Pharm test 2.5: CNS
Migraines and pregnancy may be safely treated with
Acetaminophen with codeine Tylenol 3
TCA should be prescribed cautiously and patient with
Heart disease
Inappropriate first line drug for the treatment of depression with fatigue and low energy would be
Venlafaxine (Effexor)
Monitoring for a child on ritalin for ADHD includes
ADHD symptoms, routine height and weight checks, amount of ritalin being used
Casey fractured his ankle in two places and is asking for medication for his pain. The appropriate first line medication would be
Acetaminophen with hydrocodone or Vicodin
Which of the following should not be taken with an SSRI
Alcohol
Patient should be instructed regarding the rapid onset of Ambien because
Ambien should be taken just before going to bed
Sarah a 42-year-old female request a prescription for anorexiant to treat her obesity. A trial of phentermine as prescribed. Prescribing precautions include
Anorexiants may cause tolerance and should only be prescribed for six months
Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor antidepressant work would be
Appetite and concentration improve in the first one in two weeks
Soak has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having strange thoughts. The appropriate initial action would be
Assess for suicidal ideation
Vicky age 56 comes to the clinic requesting a refill of her Fiorinal that she takes for migraines. She has been taking this medication for over two years for migraines and states one does she usually works to abort her migraine. What is the best care for her
Assess how often she is using Fiorinal and refill her medications
Nonpharmacologic therapy for tension headache includes
Bio feedback, stress management, massage therapy
Six-year-old Lucy has recently been started on Zarontin for seizures. She should be monitored for
Blood dyscrasias which are uncommon but possible
When prescribing Adderall which is a phentermine and dextroamphetamine two adults with ADHD the nurse practitioner will need to monitor
Blood pressure
A 19-year-old male who was started on risperidone. Monitoring for risperidone includes observing for common side effects such as
Bradykinesia, akathisia and agitation
A patient with anxiety and depression may respond to
BuSpar and an SSRI combined
Inappropriate first line drug to try from mild to moderate generalized anxiety disorder would be
Buspirone BuSpar
Dwayne has recently started on Carmazapine to treat seizures. He comes to see you and you know that while his Carmazapine levels have been therapeutic range, they are now low. The possible cause for low Carmazapine levels include
Carbamazepine Auto and deuces metabolism, leading to lower levels in spite of good compliance
Cynthias taking Depakote for seizures and would like to get pregnant. What advice would you give her?
Depakote is a known teratagenic but maybe take an after the first trimester if necessary
Carbamazepine has a black box warning due to life-threatening
Dermatologic reaction including Stephen's Johnson's and toxic epidermal necrolysis
Inappropriate drove to initially treat panic disorder is
Diazepam (Valium)
Cara is taking Keppra to treat seizures. Routine education for Keppra includes reminding her
Do not abruptly discontinue the Keppra due to the risk for withdrawal seizures
One major drug used to treat bipolar disease is lithium. Because lithium has an arrow therapeutic range, it is important to recognize symptoms of toxicity such as
Drowsiness and nausea
Cecelia presents with depression associated with complaints of fatigue sleeping all day and lack of motivation. And appropriate initial antidepressant for her would be
Duloxerine (cymbalta) -an SNRI-preferred by pts who have hypersomnja and low energy from depression
Thomas taking lithium for bipolar disorder. He should be taught to
Eat or diet with consistent levels of salt or sodium
Preventative therapy for cluster headaches includes
Ergotamine nightly before bed
Keppra has known drug interactions with
Few if any drugs
Taylor is a 10-year-old child diagnosed with major depression. The appropriate first line antidepressant for children is
Fluoxetine (Prozac)-SSRI
Rabbi is being prescribed phenytoin for seizures. Monitoring includes assessing
For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response
Have you noticed that you were having more sleep issues since you started that?
David is a 34-year-old patient who starting on peroxytine (Paxil)for depression. David education regarding his medication would include
He may experience sexual dysfunction beginning a month after he starts therapy
Scott seizures or well-controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his Topiramate includes
He should monitor his temperature and ability to sweat in the heat while playing
And 66-year-old male was prescribed Nardil/Phenelzine While in an acute psychiatric unit for recalcitrant depression. The nurse practitioner managing his primary care needs to understand the following regarding final scene and other MOAIs
He should not be prescribed any seretonergenic drugs such as sumatriptan, anyway eyes interact with many come in foods like yogurt sour cream and soy sauce, symptoms of hypertensive crisis with your headache tachycardia and sweating require immediate treatment
Prior to starting antidepressants, patient should have laboratory testing to rule out
Hypothyroidism
Kirk sprained his ankle and is asking for pain medication for his mild to moderate pain. The appropriate first line medication would be
Ibuprofen (Advil)
Patient to our prescribed olanzapine or Zyprexa should be monitored for
Insomnia
Jack H8 has attention deficit disorder and is prescribed Ritalin. He and his parents should be educated about the side effects of ritalin which are
Insomnia and decreased appetite
Why is the consistency of taking paroxetine (Paxil) so I never running out of medication is more important than with most other SSRIs?
It has a shorter half live in withdrawal symptoms have faster answer without taper
Inappropriate drug for the treatment of depression with anxiety would be
Lexapro
A first line drug for a board of therapy and simple migraine is
Naproxen (aleve)
We need a presents to the clinic with complaint of headache often on for months. She reports they feel like someone is squeezing her head. She occasionally takes Tylenol for the pain but usually just toss it out. Initial treatment for tension headache includes asking her to keep a headache diarrhea in a prescription for
Naproxen (aleve)
Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average once a month. The migraines are effectively aborted with naratriptan or emerge. When refilling Amber is near tripped in education would include
Naratriptin and will interact with antidepressants including SSRIs, and St. John's wort's and she should inform the provider she says that she has migraines. Continue to monitor for headaches if the migraine is consistently happening around her menses there's preventative therapy available. Pregnancy is contra indicated we taking a trip down done
James has been diagnosed with cluster headaches. Appropriate a cute therapy would be
Oxygen 100% for 15 to 30 minutes
Anti-cholinergic agents such as benzotropine or Cogentin maybe given with a phenothiazine to
Potentiate affects of the drug
Xi a 54-year-old female with a history of migraines that do not respond well to over-the-counter medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would include
Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with her first dose
Kelly is a 14-year-old patient who presents to the clinic with the classic migraine. She said she is having a headache 2 to 3 times a month. The initial plan would be
Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers
Jehle is a nine-year-old patient who has been diagnosed with migraines for almost 2 years. She's missing up to a week of school each month. Her headache diarrhea confirm she averages 4 to 5 migraines per month. Which of the following would be appropriate?
Prescribe propranolol ( Inderal) to be taken daily for at least three months
Selma who is overweight recently started taking topiramate for seizures and at her follow up visit you know she has lost 3 kg. The appropriate action would be
Reassure her that this is a normal side effect of topiramate and continue to monitor her weight
Monitoring of a patient on gabapentin to treat seizures include
Recording seizure frequency duration and severity
Antonio is a three-year-old child has a history of status epilepticus. Along with her routine anti-seizure medication she should also have a home prescription for what to be used for an episode of status epilepticus
Rectal diazepam
When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication over his headaches. A clinical characteristic of medication of his headaches is that they
Recur medication wears off
Samantha is taking Lamictal for her seizures and request a prescription for a combined oral contraceptive, which interact with Lamictal and may cause
Reduced Lamictal levels requiring doubling the dose of Lamictal
JC has been on Lexapro for a year and is willing to try tapering off of SSRIs. What is the initial dosage adjustment when starting a taper off antidepressants?
Reduced it by 50% for 3 to 4 days
Before prescribing phentermine to Sarah, I throw drug history should be taken including assessing for the use of serotonin agent such as SSRIs and St. John's wort due to
Risk of serotonin
Zanib taking Lamictal and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes
Ruling out hypersensitivity reaction that may lead to multi organ failure
Susanna started on Paroxetine (paxil) a selective serotonin reuptake in Hibbett her for depression. Education regarding her antidepressant includes
SSRIs may take 2 to 6 weeks before she will have maximum drug affects
When prescribing for migraines patient education includes
Stress reduction in regular sleeper integral to migraine treatment
When combining temazepam or restoril for insomnia, patient education includes
Temazepam should not be used more than three times a week for less than three months
Page has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventative medication includes
The goal treatment is to reduce migraine occurrence by 50%
When prescribing an opioid analgesic such as acetominophen and codeine instructions to the patient should include
The medication may call sedation and they should not drive, constipation is this common side effect and they should increase fluids and fiber, patient should not take any other acetaminophen containing medications at the same time
The laboratory monitoring required when a patient is on an SSRI is
There is no laboratory monitoring required
The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional Newark celebrating triggers of their anxiety. What is the probable reason
They become tolerant of the medication which is characterized by the need for higher and higher doses
What onset of action symptoms should be reviewed with patients who have been newly prescribed an SSRI
They can feel a bit of nausea but this resolved in a week
When prescribing ergotamine suppositories or wigtrain to treat a cute migraine patient education would include
They may need pre-medication with an anti-nausea medicine
Common mistakes practitioners making treating anxiety disorders include
Thinking a partial response to medication is acceptable
Jake is a 45-year-old patient with schizophrenia, he recently was hospitalized for acute psychosis do the medication noncompliance. He was treated with I am long acting haloperidol. Besides monitoring her schizophrenia symptoms, the patient should be assessed by his primary care provider for
With you have normal involuntary movement scale for extrapyramidal symptoms
And choosing a benzo diazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepine with the greatest likelihood of rapidly developing dependence is
Xanax
Long term monitoring of patients who are taking carbamazepine includes
complete blood count 3-4 mths
