Nursing Pharmacology 2

Dopamine Agonist, Adverse Effect:

...Issues with controlling impulses

NMDA use:

...Moderate-to-severe AD

Negative symptoms in SCHIZOPHRENIA

Affective flattening, apathy-TOOK AWAY

Alzheimer's Dx

Age, clinical manifestations, diagnostic testing: MRI-atrophy of brain; DEFINITIVE Dx: AUTOPSY

PD-Other drugs:

Anticholinergic=control tremors, exacerbate dementia...

A client who has stopped smoking "cold turkey" after 2 years of smoking 1 pack per day calls for a clinic appointment. The nurse teaches the client that signs of nicotine withdrawal include

Depression & decreased blood pressure

CAMR:

Depression of the CNS, hepatic toxicity, physical dependence

Only drug effective on both spasm and spasticity:

Diazepam

Cervial ripening (shorter,softer,dilate)

Do not use with someone with C-section. (uterine scar)

Buspar

Doesn't exhibit muscle relaxant, binds with serotonin/dopamine receptors; takes several weeks to get significant anti-anxiety effects....works by SLOWing brain transmission

EPS-Alpha2 Block:

Hypotension, tachycardia

Baclofen antidote:

NONE

Typical Antipsychotics:

Phenothiazines; seroquel

Benzodiazepine: TREATS OVERDOSE

Romazicon (elderly more vulnerable)

A patient comes to the clinic with severe spastic paralysis. During the health history the patient asks a nurse which drug could be used in an attempt to provide relief from the spasms. The nurse explains that the only benzodiazepine used to treat spasticity is

diazepam (Valium)

A patient with multiple sclerosis is admitted to the unit for an acute exacerbation and is given interferon beta-1a (Avonex). What questions related to adverse effects should the nurse include in the physical assessment?

"Do you have a headache, chills, or muscle aches?"

A nurse is providing patient education for a 71-year-old patient. The patient has taken levodopa (Dopar) for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. The nurse should tell the patient

"It may take several months for a response to occur. Continue the medication as prescribed."

A nurse is teaching a class on Alzheimer's disease to a group of nurses. One of the nurses asks how a cholinesterase inhibitor drug works in the Alzheimer's patient. The nurse's best response would be

"It prevents the breakdown of acetylcholine by acetylcholinesterase, reducing symptoms, such as memory loss."

Which statement is true about the Dopaminergic (Levodopa) and dopamine agonist?

"Postural or orthostatic hypotension is common in patients taking levodopa and pramipexole;

A patient with Parkinson's disease who has been responding well to drug treatment suddenly develops a relapse of symptoms. Which explanation by the nurse is most appropriate?

"This is called the 'on-off' phenomenon. Avoiding high-protein meals and adding another drug may help."

A client expresses the desire to quit smoking. She elects to use Nicorette gum replacement therapy. Which statement by the nurse is true regarding this smoking cessation technique?

"You should not eat or drink for 15 minutes before or after chewing the gum."

A patient with Parkinson's disease says, "I always take my other medications with my bacon and eggs each morning. Can I take the levodopa (Dopar) at this time too?" The nurse's best response would be

"You should take the levodopa at least 1 hour before you eat your breakfast."

Immunomodulator: Cost & Administration:

$$$$$ & Parenterally

SSRI DDI: St.Johns Wort; MANY others

...

Traditional Antipsychotics, Disadvantages:

...-Doesn't treat negative schizo symptoms; EPS side effects; dyskinesia; LOW seizure threshold

Parkinson's risk factors:

...>50; reduced risk smokers

Drugs for PD:

...ALL=goal to increase dopamine; dopaminergic agonists; dopamine agonists; COMT inhibitors; MAO-B inhibitors: REDUCE ACETYLCHOLINE ACTION

COMT inhitors:

...Allow more levodopa to reach brain

Hyperthyroidism:

...Anemia, WBC/infection, Bleeding/bruise

Trazodone:

...Antidepressant; PREFERRED for INSOMNIA! Much safer than TCAs

Non-Benzodiazepine:

...Antihistamine (Benadryl) Antidepressant (Zoloft/Paxil)

Benzodiazepine implications:

...As hypnotic: induce sleep rapidly, effect gone by AM; in same class as alcohol-can use with withdrawal!!

Antianxiety/sedative-hypnotic drug

...Benzodiazepines (WIDELY USED, antianxiety)

Hyperthyroidism:

...Beta Blockers MOA: Blocks sympathetic nerve system, fight or flight; symptom relief

Tacrine + Elderly:

...Cognition medication; DO NOT give to elderly due to HEPATOTOXICITY

COMT Inhibitors Comtan vs Tasmar:

...Comtan: ONLY peripherally active, NO adverse effects Tasmar: Both peripheral and CNS active, causes hepatotoxicity

Levodopa; side effects:

...DARK sweat/urine; punding-(fascinated by one act, arranging books)

Parkinson's characteristics:

...Death of DOPAMINE-producing cells, tremors/rigidity/abnormal gait/dementia

Hemichoretic gait:

...Debbie; circumduction

Indication of HYPERthyroidism:

...Decreased TSH; increased T3,T4

Atypical Antipsychotics, Advantages:

...Diminishes (-) & (+) symptoms of schizophrenia; decreases suicidal behavior

Buspirone:

...Does NOT exhibit muscle relaxant or anticonvulsant activity; sedative-hypnotic properties

Cholinesterase inhibitor approved for treatment of ADVANCED Alzheimers:

...Donepezil

Traditional Antipsychotics:

...Dopamine antagonist, target POSITIVE symptoms of SCHIZOPHRENIA.

Levodopa is in what class?

...Dopaminergic

Indication of HYPOthyroidism:

...Elevated TSH; decreased T3,T4

Anticonvulsants:

...Enhance effects of inhibitory neurotransmitter, GABA; desensitizing stress/trauma effects

Neuroleptic Malignant Syndrome:

...Fever, Encephalopathy, Vital Instability, Elevated WBC, Rigidity, Sweat/Shock

Dopaminergics; Levodopa MOA:

...GOLD STANDARD; Long-term use=Risk for disabling dyskinesia

Dopaminergic DDI:

...High protein & vitamin B=reduce effects

Thyrotoxic crisis/Thyroid storm:

...Hyperthyroid patients under a lot of stress; causes hyperthermia/tachy/tremor/coma...TREAT: Potassium Iodide (Lugol's), Beta-blocker, Cool, IV fluids

Traditional Antipsychotics, Advantages:

...INEXPENSIVE than atypical

COMT Inhibitor MOA:

...Increases dopamine/prevents breakdown of dopamine

MAO-B inhibitors:

...Inhibit monoamine oxidase B that breaks down dopamine in brain

NMDA receptor antagonist MOA:

...Inhibits GLUTAMATE release

Cholinesterase inhibitor MOA:

...Inhibits breakdowns of Ach-use with mild/moderate Alzheimers

Disabling dyskinesia, defined:

...Involuntary Movements

Benzodiazepine + Pregnancy:

...Late: floppy infant syndrome, poor sucking reflex

MAO-B Inhibitors Patient teaching:

...Low-protein OR take levodopa 30 minutes before meals; RESTRICT TYRAMINE w/ High Doses

On/Off states:

...Medication response fluctuates-on=effective; off=ineffective

Calcium channel blockers:

...Modulate mood; inhibit calcium channels, similar to LITHIUM so if Lithium doesn't work-CCB likely will work

Levadopa, described:

...More effective, needs to be activated, Short duration, Inexpensive, Dyskinesia is common, Affected by diet (Dopamine Agonist is Exact OPPOSITE)

COMT Inhibitor Side Effects:

...Muscle aches, rhabdomylosis, liver damage, neuroleptic malignant syndrome

AD-1st line therapy:

...Non-pharmacological; other-Risperdal; Haldol: SHORT-TERM ONLY

Carbidopa's effect on levodopa:

...Prevents levidopa metabolization so quickly (carbidopa/levodopa; Sinemet)

Hyperthyroidism:

...Radioactive Iodine-131 MOA: Destruction of thyroid gland; GLOWS, dispose of items down toilet if have body fluid on them

MAO-B:

...Reduces breakdown of dopamine & phenethylamine: NO diet restrictions

MAO-A:

...Reduces the breakdown of serotonin, norepinephrine, & dopamine: Watch Tyramine intake

Cholinesterase Inhibitor SIDE EFFECTS:

...SLUDGE: salivation;lacrimation;urination;diarrhea;GIupset;emesis; DUMBBELSS: diarrhea;urination;miosis/muscleweakness;bronchorrhea;bradycardia;emesis;lacrimation;salivation;sweating

Antidepressant drugs:

...SSRI, SNRI, TCA, MAOI, etc.

Administering drug therapy for AD:

...SWALLOWING ability; FALL Risk; may be effective for 6month-3years;combination therapy

Atypical Antipsychotics-FIRST LINE:

...Serotonin-dopamine antagonist

Parkinson's, defined:

...Slow, progressive, degenerative CNS disorder w/ UNKNOWN CURE

Antihistamine:

...Sometimes used as sedative-hypnotic agent; not as effective as benzos, BUT don't cause dependence

Hyperthyroidism: Nonradioactive Iodine (LUGOL'S solution) MOA:

...Suppresses thyroid function; brassy taste; soreness in teeth/gums

Thyroid hormones:

...T3,T4=Iodine needed to produce both, generates heat, basal metabolic rate, stims cardiopulmonary system

Hyperthyroidism, described:

...Tapazole-inhibits thyroid hormone synthesis; thyrotoxic crisis/storm; may cause myelosuppression, agranulocytosis (no new cell), hepatoxicity, jaundice, decreased immunity; MAYBE 3-4 WEEKS TO WORK! Remove thyroid; hyperglycemia,hypernatremia,hypokalemia=(exact opposite hypothyroidism) RED, WHITE, BLUE:

Hypothyroidism, described:

...Use synthroid: TAKE ON EMPTY STOMACH same time every AM; obesity/short statue/infertility if overdosed, check glucose/heart levels: 65+=1.0mcg/kg;

Benzodiazepine-side effects:

...Usually harmless, dose-related; VERY HIGH therapeutic index-Almost NO fatalities

Serotonin Syndrome:

..Cognitive, autonomic, somatic effects muscle twitching).

Lithium

0.6-1.4 therapeutic range

A patient is going to take the immunosuppressant, Mitoxantrone (Novantrone), for the treatment of multiple sclerosis. What are some baseline tests need to be done prior to the drug therapy? 1. Complete blood counts and differentiation; 2. Liver function tests (LFTs) 3. The pregnancy test 4. EKG

1,2,3,4

A client is to start a new medication to help with alcohol abuse. The nurse providing medication education about the disulfiram (Antabuse) is sure to include which topics in the education plan? 1. It is important to take this medication every day. 2. If planning to drink alcohol, stop disulfiram treatment 1 day before alcohol consumption. 3. Disulfiram works by disrupting the metabolism of alcohol. 4. Use of alcohol may cause nausea, vomiting, and may even be fatal.

1,3,4

Which statement is true about antidepressant agents? 1. Tricyclic antidepressants (TCA) are associated with cardiac dysrhythmias 2. Tranzadone (Desyrel) can cause hyperactivity and insomnia 3. It is more effective and safer to use SSRI and MAOI together. 4. Bupropion can be used to help smoking cessation.

1,4

______________ are associated with the inbibitory neurotransmitter, Gamma-amino-butyric acid (GABA). 1. Anticonvulsants 2. Lithium 3. SSRI 4. Benzodiazepin

1,4

Drugs that the nurse would anticipate administering to a client who has been admitted with acute alcohol intoxication include which drugs? 1. naloxone (Narcan) 2. thiamine 3. lorazepam (Ativan) 4. intravenous glucose solution

2,3,4

Benzodiazepine

2nd line defense for anxiety for long-term treatment, we want to see it used short-term

The nurse is doing discharge teaching with a client with the diagnosis of schizophrenia on the medication, clozapine (Clozaril). Which of the following statements accurately reflects information the nurse must provide? 1. "You should avoid eating foods high in tyramine, such as aged cheeses and pickled fish." 2. "The most common problems with Clozaril are the extrapyramidal side effects, including tardive dyskinesia." 3. "You will need to have your blood drawn frequently in order to check your white blood count." 4. "If you experience sore throat, fever or other flu-like symptoms, you need to contact your health care provider immediately."

3,4

The nurse is aware that physiologic and psychologic dependence on caffeine has been found with chronic use of _______ or more per day?

5 cups of coffee

BPH: 5-ARI & Alpha1 Blocker

5-ARI: Reduce prostate growth, alopecia, sexual dysfunction Alpha1 Blocker-smooth muscle relaxant

Which statement is true about hypothyroidism and its treatment?

A patient with hypothyroidism is taking both levothyroxine (Synthroid) and warfarin (Coumadin) together. Levothyroxine is expected to enhance warfarin's blood level, leading to potential risk of bleeding.

Dantrolene MOA:

Acts on SKELETAL MUSCLE, not CNS

Myasthenia Crisis vs. Cholinergic Crisis

Administer EDROPHONIUM, ultra-short acting cholinesterase inhibitor. This causes elevation of Ach, and if it works, it was myasthenic.

Which statement is true regarding how to differentiate between a myasthenic crisis and a cholinergic crisis?

Administer edrophonium (Tensilon) and monitor the response.

The nurse observes a schizophrenia client with head rotated to one side in a stiffly fixed position and lower jaw is thrust forward and saliva is coming from the mouth. Which intervention is most warranted?

Administering benztropine (Cogentin) 2 mg intramuscularly

Risk Factor of Alzheimer's

Advanced age, Genetics, Female

Which symptoms would the nurse expect to see in a client suspected to have serotonin syndrome?

Agitation, restless,tremor and sweating.

All patients with relapse-remitting MS should receive what?

An immunomodulator, continued indefinitely

Drugs used for muscle spasm/spasticity:

Analgesic anti-inflammatory agents (ASA) & Centrally acting muscle relaxants (About the same effectiveness)

A client is experiencing acute dystonia, an extrapyramidal symptom (EPS). In addition to reduce or discontinue the antipsychotic agent, the nurse would anticipate administering a medication in which category?

Anticholinergic

Cholinesterase Inhibitor TREATMENT:

Atropine-decreases muscarinic effects

A client with congestive heart failure receives digoxin (Lanoxin) to slow and strengthen ventricular contraction. He tells a nurse during his health history that he frequently uses amphetamines to "deal with all the stress." Which assessments and diagnostics would be a priority for this client?

Auscultation of the heart rhythm & an ECG

If client is on MAOI, and tyramine has gotten to liver...

Avoid INGESTION of tyramine (aged foods, fermented products): interacts with warfarin/glycemic drugs

Major toxicities of cancer chemotherapy

BAD ACHES: bone marrow suppression, Anorexia/anxiety, Diarrhea, Alopecia, Carcinogenesis, Hyperuricemia, Extravation, Stomatitis CANCER: Cardiotoxicity, anemia, neuropathy, cognitive impairment, ear damage, renal damage

Acute dyskinesia medication

BENADRYL-IV or IM!!

EPS: opisthotonus and oculgyric crisis

Back arched, and eyes rolled up in back of head, gotta run! Ticking (Tardive dyskninesia is LATE)

Spasticity drugs that work on the CNS:

Baclofen and diazepam

Drugs that relieve spasticity:

Baclofen, diazepam, dantrolene

BPH

Benign prostatic hyperplasia; 5-alpha & alpha1 (blood vessel) SCREEN for prostate cx & prevent fall

A patient was admitted to hospital for overnight observation for acute onset anxiety related to unexpected life events. What classification of medication would the nurse anticipate will be ordered first?

Benzodiazepine

Most widely prescribed drugs in the world

Benzodiazepines; prompt, limited side effects

Drugs that effect uterine function

Between 20-37 weeks only; .....Prevents premature birth/stop contraction...Relaxes uterine muscle; give CORTICOSTEROID to help fetal lungs mature

Hormone Replacement Therapy: Progestin

Bleeding, teratogenic risk in pregnancy

Antitumor Antibiotics

Block DNA synthesis, damage DNA during all phases: IV Administration: NOT INFECTIONS

Antimitotics

Block mitosis; Effect M-Phase

SSRI

Block reuptake of serotonin=GOOD, because there's less with depression in that synaptic junction

Estrogen

Bone mineralization; Cause uterine cancer

The nurse is caring for a client who is detoxifying after an opioid overdose. The nurse anticipates that which drug will be given to substitute for the opioid?

Buprenorphine (Subutex)

Immunogenic

Can stimulate production of antibodies against itself

Benzodiazepine, alcohol

Can use with alcohol withdrawal...able to titrate down: SHOULDN'T TAKE TOGETHER

Centrally Acting Muscle Relaxants MOA:

Cause sedation, not on CNS though

Apoptosis

Cell suicide-Occurs in NORMAL cells

Oligodendrocytes

Cells that make myelin

Cholinergic Crisis:

Characterized by extreme muscle weakness/frank paralysis/excessive muscarinic stimulation; TREAT w/ ATROPINE + respiratory support

Spasticity:

Characterized by increased muscle tone, spasm, and loss of dexterity

Multiple sclerosis

Chronic, inflammatory, autoimmune disorder, damages myeline sheath

A nurse in the emergency department receives a call that a client is being transported to the hospital by paramedics. The client is a known heroin addict and is showing signs of potential overdose. The nurse would expect which symptoms?

Clammy skin, constricted pupils, decreased level of consciousness

To Dx MS

Clinical presentation and lab data requires objective evidence of 2+ clinical attacks separated in time and space

When caring for a client recovering from an episode of opioid toxicity, the nurse determines that the client has an addiction to the drug based on which finding?

Craving that results in drug-seeking behaviors

Natalizumab: approved for what two autoimmune disorders?

Crohn's & MS

Alkylating agents & platinum compounds

Cross-link(glues DNA strands together) w/ DNA-dysrupts DNA cycle, Drug resistance is common (All phases)...GIVE BOLUS

A client is taking an anxiolytic agent secondary to grief-related anxiety. The client questions the provider about abruptly discontinuing the drug. Which response from the care provider is most likely appropriate?

Dosage must be TAPERED off to avoid withdrawal

Which intervention is highest priority for the care plan of a client on lithium therapy?

Drink 1-2 liters/daily

Ptosis

Drooping eyelids

Atypical Antipsychotics, side effects-anticholinergic:

Dry mouth, dry eyes, constipation; extrapyramidal: tardive dyskinesia/pseudoparkinsonism

Flexeril Adverse Effect:

Dry mouth, vision problems

Cholinesterase Inhibitor side effects/Cholinergic Crisis:

Excessive muscarinic stimulation, respiratory depression, GI issues, can cause too much Ach accumulation

What is a common side effect for which the nurse must monitor during administration of Haloperidol (Haldol)?

Extrapyramidal symptoms

Benzos-taken before birth

Floppy infant syndrome, poor sucking

Interferon Beta, adverse effects:

Flu-like reactions, hepatotoxicity (get LFTs), myelosuppression (get blood checked), depression, immunogenic.

A client is admitted to the emergency room after overdosing on a benzodiazepine. The nurse anticipates that the healthcare provider will order which antidote?

Flumazenil (Romazicon)

Cholinesterase Inhibitor (Anticholinergic Agent) MOA:

For MG, increases muscle strength

Non-benzo

For long-term, take 2-6 weeks for effect....tend to use benzos during the 2-6 weeks that non-benzos aren't taking effect

Cell cycle

G0=resting, no cell replication G1=pre-DNA synthesis, cellular contents duplicated S-Phase=DNA SYNTHESIS G2=rapid cell growth & protein synthesis Mitosis-Separates

Alzheimer's Disease, defined:

GRADUALLY progressive; Plaque-Memory Loss-Impaired Thinking-Inability to Perform ADLs-Death (breaks down breathing); Incurable

What drug is used to treat acute episode (relapse) of multiple sclerosis?

Glucocorticoid

Treating an Acute Episode (Relapse) MS:

Glucocorticoid-high dose IV, reduce inflammation; short-course OR Gamma globulin IV

Cancer therapy

Go intermittent (Does not work in G0 phase); combination therapy

Tegretol

Grape juice affects drug

Xanax and valium react with

Grapefruit juice....get more of an effect; benzo; binding/targeting the GABA receptor

NMDA Adverse Effects:

Hallucinations; confusion...

Solid tumor

Hard to treat because they grow slowly, respond poorly to drugs (less circulating blood flow)

A client comes to the medication clinic on Tuesday. The client's regular weekly appointment is Friday. The client complains to the nurse that he has a terrible sore throat. The nurse reviews the client's record and finds that the client is receiving Clozaril (clozapine). The client's temperature is 100 degrees F. The nurse should make arrangements:

Have WBC done.

Dantrolene Adverse Effects:

Hepatic toxicity, n/v, drowsiness

A client in the hospital is experiencing methamphetamine withdrawal. What does the nurse expect the symptoms and treatment to be?

Hypersomnia, irritability; treated by supportive care including pushing food and fluids

2 Main Disease-Modifying drugs:

Immuno-modulators & Immuno-suppressants

Alzheimer's DRUGS:

Improve symptoms: Aricept is MOST COMMON; Include cholinesterase inhibitors & NMBA receptor antagonist

A patient has been recently diagnosed with Parkinson's disease. A nurse is providing patient education for the patient and the spouse. The nurse is correct to state that the goal with the current drug regimen is to

Improve the patient's ability to carry out activities of daily living.

Positive symptoms in SCHIZOPHRENIA

Inappropriate affect, DELUSIONS

Dopamine Agonist (Mimic Dopamine), MOA:

Increase dopamine effect-binds to receptor in brain

Topoisomerase inhibitors

Inhibit uncoiling DNA=Attack S-PHASE, Diarrhea

Interferon Beta MOA:

Inhibiting leukocytes to BBB, preventing cells from reaching neurons of CNS

Mitoxantrone MOA:

Inhibits DNA/RNA synthesis; immunosuppressant-decreasing autoimmune destruction of myelin

Antimetabolites

Interferes w/ synthesis by preventing folic acid production (S-phase specific)

Immunomodulators:

Interferon Beta, Glatiramer Acetate, Natalizumab (SAFER than mitoxantrone)

A client with a history of long-term alcohol abuse is diagnosed with Wernicke's encephalopathy. The nurse would plan the client's care with the knowledge that which treatment will be needed first?

Intravenous thiamine to address nutritional deficiency

Muscle spasm:

Involuntary contraction of a muscle (can be associated with hypocalcemia)

Non-benzodiazepine

Leaves cognition in tact....controls physical anxiety-related things such as increased heart rate, sweating....GOOD WITH PERFORMANCE ANXIETY!

Natalizumab Adverse Reactions:

Leukoencephalopathy, hepatotoxicity, hypersensitivity reactions (anaphylaxis), PML

Glatiramer Acetate is for:

Long-term therapy of relapse-remitting MS and is generally WELL TOLERATED

A psychiatric patient has greatly increased seemingly non-goal-directed motor activity and seems terror-stricken. He does not respond to nursing staff efforts to calm him. He is noted to have distorted perceptions and disordered thoughts. Of the medications listed on the patient's medication administration sheet, which one, with the appropriate order, can be given as a prn anxiolytic?

Lorazepam (Ativan), benzodiazepines

The nurse is caring for a patient who was diagnosed 2 days ago with hypothyroidism and has not yet been started on a drug regimen. Which of the following laboratory findings would the nurse most likely anticipate being consistent with a patient with hypothyroidism?

Low serum T4 and elevated TSH

Cyclophosphamide side effects:

MS, myelosuppression, alopecia

Menotropins (infertility drug)

Make uterine lining thicker, ovulation maturation

Disease modifying:

May prevent permanent damage to the axons, slowing down the disease progression

Rozerem

Melatonin agonist (comes from pinneal gland, made out of serotonin)...is a sleep aid...SLEEP-Not rested

Hormone Replacement Therapy: Estrogen

Menstration, Breast cancer

Diazepam:

Mimics GABA, sedation is common when treating spasticity

Baclofen MOA:

Mimics GABA; overdose can cause COMA & respiratory depression, can be physically dependent

Only FDA -approved immmunosuppressant for MS

Mitoxantrone

A client scheduled for elective gallbladder surgery is addicted to heroin and is in a methadone treatment program. Postoperatively, the nurse would expect the client's surgical pain to be treated with which measure?

Morphine or other opioids

Which part of a neuron would be the most damaged in a patient with multiple sclerosis?

Myelin sheath

Mitoxantrone, Adverse Effects:

Myelosuppression, Cardiotoxicity-left ventricular ejection fracture reduction, & fetal harm.

TCAs

NARROW therapeutic index, interact with A LOT, inactivating PUMP...blocks enzymes in liver that breaks down tyramine (causes HUGE Vasoconstriction!)

MS cure:

NONE

The nurse is caring for a client with opioid addiction. The client requires the reversal of respiratory depression and coma. The nurse anticipates that she will be treated with which medication?

Naloxone (Narcan)

Most effective immunomodulator:

Natalizumab, MORE HARSH: use ONLY when patient's haven't responded to other drugs

Baclofen Adverse Reactions:

Nausea, constipation, urinary retention

A patient with schizophrenia has difficulty in holding a normal conversation. He replies the questions sparsely, and his speech lacks spontaneous content. In addition, he frequently fails to provide the answers. These symptoms are categorized under:

Negative symtoms

Myasthenia Gravis, defined:

Neuromuscular disorder that's characterized by fluctuating muscle weakness and rapid fatigue

Agranulocytosis (Anticonvulsants)

No new cells; WBC check

Why so hard to treat cancer?

Nonselective toxicity, Cure requires 100% KILL, Absence of early detection, heterogeneity of tumor cells

SNRI

Norepinephrine/serotonin=LOC, more available at synaptic junction

Chemotherapy drugs are more toxic to...?

Normal cells w/ rapid growth rate: (marrow, skin, sperm, GI tract) (NO drug during G0 phase)

Diazepam:

Only CAMR that can be used with CNS-related spasms

A postoperative client received morphine in the recovery room. On assessment, the nurse notes that the client's respiratory rate is 6 breaths per minute and that the client has a decreased level of consciousness. The anesthesiologist orders naloxone (Narcan). The nurse administers this medication with the knowledge that this drug is a(n):

Opioid antagonist

A client hospitalized with a fractured femur following an automobile accident develops diarrhea and vomiting with abdominal cramps, chills with goose bumps, and dilated pupils. The nurse suspects the client is experiencing which reaction?

Opioid withdrawal

Which one of the following medications is most likely to be ordered for a client to assist in controlling the occurrence of panic disorder?

Paxil, SSRI

A patient on levodopa (Dopar) for Parkinson's disease comes to the emergency department complaining of a severe headache. The vital signs are: temperature 98.8° F, pulse 92/minute, blood pressure 202/107 mm Hg, and respirations 18/minute. A nurse should be most concerned if which of the following drugs is on the patient's current list?

Phenelzine (Nardil)

Erectile dysfunction

Phosphodiesterase inhibitor (VIAGRA)-vasodilator Start IV first=maintain BP; blocks calcium, REDUCE fat intake

Uterin stimulants

Pitocin, Causes issues of WATER RETENTION because is ADH, increases contractions; KNOW BP/pulse

A patient is taking Selegiline (Eldepryl), Monoamine Oxidase Inhibitors (MAOIs). What diet would be appropriate for him?

Potatoes, ground beef patty, corn, and green beans

Natalizumab-associated with?

Potentially fatal infection of the brain

Natalizumab MOA:

Prevents circulatory leukocytes from leaving vasculature-binds with integron.

Glatiramer Acetate MOA:

Promotes T-cell shift; Go across BBB & suppress myelin sheath attack

Common symptoms of Myasthenia Gravis:

Ptosis, difficulty swallowing, weakness of skeletal muscle

Combination therapy

Reduce resistance, increase killing power, reduce side effects

Alzheimer's Pathophysiology:

Reduced ACh, Plaques, Tangles, Degeneration of Neurons: Early hippocampus/memory; Late cerebral cortex/speech/reasoning

Cyclophosphamide treats:

Refractory MS

Most common MS:

Relapse-remitting

A nurse observes a colleague taking oral opioids from the medication room at the hospital. Which is the best action by the nurse?

Report the finding to the nursing supervisor to enable the colleague's participation in a diversion program.

A patient with multiple sclerosis began a treatment regimen with mitoxantrone (Novantrone) 2 weeks ago. Which nursing diagnosis would have the highest priority in the plan of care?

Risk for infection secondary to myelosuppression.

The client is known to have overdosed on a benzodiazepine medication. The nurse anticipates that which medication will most likely be ordered?

Romazicon

Trazadone

Sedative

A patient with a history of Alzheimer's disease has been taking tacrine (Cognex) for 18 months. Based on the side effects of the medication, the nurse should monitor which laboratory finding?

Serum alanine transaminase (ALT)

Menopause

Short-term therapy; post-hysterectomy: use ESTROGEN ALONE...no uterine...

Sedative-hypnotic (Restoril)

Sleeping pill, rapid, clean by AM

Centrally acting muscle relaxant medications:

Soma, Diazepam (Valium)

Myasthenic Crisis:

State characterized by extreme muscle weakness caused by insufficient Ach at the NMJ. If untreated=death from paralysis of respiration; TREAT w/ cholinesterase inhibitor

While teaching the parents of an adolescent who has been using marijuana, the nurse explains that the euphoria that results from the use of abused psychoactive substances is believed to be caused by which?

Stimulation of the dopamine pathways in the pleasure areas of the brain

The spouse of a patient with advanced Alzheimer's disease confides to the nurse that the patient's wandering, pacing, and agitation seem to get worse in the evening. The nurse correctly explains this phenomenon to the spouse as

Sundowner's Syndrome

Alzheimer's Disease associated with:

Sundowner's syndrome (exhaustion of the receptors)

Atropine is used in cholinesterase inhibitor overdose. True or False?

TRUE

Which statement is true about mood stabilizers?

The SEs/ADEs of Lithium include: GI discomfort, hand tremors, renal dysfunction and Ataxia

The client has been started on Elavil. He tells the nurse that he does not take any other medication except for St. John's wort, which he has found to be mildly therapeutic. What should be the nurse's highest priority response to this information?

The combination of St. John's wort and Elavil can produce serotonin syndrome

A client is placed on antidepressant therapy with Zoloft (sertraline). What type of information should be included in the client's medication teaching plan?

This medication can cause sexual dysfunction, weight gain, and GI upset.

A client is admitted to the emergency department with acute cocaine toxicity. Which is the most important intervention by the nurse?

To institute cardiac monitoring and obtain frequent blood pressures

Progesterone

Treats uterine cancer; promote & sustain pregnancy

An Alzheimer's patient has been taking a cholinesterase inhibitor for a week. What anticipated side effects (signs and symptoms) related to the medication would the nurse anticipate in the patient?

Urinary incontinent, excessive sweating, and diarrhea

Atypical Antipsychotics, Disadvantages:

Weight gain, metabolic abnormalities

Mitoxantrone, used with:

Worsening RR MS, Secondary progressive MS, and Progressive-relapsing MS

Calcium channel blocker: psychiatric vs. medical

access1-clinical dx access2-personality disorders/mental retardation access3-medical conditions (nothing on 3=psych reason), that currently effecting patient access4-dysfunction because of pyschiatric illness (homeless, legal trouble) access5-global assessment of functioning 0-100

When interviewing and caring for a university students with test anxiety, the nurse must be aware that test anxiety is often treatable with:

beta blocker

A patient has been taking neostigmine (Prostigmin) for the treatment of myasthenia gravis. What are the side effects/adverse effects of neostigmine (Prostigmin)?

bradycardia, diaphoresis, and urinary urgency.

A client enters the emergency department complaining of acute lower right quadrant abdominal pain. It is determined that the client has appendicitis and is scheduled to go to the operating room immediately. The nurse notes on the database that the client generally drinks 10 to 12 beers a day, although he did not drink in the past 4 days because of the pain. The nurse would expect that the:

client would require a greater level of anesthesia as a result of cross-tolerance.

A nurse is caring for a patient admitted to the unit who is receiving dantrolene (Dantrium) for spasticity. The nurse should particularly monitor the patient's

liver enzymes

Main structures in limbic system

omidalla and hippocampus effected

A nurse suspects that one of the patients she is caring for exhibits symptoms of baclofen (Lioresal) overdose. The patient is unresponsive. What should the nurse's initial action be?

prepare to support respirations

A nurse is providing patient education for a patient who is to gradually discontinue baclofen (Lioresal). The nurse advises the patient to avoid abrupt discontinuation of the medication to prevent which adverse effect?

seizures

Ovarian hyperstimulation syndrome

sudden ENLARGEment; ascites, pleural effusion

A patient is being admitted to the unit from the emergency department. The nurse calls in the report on the patient to the receiving nurse and conveys the assessment findings: complaints of restlessness, agitation, and tremor; vital signs are: temperature 105° F, pulse 122/minute, blood pressure 90/47 mm Hg, and respiration 28/minute. The nurse suspects that the patient is showing signs and symptoms of ___________ and anticipates the administration of multiple drugs, including ______________ to suppress thyroid hormone release.

thyroid storm; potassium iodide or a strong iodine solution