Pharm - Chapter 13 - CNS Stimulants and Related Drugs

Which adverse effect does the nurse anticipate in a patient who uses analeptics at high doses? 1 Diarrhea 2 Reflex bradycardia 3 Decreased respiratory rate 4 Increased deep tendon reflexes

1 Diarrhea Analeptics at high doses stimulate the vagal, vasomotor, and respiratory centers of the medulla in the brainstem and increase the blood flow to the skeletal muscles. Vagal stimulation may cause diarrhea and reflex tachycardia. High doses of analeptics can cause an increase in respiratory rates. The neurologic effects of high-dose analeptics include reduced deep tendon reflexes.

Which patient condition is a contraindication for administration of anorexiants? 1 Glaucoma 2 Peptic ulcer 3 Common cold 4 Bladder dysfunction

1 Glaucoma Anorexiants are prescribed for patients who are obese to suppress the appetite. Anorexiants are contraindicated in patients with glaucoma. Anorexiants are not contraindicated in patients affected with peptic ulcer disease, the common cold, or bladder dysfunction.

Which patients who have which conditions are contraindicated for anorexiant therapy? Select all that apply. 1 Glaucoma 2 Hypotension 3 Drug allergies 4 Hypothyroidism 5 Bulimia nervosa

1 Glaucoma 3 Drug allergies 5 Bulimia nervosa An anorexiant is a drug that decreases body weight and suppresses the appetite. It is contraindicated for patients who have bulimia nervosa, an eating disorder. Anorexiants are also contraindicated for patients who have glaucoma and drug allergies. They are contraindicated for patients who have severe hypertension, not hypotension, and hyperthyroidism, not hypothyroidism.

Which drug is indicated for the improvement of wakefulness in patients who have excessive daytime sleepiness? 1 Modafinil 2 Sumatriptan 3 Phentermine 4 Atomoxetine

1 Modafinil Modafinil is a psychostimulant that enhances the memory and brightens the mood. It is indicated for the improvement of wakefulness in patients who have excessive daytime sleepiness. Sumatriptan is a serotonin receptor agonist used in the treatment of acute migraines. Phentermine is a sympathomimetic anorexiant used to treat obesity. Atomoxetine is a selective-norepinephrine reuptake inhibitor used in the treatment of attention deficit hyperactivity disorder.

Which medication inhibits the pancreatic enzyme lipase? 1 Orlistat 2 Phentermine 3 Atomoxetine 4 Amphetamine

1 Orlistat Orlistat is an anorexiant that blocks the pancreatic enzyme lipase that reduces fat absorption. Phentermine is an anorexiant that suppresses appetite centers in the central nervous system (CNS). Atomoxetine and amphetamine are medications used to treat attention-deficit/hyperactivity disorder (ADHD).

Which adverse effects may occur in an obese patient with attention-deficit/hyperactivity disorder (ADHD) who has been prescribed phentermine and dexmethylphenidate? Select all that apply. 1 Seizures 2 Insomnia 3 Headache 4 Dysrhythmias 5 Severe hypertension

1 Seizures 2 Insomnia 4 Dysrhythmias Dexmethylphenidate is a central nervous system (CNS) stimulant currently indicated for ADHD. Phentermine is an anorexiant used to suppress appetite in people who are obese. Phentermine interacts with CNS stimulants and results in additive toxicities like seizures, insomnia, and dysrhythmias. Therefore the most likely adverse effects are seizures, insomnia, and dysrhythmias. Headache and severe hypertension are not the adverse effects associated with the interaction of these two drugs; these are the effects of interactions of phentermine with monoamine oxidase inhibitors.

Which characteristic of amphetamines is the most likely reason that these drugs are abused? 1 They induce euphoria. 2 They increase energy. 3 They induce wakefulness. 4 They promote industriousness.

1 They induce euphoria. The effect of amphetamines that makes them targets for abuse is euphoria, which includes a sense of joy, elation, and excitement. Amphetamines can also increase an individual's energy level, degree and duration of wakefulness, and capacity for work; they are used for all of these purposes.

Which information explains why the nurse would suggest taking amphetamine aspartate for attention-deficit/hyperactivity disorder (ADHD) 5 to 6 hours before bed? 1 To prevent insomnia 2 To prevent gastric ulcer 3 To prevent hyperglycemia 4 To prevent nutrition deficiency

1 To prevent insomnia The child who is diagnosed with ADHD is usually prescribed amphetamine aspartate, which is a stimulant drug that causes alertness and insomnia. Therefore the nurse suggests giving the medication 5 to 6 hours before sleep. Giving the medicine at least 5 to 6 hours before sleep helps reduce the effect of the drug so the child does not stay awake for a longer period. The medication given in ADHD does not show adverse effects on the gastrointestinal system, so there is no risk of gastric ulcer. ADHD medications are usually central nervous system (CNS) stimulants and do not alter the levels of blood glucose. ADHD drugs do not affect the nutritional balance because they are CNS stimulants and affect CNS receptors directly.

A patient is being discharged with a prescription for morphine for postoperative pain. Which information would the nurse include in the discharge teaching plan? Select all that apply. 1 "Rest before taking the medication." 2 "Drink at least 3 liters of fluid a day." 3 "Take acetaminophen with the morphine." 4 "Take an over-the-counter stool softener daily." 5 "Increase the dose of morphine if there is no relief of pain."

2 "Drink at least 3 liters of fluid a day." 4 "Take an over-the-counter stool softener daily." Constipation is one of the major side effects of morphine administration. It may be managed with increased intake of fluids and the use of over-the-counter stool softeners. Adequate rest is required for a patient who has undergone surgery. It is, however, not important before taking the morphine. Acetaminophen does not have to be taken with the morphine. The details of medication dosage are provided in the discharge summary. The medication would never be increased without discussion with the primary health care provider.

Which statement by the nurse indicates understanding of the teaching about medication administration for patients with attention-deficit/hyperactivity disorder (ADHD)? 1 "I may dispense these medications to nursing staff if needed." 2 "I will give these drugs 30 to 45 minutes before meals to improve absorption." 3 "It is permissible to crush extended-release medications for patients who have difficulty swallowing pills." 4 "If I notice side effects of these medications, I should stop giving the drug immediately and notify the provider."

2 "I will give these drugs 30 to 45 minutes before meals to improve absorption." ADHD medications should be given 30 to 45 minutes before eating so that they are given on an empty stomach. These are controlled substances and can never be dispensed without a prescription. Patients taking these medications should be weaned off of them when necessary and not stopped abruptly. Extended-release preparations should not be crushed or chewed.

Which response is appropriate for a patient with insulin-dependent diabetes who asks how to reduce their weight? 1 "You should drink coffee and alcohol once a week to reduce obesity." 2 "You should follow a nutrition and exercise regimen for weight management." 3 "Ask the primary health care provider to prescribe an oral hypoglycemic medication." 4 "Ask the primary health care provider to prescribe an anorexiant because it will reduce obesity."

2 "You should follow a nutrition and exercise regimen for weight management." A nutritious diet and regular exercise may facilitate weight loss. Coffee and alcohol do not help with weight loss. Coffee is used to increase alertness and reduce sleep. Treatment with anorexiants, such as monotherapy, is not effective. Most of the oral hypoglycemic agents cause weight gain in the patient, so they do not help in reducing weight.

Which analeptic may cause gasping syndrome in a newborn? 1 Caffeine 2 Doxapram 3 Theophylline 4 Aminophylline

2 Doxapram Doxapram is an analeptic that is used as a respiratory stimulant. It is contraindicated for newborns because it causes gasping syndrome as a result of the presence of benzyl alcohol. Caffeine is contraindicated in patients who have a history of peptic ulcers. Theophylline causes a delay gastric emptying, not gasping syndrome, in newborns. Aminophylline is used to treat apnea in newborns and does not cause gasping syndrome.

Which drugs are indicated as first-line abortive therapy for migraine headaches? Select all that apply. 1 Diazepam 2 Naratriptan 3 Ergotamine 4 Sibutramine 5 Zolmitriptan 6 Atomoxetine

2 Naratriptan 5 Zolmitriptan Selective serotonin receptor agonists (SSRAs) are the medications most commonly used as abortive therapy for migraine headaches. SSRAs include naratriptan and zolmitriptan. Diazepam, a benzodiazepine, is used to ease anxiety, induce muscle relaxation, and relieve seizures. Ergot alkaloids such as ergotamine are rarely used as abortive therapy and are no longer considered first-line drugs. Sibutramine is an anorexiant, and atomoxetine is used for attention-deficit/hyperactivity disorder.

Which barbiturate has a short duration of action? 1 Butabarbital 2 Pentobarbital 3 Phenobarbital 4 Mephobarbital

2 Pentobarbital Pentobarbital has a short duration of action of about 3 to 4 hours. Butabarbital has a duration of action of about 6 to 8 hours. Phenobarbital has a duration of action of about 6 to 12 hours. Mephobarbital has a duration of action of about 10 to 16 hours.

Which factor associated with a drug that has a low therapeutic index (TI) would the nurse be aware of? 1 There is less possibility of developing dependence. 2 There is a high possibility that overdose events will occur. 3 The drug will have low tolerance when compared with other drugs. 4 The chances of side effects are low with this drug relative to other drugs.

2 There is a high possibility that overdose events will occur. A low TI indicates that the difference between the therapeutically active dose and the toxic dose of the drug is small. Therefore a drug that has a low TI has a greater likelihood of side effects relative to other drugs. There may be a high possibility of overdose with this drug. Tolerance and dependence are not related to the TI.

Which prescription will the nurse discuss with the health care provider to replace the benzodiazepine when a patient reports increased daytime sleepiness? 1 Zaleplon 2 Zolpidem 3 Ramelteon 4 Eszopiclone

2 Zolpidem Zolpidem has a short half-life and lacks active metabolites, so it has a lower incidence of daytime sleepiness. Zaleplon is administered for patients with sleep difficulties like early awakenings. Ramelteon is indicated for patients having difficulty with the onset of sleep. Eszopiclone must be avoided when the patient must wake up after less than 6 to 8 hours of sleep.

A patient is given a drug that has a half-life of 8 hours. The peak level of this drug is 100 mg/L. What would be the concentration of the drug after two half-lives? Record your answer using a whole number. ________ mg/L

25 A half-life is the time required for one half of a given drug to be removed from the body. A drug's peak effect refers to the time needed for the drug to reach its maximum therapeutic response. For a drug with a half-life of 8 hours and a peak level of 100 mg/L, 25 mg/L of drug would remain in the body after two half-lives because half of 100 is 50, and half of 50 is 25.

Which is an adverse effect of orlistat therapy? 1 Mania 2 Diarrhea 3 Fecal incontinence 4 Foul taste in the mouth

3 Fecal incontinence Orlistat is a drug used in the treatment of obesity. A common adverse effect of orlistat is gastrointestinal distress, which causes fecal incontinence and oily stools. Mania is an adverse effect of amphetamines. Orlistat does not cause diarrhea. A foul taste in the mouth is an adverse effect of triptans.

Which adverse effect might the patient develop if treated with primaquine? 1 Hemolysis of platelets 2 Bone marrow suppression 3 Hemolysis of red blood cells 4 Hemolysis of white blood cells

3 Hemolysis of red blood cells G6PD (Glucose-6-Phosphate Dehydrogenase) is an enzyme that reduces the risk of hemolysis of red blood cells upon exposure to oxidizing drugs. Therefore patients with G6PD deficiency are at risk of developing hemolysis of red blood cells when taking primaquine. G6PD deficiency does not increase the risk of hemolysis of platelets or white blood cells. It also does not increase the risk of bone marrow suppression.

Which drug should be used with caution with the herbal drug ginseng to prevent possible drug interactions? 1 Aspirin 2 Warfarin 3 Metformin 4 Disulfiram

3 Metformin Metformin is an antidiabetic drug that should be used with caution when the herbal drug ginseng is used, as it may cause possible drug interactions. Aspirin may cause complications when it is used along with ginkgo biloba, but not with ginseng. Ginkgo biloba, not ginseng, may affect clotting when taken with warfarin. The use of disulfiram may cause drug interactions when combined with the herbal drug guarana, not ginseng.

Which drug is an obese patient taking who is instructed to take it in the morning and to avoid taking it before going to bed? 1 Morphine 2 Diazepam 3 Phentermine 4 Phenobarbitone

3 Phentermine A patient who is obese is administered anorexiants. These drugs are central nervous system (CNS) stimulants that may interfere with sleep patterns. Phentermine is an anorexiant that is administered for obesity. So, it is administered early in the morning and is avoided before going to bed. Morphine, diazepam, and phenobarbitone are CNS depressants and should be taken before bedtime because they cause sedation.

Which drug would the nurse expect to be prescribed for a patient who is obese, frequently hungry, and eats to satisfy hunger? 1 Caffeine 2 Almotriptan 3 Phentermine 4 Dextroamphetamine

3 Phentermine Patients who frequently feel hungry might overeat to satisfy hunger. To reduce the appetite, the patient must be given anorexiants, such as phentermine. Caffeine, almotriptan, and dextroamphetamine do not have any anorexiant effects. These drugs may not be useful for the patient. Caffeine may impair the absorption of calcium and cause osteoporosis. Almotriptan and dextroamphetamine are prescribed for the treatment of attention-deficit/hyperactivity disorder and migraine headache, respectively.

Which symptom does the nurse expect to find in a patient with narcolepsy? 1 Hyperactivity 2 Pulsating headache 3 Skeletal muscle weakness 4 High body mass index (BMI)

3 Skeletal muscle weakness Cataplexy is a symptom associated with narcolepsy and is characterized by skeletal muscle weakness. Hyperactivity is not a symptom of narcolepsy. It is seen in attention-deficit/hyperactivity disorder. Pulsating headache is a symptom of migraine headache. High BMI is not seen in narcolepsy; it is the symptom associated with obesity.

Which does the nurse suggest to the parents who express concern about the addictive quality of stimulants their child was prescribed to treat attention-deficit/hyperactivity disorder (ADHD)? 1 Reduce the dose of the medication slightly. 2 Switch the child to caffeine, which is a more natural stimulant. 3 Talk to the health care provider about instituting "drug holidays." 4 Use deep breathing exercises instead of medication to keep the child calm.

3 Talk to the health care provider about instituting "drug holidays." Stimulants are effective treatment for ADHD, but they can be addictive for the patient. Specialists sometimes recommend periodic "drug holidays," or short periods without medication to diminish the addictive tendencies of stimulant drugs. These holidays are kept short (e.g., 1 day a week or over a weekend). It is outside the scope of practice for a nurse to suggest a reduction in the dose of the patient's medication, and the parents should discuss any adjustments with the primary care provider. Although caffeine is also a stimulant, a nurse would not suggest its use instead of medication that is prescribed and monitored by a primary care provider. Deep breathing exercises may be used in addition to medication to help calm a child, but these exercises do not effectively treat ADHD and would not be a full-time substitute for medication.

Which statement is correct for the nurse to reply to the worried parents of a 7-year-old child who is highly impulsive and has not been attentive in school for the last two months? 1 "This is the normal behavior of a 7-year-old child." 2 "You should consult a child psychiatrist immediately." 3 "Your child has attention-deficit/hyperactivity disorder (ADHD)." 4 "You should continue to observe the child's behavior for 4 months."

4 "You should continue to observe the child's behavior for 4 months." ADHD usually begins after 7 years of age. The child may have reduced attention and may become impulsive. This disorder can be diagnosed if the child has these symptoms continuously for 6 months. Therefore the nurse would inform the parents to observe the child for more than 4 months. Being inattentive and highly impulsive is not a normal finding; it indicates that the child is feeling stressed. Being inattentive and highly impulsive for the past 2 months does not indicate that the child has a psychological illness, so the nurse would avoid referring the parents to a psychiatrist. The child may be impulsive due to changes in his surroundings. Therefore the nurse should not conclude that the child has ADHD.

Which dose of flumazenil does the nurse expect to be given for an overdose of midazolam? 1 2 to 6 mg/kg 2 5 mg/mL intravenously (IV) 3 0.2 mg/2 mL IV over 15 seconds 4 0.2 mg/2 mL IV over 30 seconds

4 0.2 mg/2 mL IV over 30 seconds A dose of 0.2 mg/2 mL of flumazenil IV over 30 seconds is administered for the management of suspected overdose of midazolam. Diazepam is administered at a dose of 5 mg/mL IV for the induction of sleep. Pentobarbital is administered at a dose of 2 to 6 mg/kg for treating convulsions. A dose of 0.2 mg/2 mL of flumazenil IV over 15 seconds is administered for the reversal of moderate sedation or general anesthesia.

Which phenobarbital level would the nurse anticipate for a patient with clammy skin and a respiratory rate of 5 breaths/min? 1 35 mcg/dL 2 42 mcg/dL 3 12 mcg/mL 4 43 mcg/mL

4 43 mcg/mL Phenobarbital is a short-acting barbiturate that is used as an anticonvulsant and preoperative sedative. The normal therapeutic level of phenobarbital is between 10 and 40 mcg/mL. Cold extremities and a decreased respiratory rate are symptoms caused by an excessive dose of barbiturates. The patient would experience cold, clammy skin and a respiratory rate of less than 10 breaths/min if the serum levels of the drug were above 40 mcg/mL. Therefore it is most likely that the serum level of phenobarbital in the patient is 43 mcg/mL (above 40 mcg/mL). The serum concentrations of phenobarbital are not calculated with mcg/dL units. Thus serum concentrations of 35 mcg/dL and 42 mcg/dL are not the probable reasons for such symptoms in the patient. The serum level of 12 mcg/mL is within the normal range, so the patient would not have the symptoms of overdose with this value of phenobarbital.

Which is the dose regimen of methylphenidate (Ritalin) for a 6-year-old child with attention-deficit/hyperactivity disorder (ADHD)? 1 20 mg after lunch 2 120 mg at each meal 3 50 mg as a single dose 4 5 mg before breakfast and lunch

4 5 mg before breakfast and lunch Methylphenidate (Ritalin) is a central nervous system (CNS) stimulant prescribed for the treatment of ADHD. In a 6-year-old child, a 5-mg dose is prescribed before breakfast and lunch. The dose prescribed to an adult is 20 mg after lunch. A patient taking orlistat (Xenical) therapy is prescribed 120 mg of orlistat at each meal. Finally, 50 mg as a single dose is prescribed for methylphenidate (Concerta) in an adult.

Which action would the nurse expect the health care provider to take when prescribing antibiotic therapy to a patient who has end-stage renal disease? 1 Increase the dose from the recommended dose. 2 Administer the antibiotic with diuretic medications. 3 Prescribe an antibiotic with a low therapeutic index. 4 Initiate therapy with a lower-than-recommended dose.

4 Initiate therapy with a lower-than-recommended dose. Impaired renal function leads to impaired excretion of medication. This can cause toxic levels of a drug in the bloodstream. It is usually best to start with a lower dose and increase as the patient tolerates. Diuretics are not indicated. Drugs with a low therapeutic index have a narrow range between effectiveness and toxicity and are not as safe in patients with renal disease.

Which preadministration assessment data are the nurse's priority in the evaluation of adverse effects of therapy to cyclobenzaprine? 1 Muscle spasms 2 Amount of bleeding 3 Indicators of infection 4 Level of consciousness

4 Level of consciousness The nurse compares the patient's level of consciousness after the administration of cyclobenzaprine to the findings of the preadministration neurologic assessment to evaluate the adverse effects of the drug, which can cause significant sedation. However, because the patient was in a motor vehicle accident, a significant reduction in the level of consciousness or unresponsiveness warrants further investigation by the nurse to rule out increased intracranial pressure. The nurse assesses muscle spasms to evaluate the effectiveness of therapy because less muscle spasticity is expected after the administration of cyclobenzaprine; as long as the spastic muscles are not bleeding, it should have no direct effect on bleeding. Cyclobenzaprine should have no effect on infection.

Transdermal fentanyl is indicated for which type of pain? 1 Pain after abdominal surgery 2 Acute migraine 3 Lower back pain related to lumbar strain 4 Severe pain resulting from cancer metastasis

4 Severe pain resulting from cancer metastasis Transdermal fentanyl is indicated only for persistent severe pain in patients who already tolerate opioids because it can cause fatal respiratory depression in patients who are opioid naive. For this reason, the patch is not indicated for acute pain such as postoperative pain, intermittent pain, or pain that responds to a less powerful analgesic.

Which strategy would be used to complete an assessment of a patient with a health history of narcolepsy? 1 Provide a structured form for the patient to complete in writing. 2 Seek information from significant others rather than the patient. 3 Use the patient's past medical records to locate important information. 4 Use short, focused interview sessions with active participation by the patient.

4 Use short, focused interview sessions with active participation by the patient. A patient with narcolepsy will be drowsy or fall asleep easily. To obtain accurate information, the nurse would keep the dialogue short and focused. Narcolepsy is an incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities. For this reason, it is difficult for patients to complete a structured form. Seeking information from significant others may not always work. Using the patient's past medical information may be helpful, but few critical factors may be missed if the patient is not interviewed.