Exam 3 Drugs

An older adult client has been using levothyroxine for several years on an outclient basis. Which client statement should the nurse attribute to the decreased effect of levothyroxine? -"I've stopped taking aspirin for my arthritis and started using Tylenol." -"Overall, I'd say that I'm under a lot of stress lately." -"I've been using a lot of antacids lately because of my indigestion." -"My daughter and I have started the Atkin's diet to try to lose some weight."

-"I've been using a lot of antacids lately because of my indigestion."

Ipratropium

-Muscarinic antagonist -Competitively blocks muscarinic receptors, preventing bronchoconstriction. Also used for COPD. Tiotropium is long acting. Side effects: back pain, dryness of mouth, unpleasant taste Anticholinergic

A nurse should counsel clients receiving levodopa to avoid foods high in _________ as it reduces the effect of levodopa

A nurse should counsel clients receiving levodopa to avoid foods high in pyridoxine (vitamin B6) as it reduces the effect of levodopa

Levodopa/Carbidopa (Sinemet)

Abnormal and involuntary movements are among the most common and serious adverse effects of carbidopa-levodopa therapy

A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient? Administer the next dose with meals Administer the next dose with milk Withhold next dose Assess patient's blood pressure

Administer the next drug dose with meals. The nurse should administer the next drug dose with meals to manage gastrointestinal disturbances in a patient who has been administered antiparkinsonism drugs. Withholding the next dose of the drug, administering the next drug dose with milk, or observing alterations in the patient's blood pressure are not appropriate interventions when caring for a patient who is experiencing GI disturbances with the first dose of antiparkinsonism drugs.

Corticosterioids

Anti inflammitory Supress immune system Increase blood glucose

Prednisone

Anti inflammitory Supress immune system Increase blood glucose

Anticholinergic effects

Anticholinergic drugs may cause blurred vision, dry mouth, tachycardia, and urinary retention. They also decrease sweating and may cause fever or heatstroke. Fever may occur in any age group, but heatstroke is more likely to occur in older adults, especially with cardiovascular disease, strenuous activity, and high environmental temperatures. When centrally active anticholinergics are given for Parkinson's disease, agitation, mental confusion, hallucinations, and psychosis may occur.

Pyrazinamide

Antimicrobial agent used in the first few months of TB treatment Liver toxicity joint pain and swelling, gout This medicine should be taken on an empty stomach, 1 hour before or 2 hours after a meal, with a full of glass of water

Cogentin (benztropine)

Antiparkinson Agent Anticholinergic Agent

_______________ is considered a peripheral anticholinergic effect. _________, ________, and ________ _____ are considered central effects affecting the CNS.

Blurred vision is considered a peripheral anticholinergic effect. Delirium, agitation, and memory loss are considered central effects affecting the CNS.

A group of nursing students are preparing for a class presentation to discuss drugs used to treat Parkinson disease. Which drug would the group include when discussing dopaminergic agents? Carbidopa Benztropine Biperiden Procyclidine

Carbidopa Carbidopa (Lodosyn) is classified as a dopaminergic agent that treats parkinsonism by supplementing the amount of dopamine in the brain. Benztropine is classified as a cholinergic blocking drug. Biperiden is classified as a cholinergic blocking drug. Pramipexole is classified as a non-ergot dopamine receptor agonist.

Levodopa adverse effects

Choreiform movements, suicidal tendencies, and psychotic episodes

Copaxone (glatiramer acetate)

Drug therapy of Multiple Sclerosis Injectable. Patient may experience irritation at the injection site

The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for: infection. falls. excessive sedation. uncontrolled bleeding.

Falls Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls.

Rifampin

First line antibiotic for TB Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine and sweat. Advise patient to take out contact lenses. take on an empty stomach 2-3 weeks to be effective causes liver toxicity

Calcium and Vitamin D

Help absorb calcium

Calcitonin

Lowers blood calcium levels

A client with Alzheimer's disease and Parkinson's disease has been receiving benztropine since experiencing worsened tremor activity. The client is not verbally communicative and has been experiencing adverse effects of the anticholinergic in recent days. The client is uncharacteristically agitated this morning, so the nurse should perform what assessment for anticholinergic effects? Palpate the client's bladder and assess urine volume with a bladder scanner Use the FACES Pain Rating Scale to assess the client for pain Assess the client's blood pressure in the lying, sitting and standing positions, if possible Inspect the client's oral mucosa for indications of dry mouth

Palpate the client's bladder and assess urine volume with a bladder scanner Urinary hesitancy and urinary retention can occur as a result of anticholinergic effects, causing agitation. Dry mouth is an anticholinergic effect as well, but would be less likely to cause the client to be agitated. Similarly, blood pressure changes would not likely cause the client to feel agitated. Pain can cause agitation, especially in clients who are cognitively impaired, but this is not an anticholinergic effect.

Albuterol

Rescue inhaler Bronchodilator Beta-2 agonist Side effects: Shakiness, anxiety, throat or nasal irritation Tachycardia, palpitations

Thyroxine

Take 30-60 mins before eating, on an empty stomach, in the morning Check thyroid before moving to another brand of thyroxine She can get pregnant. Tailor therapy during pregnancy Do not take with other medications If you miss a dose, take it as soon as you remember, unless it's almost time for the next dose

Bisphosphonates Alendronate

These drugs inhibit osteoclastic activity and promote calcium deposition into bone. Take on an empty stomach, first thing in the morning, remain upright for at least 30 mins

Oseltamivir (Tamiflu)

Treatment and prevention of influenza Must have symptoms for less than 2 days Prevents shedding of the viral protein coat Prevents viral replication

A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine? With amantadine, 50% of the drug is excreted via the kidneys. With amantadine, metabolism occurs in the kidneys. With amantadine, catabolism occurs in the kidneys. With amantadine, excretion is primarily via the kidneys.

With amantadine, excretion is primarily via the kidneys, and the drug should be used with caution in clients with renal failure.

Benztropine Mesylate

anticholinergic agent used to control tremor and rigidity in Parkinson disease

Isoniazid

liver toxicity depletes vitamin B6

Baclofen (Lioresal)

muscle relaxants "back loafin" 1-cause drowsiness 2-cause fatigue 3-don't drink alcohol 4-don't drive car 5-don't be responsible for kids under 12

Naloxone (Narcan)

opioid antagonist

ramipexole (Mirapex), ropinirole (Requip), and rotigotine-transdermal (Neupro)

stimulate dopamine receptors in the brain. They are approved for both beginning and advanced stages of Parkinson's disease. In early stages, one of these drugs can be used alone to improve motor performance, improve ability to participate in usual activities of daily living, and delay levodopa therapy.