PHARM - neuro 1

What administration considerations apply to cholinergic agonists, cholinesterase inhibitors, & beta-adrenergic blockers ophthalmic drops?

- ECHOTHIOPHATE: admin in evening at least 5min apart from eye drops - ALL EYE DROPS: hold pressure on puncta & nasolacrimal sac at least 60 secs after instillation - ALL EYE DROPS: try not to touch or drop eye dropper -- when instilling eye drops for a client, apply clean gloves & instruct client to wash hands before instilling eye drops - do not apply with contact lens in place

What administration considerations apply to carbamazepine?

- admin w/ meals to reduce GI symptoms - sustained-release form should be swallowed whole - chewable tablets should be chewed or crushed & taken w/ liquid - oral suspension should not be mixed with other oral suspension drugs

What administration considerations apply to baclofen?

- administered orally or by intrathecal infusion - start oral baclofen in low doses, gradually increasing dose up to max 20mg 3-4x / day - give w/ food or milk to prevent GI symptoms - do not stop oral or intrathecal administration abruptly

What administration considerations apply to methohexital sodium?

- available for IV injection or infusion only - assure that intra-arterial / vein extravasation do not occur (can cause tissue and/or artery damage)

What administration considerations apply to amphetamine / dextroamphetamine sulfate?

- available in both regular tabs & SR form (commonly Adderall XR) - administer the drug whole - instruct client not to chew / crush drug

What administration considerations apply to fentanyl?

- available in multiple forms for surgical premedication, incl IV & stick lozenges - child or adult: place stick lozenge between cheek and gum - client should suck (not chew) on lozenge longer than 15 mins

What administration considerations apply to dantrolene?

- available in oral and IV preparations - for prophylaxis of malignant hyperthermia, give orally for 1-2 days pre-op - IV form is used to treat malignant hyperthermia

What administration considerations apply to bupropion hydrochloride?

- available in tabs, SR tabs, ER tabs -- ensure client is taking prescribed form - ensure client swallows ER and SR tabs whole - give w/ food if GI symptoms occur

What administration considerations apply to memantine?

- available orally in tabs or liquid solution - give w/ or w/o food

What administration considerations apply to valproic acid?

- available orally or IV - give EC form & admin w/ food to prevent GI symptoms - dilute IV form in atleast 50ml of diluents & do not mix w/ other drugs in solution - Depakote sprinkles may be opened and sprinkled on food (applesauce) before consuming

What administration considerations apply to lidocaine?

- avoid eyes w/ topical form - do not apply to broken skin (increased risk of tox) - assure that correct concentration & form are used for specific procedure - addition of epinephrine to lidocaine increases time of anesthesia, but may cause gangrene in end-artery sites (fingers, toes, nose, etc) - some forms contain preservatives which are contraindicated for certain procedures

What administration considerations apply to levodopa / carbidopa?

- begin admin w/ low doses to reduce adverse effects - advise client that it can take up to 6mo for full response to drug to occur - monitor for loss of drug effect & "on-off" phenomenon & report these to provider - IR tabs begin working within 30mins, then begin to wear off - ER tabs work over 4-6hr but can take up to 2hr to begin working in the morning

What administration considerations apply to phenelzine?

- begin w/ lowest dose & titrate upward - when discont, titrate dose downward to prevent rebound effect (headache, restlessness, sometimes incr depression)

What administration considerations apply to midazolam?

- can be given orally to children pre-op - may admin IM into large muscle mass for conscious sedation - give IV bolus or infusion for induction of anesthesia or conscious sedation - do not give bolus dose to neonates - may combine w/ an opioid for conscious sedation

What administration considerations apply to pramipexole?

- give 2-3hr before bedtime for restless leg syndrome - when incr dosage, allow 5-7 days between each incr

What administration considerations apply to diazepam and alprazolam?

- give alprazolam orally - take oral benzodiazepines w/ food if GI symptoms occur - give diazepam slowly & have emergency resuscitation equipment nearby - be aware that IV diazepam precipitates in solution w/ some diluents & drugs - do not give the emulsion form IM -- IV ONLY - avoid IM diazepam due to inconsistent absorption - if necessary, inject slowly into a large muscle

What administration considerations apply to donepezil?

- give at bedtime daily w/ w/o food - available as a syrup & in orally-disintegrating tabs

What administration considerations apply to modafinil?

- give in the morning for narcolepsy & sleep apnea - give 1hr before work for clients with shift-work sleepiness

What administration considerations apply to chlorpromazine?

- give oral dose w/ food and/or full glass of water to prevent GI effects - have client swallow SR tabs whole - give IM injection in large muscle, rotate sites - keep client recumbent for 30mins after IM or IV dose due to possible hypotension - IV form incompatible w/ multiple drugs - give IV bolus no faster than 1mg/min

What administration considerations apply to methylphenidate?

- give oral forms as/d depending on duration of action & type of preparation - SR forms must never be crushed or chewed -- swallow whole - Metadate CD and Ritalin LA caps may be opened / sprinkled on food (applesauce) - apply transdermal patch (Daytrana) in a.m. leaving on for no more than 9hr/daily - apply patch to new area daily, do not apply over rash or imflamed skin

What administration considerations apply to amitriptyline?

- give orally at bedtime - monitor for therapeutic effects after several wks - expect long-term use to control depression

What administration considerations apply to fluoxetine?

- give orally in tabs, caps, solution, or SR wkly capsules (fluoxetine) - know that it may take 4-6wks to reach clinical effectiveness - admin w/ food if GI upset occurs - give in the morning to prevent sleep disruption

What administration considerations apply to buspirone?

- give orally on a regular basis (NOT PRN) for anxiety - begin 2-4wk before tapering benzodiazepines due to delayed therapeutic effect of buspirone

What administration considerations apply to sumatriptan?

- give orally, SC, or nasal spray - use nasal spray by spraying 1x into single nostril -- may repeat after 2hr - single dose ranges from 5-20mg - max dose is 40mg in 24hr - give one SC injection 1x after 1hr if no relief -- no more than 2 doses in 24hr - give one oral tablet -- repeat 1x after 2hr if no relief - single dose ranges from 25-100mg - max dose is 200mg in 24hr

What administration considerations apply to phenytoin?

- give w/ meals to prevent GI symptoms - inject IV form slowly, using correct dilution - monitor vs during IV admin to prevent cardiac dysrhythmias and hypotension - narrow therapeutic range - carefully monitor plasma levels (which should remain between 10-20mcg/ml -- levels greater than 30mcg/ml can be toxic)

What administration considerations apply to lithium?

- give w/ milk or meals to prevent GI effects - assure that SR tabs are swallowed whole

What administration considerations apply to selegiline?

- give with levodopa / carbidopa so that levodopa dosage may be reduced - give disintegrating form orally (Zelapar) by placing it on top of the tongue - give before morning meal - no food / drink 5 min before or after admin

A nurse is teaching a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects? (Select all that apply)

- hirsutism - DROWSINESS - HEADACHE - ataxia - RASH

What administration considerations apply to risperidone?

- mix oral solution w/ juice, milk, water, coffee - do not mix with tea or soft drinks - remove rapidly disintegrating form from packaging immediately before admin - admin long-acting IM form (Risperdal Consta) every 2wks using large gluteal muscle & supplied needle - cont giving oral risperidone for 3wks after Risperdal Consta therapy has started

What administration considerations apply to venlafaxine?

- start w/ low doses & titrate upward every 4 days until optimal dosage is reached - give w/ food to minimize GI symptoms - make sure clients swallow SR caps whole

What administration considerations apply to interferon beta-1a and beta-1b?

BETA-1a (Avonex) - give IM weekly BETA-1a (Rebif) - give SC daily 3x/day each week - admin later in day - allow 48 hours between injections BETA-1b (Betaseron) - give SC every other day - use within 3hr after reconstituting

A nurse is teaching a client who received a prescription for interferon beta-1a for the treatment of multiple sclerosis. Which of the following information should the nurse include?

a. "have kidney function tests done every month for a year" b. "take an extra dose is muscle aches occur" c. "store the drug at room temperature after mixing it" d. "ADMINISTER THE DRUG IN YOUR THIGH OR UPPER ARM"

A nurse is teaching a client who has a prescription for baclofen. Which of the following instructions should the nurse include?

a. AVOID DRIVING UNTIL THE DRUG'S EFFECTS ARE EVIDENT b. stop taking the drug immediately if headache occurs c. take the drug as needed for spasticity d. take the drug with antacids to reduce gastric effects

A nurse is teaching a client who has a prescription for carbamazepine. Which of the following instructions should the nurse include to help the client avoid adverse effects of this drug?

a. BEGIN TAKING THE DRUG AT A LOW DOSAGE b. discontinue the drug immediately if diarrhea occurs c. have serum glucose levels checked regularly d. take the drug on an empty stomach

A nurse is teaching a client who is taking levodopa / carbidopa to treat Parkinson's disease. Which of the following instructions should the nurse include?

a. CHANGE POSITION SLOWLY TO PREVENT ORTHOSTATIC HYPOTENSION b. eat a high-protein snack to increase absorption c. take the drug at bedtime to avoid daytime drowsiness d. expect eye twitching to develop with long-term therapy

A nurse is teaching a client who is about to begin sumatriptan therapy to treat migraine headaches. The nurse should instruct the client to monitor for which of the following adverse effects?

a. CHEST PAIN b. polyuria c. joint pain d. insomnia

A nurse is teaching a client who has a prescription for modafinil to treat narcolepsy. Which of the following instructions should the nurse include?

a. TAKE THE DRUG IN THE MORNING b. take the drug 30 min before bedtime c. anticipate daytime drowsiness d. expect urinary frequency

A nurse is caring for a client who has been taking amphetamine / dextroamphetamine sulfate for the treatment of attention deficit hyperactivity disorder (ADHD) for 2 weeks. The nurse should report which of the following findings to the provider?

a. WEIGHT LOSS OF 2.3kg (5lb) b. BP 110/70 mm Hg c. apical pulse 10/min d. respiratory rate 16/min

A nurse is caring for a client who has a new prescription for pramipexole to treat Parkinson's disease. The nurse should recognize that which of the following laboratory tests requires monitoring?

a. c-reactive protein b. CREATININE CLEARANCE c. thyroid function d. cbc

A nurse is caring for a client who is receiving methohexital sodium. The nurse should monitor the client for which of the following adverse effects?

a. cardiac excitability b. RESPIRATORY DEPRESSION c. hyperthermia d. hypertension

A nurse is caring for a client who is taking donepezil to treat Alzheimer's disease. For which of the following adverse effects should the nurse monitor?

a. confusion b. dry mouth c. NAUSEA d. double vision

A nurse is caring for a client who has been taking selegiline to treat Parkinson's disease. The provider is considering the use of analgesics for the client but should be aware that a drug interaction between selegiline and meperidine can result in which of the following?

a. frequent urination b. jaundice c. cellulitis d. MUSCLE RIGIDITY

A nurse is providing teaching for a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects?

a. hirsutism b. depression c. JAUNDICE d. gum irritation

A nurse is reviewing the medical record of a client who has a newly diagnosed seizure disorder and a new prescription for valproic acid and phenytoin. The nurse should identify that which of the following can occur as a result of an interaction between these drugs?

a. hyperammonemia b. PHENYTOIN TOXICITY c. hypertension d. peptic ulcer disease

A nurse is caring for a client who has a new prescription for amphetamine sulfate. The nurse should monitor the client for which of the following adverse effects?

a. hypotension b. tinnitus c. TACHYCARDIA d. bronchospasm

A nurse is teaching a client who has Alzheimer's disease and their caregiver about memantine. Which of the following instructions should the nurse include?

a. increase fluid intake to improve renal excretion b. report memory loss or confusion c. watch for signs of liver impairment, such as jaundice and abdominal pain d. AVOID TAKING OTC ANTACIDS

A nurse is teaching a client who has a new diagnosis of Parkinson's disease about how levodopa / carbidopa can help control symptoms. The nurse should identify that the drug has which of the following pharmacologic effects?

a. increases available acetylcholine in the brain b. inhibits norepinephrine metabolism in the brain c. inhibits serotonin metabolism in the brain d. INCREASES AVAILABLE DOPAMINE IN THE BRAIN

A nurse is teaching the family of a client who has a new diagnosis of Alzheimer's disease about donepezil. Which of the following information should the nurse include?

a. monitor for constipation b. the dosage will be increased weekly to provide optimum therapeutic effect c. administering the drug first thing in the morning promotes effectiveness d. AVOID THE USE OF NSAIDS

A nurse is administering fentanyl to a client to reduce pain. Which of the following drugs should the nurse have available to reverse the effects of fentanyl?

a. neostigmine b. succinylcholine c. NALOXONE d. dantrolene

A nurse is preparing to administer memantine to a client who has Alzheimer's disease. Which of the following findings in the client's medical history indicates a need to withhold the drug and notify the provider?

a. pancreatic cancer b. hypotension c. CIRRHOSIS d. osteoporosis

A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should identify that which of the following laboratory tests requires monitoring?

a. serum potassium b. LIVER FUNCTION c. serum sodium d. thyroid function

A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should instruct the client to report which of the following adverse effects?

a. slow heart rate b. cough c. DIARRHEA d. hearing loss

A nurse is caring for a client who is taking interferon beta-1b. The nurse should identify that which of the following indicates a potential serious adverse effect of this drug?

a. tinnitus b. twitching eyelids c. blue-green skin discoloration d. FATIGUE

A nurse is preparing to administer sumatriptan to a client for the first time. The nurse should instruct the client that sumatriptan is indicated for which of the following conditions?

a. tonic-clonic seizures b. PRESENCE OF A MIGRAINE HEADACHE c. exacerbation of multiple sclerosis d. Alzheimer's disease