Pharm exam 2

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The client diagnosed with schizophrenia is admitted to the medical department for pneumonia and exhibiting in voluntary movements of the tongue and lips. Which medication should the nurse question administering.

Chlorpromazine

What is it called when a client takes haloperidol and then can't sit still after

Akathesia

TCA contraindications

Allergies, myelogram dye, BPH, glaucoma, urine retention Not for children Interact w/ MAOI, anticoagulant, other TCA

List of benzodiazepines

Alprazolam, diazepam, lorazepam

What do cholinergic agonists treat?

Alzheimer's and dementia

The mother of child taking methylphenidate for ADHD calls the pediatric clinic and tells the nurse her daughter has lost 4 pounds in the past 2 week. Which action should the nurse implement.

Make an appointment to see the HCP

What is the worst complication of succinylcholine

Malignant hyperthermia (Rigid muscles and high temp) Give dantrolene (muscle relaxant) for this

The client diagnosed with bipolar disorder is taking lithium and has a lithium level of 1.0 mEq/L. Which intervention should the nurse implement based on this laboratory result?

Schedule the clients next appointment (it is normal)

What do Chlorpromazine and Haloperidol do?

Schizophrenia Mania Tourette's Unlabeled: bipolar

What does aripiprazole do?

Schizophrenia, bipolar mania, Tourette's

Antipsychotic side effects

Sedation, suicidal thoughts, Anticholinergics, extra pyramidal effects, NMS

What is phenytoin used for?

Seizures and epilepsy

What is midazolam used for?

Short term and rapid sedation, amnesia

What is the half life of naloxone

Short- naloxone must be administered every few hours until opioid concentrations have dropped to nontoxic levels

How should Morphine be administered?

Slowly over 5 min to avoid speed shock

A client is taking the prescribed dose of phenytoin to control seizures. Results of phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this Laborataory results?

Slurred speech (Level should be 10-20)

In what a stage of anesthesia do a persons skeletal muscles begin to relax

Stage 3

What is the preferred stage of anesthesia in the OR

Stage 3

What is the first sign of atropine toxicity?

Sudden mental and neurological changes

What type of antidepressant is Imipramine

TCA

Individual antidepressant side effects (TCA, MAOI, SSRI)

TCA: Anticholinergic MAOI: liver toxicity SSRI: NMS and SS

This intervention might help with the side effects of TCAs

Take before bed to combat sedative and AC effects

Fluoxetine Info

Takes 4 weeks to work May be used in children (inc suicide risk) Less toxicities than others Avoid St Johns wort

Benzodiazepine information

Taper dose after long-term use Avoid in those with liver disease Avoid in pregnancy Older adults at inc fall risk and resp risk

why are benzo's the most frequently used anxiolytics

They are anxiolytic at much lower doses than they are sedatives

What is the must important thing to remember about NM blockers

They are used to paralyze, not to sedate or provide pain relief

What is different about Percocet and Tylox

They contain narcotics and acetaminophen (monitor 24hr intake)

Why are MAOIs not used as a first line treatment for depression

They interact with many other foods (Tyramine) and drugs

What type of people are less prepared to deal with Alzheimer's?

Those who focus on achievement and autonomy Those without strong social support

Atropine Indications

To increase HR and BP Decrease secretions before surgery Parkinsonism Dilate pupils

MAOI contraindications

Tyramines Any other antidepressants Myelogram dye, CV disease

Scopolamine contraindications

Ulcerative colitis, ileus, toxic megacolon (b/c it slows GI)

After receiving morphine, which findings indicates immediate follow up

Unconsciousness, bradycardia, bradypnea

TCA's cause Anticholinergic effects such as

Urinary retention, constipation, arrhythmia

A client is taking an MAOI but is switching to an SSRI, they must

Wait two weeks after stopping the MAOI to start the SSRI

List cholinergic effects

Wet... Constrict pupils, decrease HR and BP, increase secretions, diarrhea

When should muscle relaxants not be used

When spasticity contributes to locomotion and upright position

The client is with a seizure disorder who is taking carbamazepine tells the clinic nurse, " I am taking evening primrose oil for my premenstrual cramps, and it is really working." which statement is the nurse's best response?

You should inform your HCP (it may lower the seizure threshold)

Diazepam Indications

alcohol withdrawal syndrome, anxiety, seizure, muscle relaxant

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions?

"Good oral hygiene is needed, including brushing and flossing."

Benztropine contraindications

Caution in hot environment (b/c Dec sweating)

What is the normal level for lithium

0.6-1.2 >1.5 is toxic >2.5 can cause death

How long to wait between TCAs?

4-6 weeks (they have a long half life)

What dose can be given of Memantine Hcl

5mg for the first 4 weeks, then 10mg BID is max dose

How much of transdermal fentanyl is absorbed?

92%

What decreases absorption of the partial seizure meds

Antacids

benztropine side effects

Anticholinergic Confusion

What is included in balanced anesthesia

Anticholinergics (atropine) Sedative hypnotics Antiemetics Antihistamine Narcotics NM blocker

Lorazepam Indications

Anxiety, pre-op, chemo n/v

Anti seizure med side effects

Ataxia, confusion, dizziness, nystagmus, renal and liver toxicity Phenytoin: gum hyperplasia, bone marrow suppression, Steven Johnson syndrome

What is the antidote for cholinergics?

Atropine

What medication can be used for a pt whose heart rate drops to 38 bpm

Atropine sulfate

A client is scheduled for discharge and will be taking phenobarbital for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety?

Avoid drinking alcohol while taking this medication

Atropine Contraindications

BPH, glaucoma, MG, ileus

A nurse would question the use of an Anticholinergic for which disorders

BPH, glaucoma, urinary retention, UC

Donepizil, Rivastigmine Information

Caution w/ NSAIDs due to GI bleed May take weeks to work Do not reverse degeneration Must be titrated up and down

What Anticholinergic is used to treat Parkinson's

Benztropine (adjunct)

What is lithium used for

Bipolar mania (alters Na transport)

Atropine side effects

Blurry vision, inc IOP (due to inc BP) Inc HR, palpitation Urinary hesitancy and retention

Benzodiazepine side effects

CNS depression Constipation Tolerance/dependence Withdrawal syndrome: HA, nausea, vertigo, nightmare

Overall antidepressant side effects

CNS depression, SI, OH, dizziness

what are the partial seizures drugs

Carbamazepine Levetiracem Gabapentin

What drug can be used alone for partial seizures

Carbamazepine (levetiracem is an adjunct)

What seizure med can be used for trigemical neuralgia

Carbamazepine and levetiracem

What condition would lead to the prolonged drug action of succinylcholine

Cirrhosis (liver diseases)

what are the Nm blocking agents?

Cisatracurium and succinylcholine

Dermal Patch Application

Clean, dry, intact area Should be hairless but do not shave area (inc absorption) Place at new site, remove old one May cause transdermal burns w/ defibrillator

Which narcotic is also an antitussive

Codeine

Dopaminergic info

Contraindicated with Anticholinergic disorders Give with meals if causes GI upset Avoid multivitamins and high protein diet

How do Triptans work? What contraindications does this lead to?

Cranial vasoconstriction Not good for those with CAD, CVA, older adult

How does sumatriptan work

Cranial vasoconstriction, For migraine NOT preventative

what is the relationship between dopamine and acetylcholine

Dopamine and Ach counteract each other Both low dopamine and high Ach lead to Parkinsonian symptoms (involuntary movement) from PNS overload

What medication can be used for malignant hyperthermia and reverses the effects of NM junction blockers

Dantrolene (a muscle relaxant)

Lithium contraindications

Dehydration causes hyponatremia and toxicity Psyllium blocks absorption

Which medication would be prescribed for tonic clinic seizures

Diazepam

List indirect cholinergic agonists

Donepizel Rivastigmine N-methyl-D-aspartate antagonist Memantine Hcl

Which statement is the scientific rationale for prescribing and administering donepezil?

Donepizil increases the availability of acetylcholine

Anxiolytic drugs block awareness so they may not be best for a worker who...

Drives vehicles for a living

Oxycodone has been prescribed for a client to treat pain. Which side and adverse effects would the nurse monitor for? Select all that apply.

Drowsiness Hypotension Tremors

List Anticholinergic effects

Dry... dry mouth, blurred vision, tachycardia, constipation, urinary retention, flushing, photophobia, inc HR and BP, anxiety, dizziness, dilate pupils

What are extrapyramidal symptoms?

Dystonia, tardive dyskinesia, akathisia, pseudo-Parkinsonism

Things to avoid while on phenytoin

ETOH, primrose, ginkgo (lower seizure threshold)

antipsychotic contraindications

Elderly with dementia (inc CV death)

which suggestion is needed for a client on Anticholinergic related to environment

Ensure hydration and temperature control because they decrease sweating

What is the biggest side effect of dantrolene

Fatal liver damage

Which narcotic is used for chronic pain and has a transdermal option

Fentanyl

How does Ach relate to the SNS?

Fight or flight Anticholinergic Decreases Ach

Donepizil and Rivastigmine side effects

HA, diarrhea, fatigue, hypotension, dizziness, bradycardia Rivastigmine: transdermal patch reaction

N-methyl-d-aspartate (NMDA) and Memantine Side effects

HA, diarrhea, fatigue, hypotension, dizziness, sedation, urinary frequency

Midazolam information

Has a long half life even though it is short acting 24 hour cautions Can cause severe CNS depression

Lithium side effects

Lethargy, slurred speech, tremor, n/v/d

What are the Dopaminergic drugs

Levodopa, carbidopa/levodopa, amantadine

Drugs that are used to alter a persons response to their environment

Hypnotics

The client diagnosed with bipolar disorder is taking lithium. Which statement by the client warrants further clarification by the nurse?

I really enjoy playing soccer on the weekends

Which statements indicate the cline diagnosed with bipolar disorder who is taking lithium understands the medication teaching? Select All that Apply.

I should make sure i do not get dehydrated I should take the medication with food

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect?

Impaired voluntary movements

The client diagnosed with bipolar disorder who is prescribed lithium is admitted to the psychiatric unit in an acute manic state. Which intervention should the nurse implement first?

Implement care for the clients physiological needs

NMDA, Memantine Hcl Information

Improvement may take weeks Must be titrated up and down Does not reverse degeneration Begin w/ 5 mg, after 4 weeks can do 10mg BID Caution w/ seizures, renal impairment, urinary retention

What are NM blockers used for?

Intubation, flaccid muscle paralysis

What is an expected indication for the use of a NM blocker

Intubation, mechanical ventilation

Which side effects should be monitored for when taking carbidopa-levodopa

Involuntary movement, change in mood, tachycardia

How does Nalbuphine act in the body

It acts on certain opioid receptors and not others (agonist-antagonist)

Why is oxycodone better for pregnancy

It is category B and the rest no category C

Which statement is the advantage of prescribing donepezil over other cholinesterase inhibitors?

It is only given once a day

What is nalbuphine used for?

Labor and delivery pain

Which intervention is appropriate for a child on long term phenytoin therapy

Massage gums and floss frequently

What must be monitored for after giving naloxone

May cause CV effects from rebound and CNS excitement

The nurse is caring for a client with cancer. Morphine has been prescribed for the client. Specific to this medication, which intervention would the nurse include in the plan of care while the client is taking this medication?

Monitor bowel activity

What is a narcotic antagonist?

Naloxone (Narcan)

The serum lithium blood level of a client with manic disorder is 2.3, what is expected

Nausea, vomiting, diarrhea, decreased coordination, polyuria, slurred speech, muscle weakness

Dopaminergic side effects

OH, involuntary movement, HTN crisis when used with MAOI

Sumatriptan contraindications

Older adult and CAD b/c CV constriction Stop MAOI 2 weeks before

What age group is at a higher risk for narcotic toxicity

Older adults

Dosing and routes of narcotics

Only 50% is absorbed PO compared to IV

How can phenytoin be given

Oral or IV (filter and <50mcg/min)

What can gabapentin be used for other than seizures

Orphan for ALS, restless leg, nerve pain, post herpetic pain

Cholinergic Agonists case study

Rivastigmine can be used for those w/ dysphagia b/c patch form Monitor cardiac effects and urine output during treatment Will not restore function that is already lost

What is baclofen used for

Pain relief from muscle spasms, rigidity

What are dopaminergics used for

Parkinson's disease (inc dopamine getting to the brain)

Scopolamine side effects

Patch can cause photophobia and blurry vision

What is the antidote for atropine?

Physostigmine

Which client will the nurse take for a client who took morphine 15 minutes ago and is feeling dizzy

Place the client supine and take vitals (it can cause hypotension)

What can Nalbuphine cause?

Psychotic like symptoms

What is unique about fentanyl side effects

Respiratory depression lasts longer than analgesia

Which physiological function is the last one lost during anesthesia induction

Respiratory movement

How does Ach relate to the PSNS?

Rest and digest Cholinergic Inc Ach

Which statement made by the wife of a client diagnosed with Parkinson disease indicates mediation teaching is effective?

The medications provide symptom management but the effects may not last

Alprazolam indications

anxiety, panic disorder

What is the CNS composed of?

brain and spinal cord

Dantrolene contraindications

liver disease, respiratory disease, and cardiac disease Women taking BC and HRT

What is lidocaine used for?

local anesthetic Monitor for Phlebitis at IV site

Scopolamine indications

n/v, motion sickness, reduce secretions

What is dantrolene used for

spasticity, malignant hyperthermia

What are the two divisions of the autonomic nervous system?

sympathetic nervous system and parasympathetic nervous system


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