in patients with a history of peptic ulcers, cardiac dysrhythmia, or recent myocardial infarction.

Antagonist

a drug that binds to a receptor and prevents (blocks) a response.

Social anxiety

a fear of crowds

What does osmolality mean?

a measure of the number of dissolved particles in a fluid

opioid tolerance

a normal physiologic condition that results from long-term opioid use, in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms

reuptake system

a protein called dopamine transporter picks dopamine up and brings it back into the cytoplasm. It can either move back into a vesicle to be recycled or it may be destroyed. An enzyme named monoamine oxidase (MAO) is the principle mechanism for destroying dopamine.

What is the definition of hypertonic?

a solution has a higher solute concentration than the inside of a cell

Preparation for the NCLEX® Examination Questions - Chapter 13 8. A patient with narcolepsy is prescribed methylphenidate (Ritalin). Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.) a. Insomnia b. Headache c. Weight Loss d. Decreased blood pressure e. Increased appetite

a,b,c Insomnia, Headache, Weight Loss The adverse effects of methylphenidate on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, GI distress, dry mouth, and worsening of or new onset of psychiatric disorders (including mania, psychoses, or aggression).