Pharm Exam 2
negative symptoms of schizophrenia
the absence of appropriate behaviors (expressionless faces, rigid bodies) Lack of motivation, avoidance of relationships Less/diminished from normal behavior
Which statement by a client with RA prescribed ibuprofen 800 mg PO 3xday indicates that the nurses education about the medication side effect was effective? Select all that apply: a: I need to report dark, tarry stools. b: I will need to stop taking this medication before any scheduled surgery. c: I should change positions slowly. d: I will take this on an empty stomach e: I need to stop taking low-dose aspirin while i take this med.
A,B Rationale: Ibuprofen increases the risk for bleeding, report any black tarry stools right away. They will also need to stop takign this med before surgery to prevent excessive bleeding. They may continue taking low dose aspirin to prevent MI or stroke, but take two hours apart.
An adolescent with a major depressive disorder is prescribed venlafaxine. Which signs or symptoms related to the med will the nurse communicate immediately to the provider? Select all that apply A Blurred Vision B Suicidal ideation C Difficult urination D Tardive Dyskinesia E Transient hypoglycemia
A,B, C Rationale: Abnormal vision (blurred/double vision) is a side effect of venlafaxine. CNS effects such as emotional lability, vertigo, anxiety, insomnia, suicidal ideation in children and adolescents are side effects. Difficult or painful urination are serious side effects.
What are the signs and symptoms of anxiety? Select all that apply A- Aches and Pains B-Headaches C-Heart palpations D-Smiling and Laughing E-Trembling, sweating F-Crying and increased agitation
A,B,C,E,F
Which disorder would the nurse identify as being treated by venlafaxine? Select all that apply. A Panic Disorder B Bipolar Disorder C Major Depression D Social Anxiety Disorder E Obsessive Compulsive Disorder
A,C,D Rationale: Panic disorders, Major depression, Social anxiety disorders can be treated with venlafaxine. BPD is treated with mood stabilizers, antipsychotics, antiepileptic medications. OCD is treated with SSRIs.
A health care provider prescribes lithium carbonate for a pt with bipolar disorder, depressive episode. Which instructions will the nurse include when teaching the client about lithium? Select all that apply. A Take med with food B Adjust dosage if mood improves C Have a snack with milk before going to bed D It may take several weeks for beneficial results to occur E REstriction of sodium intake is unnecessary
A,D, E Rationale: Lithium should be taken with food to prevent gastric irritation. Lithium decreases sodium resorption by the renal tubules. If sodium intake is decreased sodium depletion may occur. Lithium retention increases when sodium is decreased. Restriction of sodium can lead to lithium toxicity.
Which medication is the most common cause of extrapyramidal side effects? A Clozapine B Haloperidol C Risperidone D Aripiprazole
B Rationale: Haloperidol is a typical antipsychotic that causes extrapyramidal side effects. Clozapine is an atypical antipsychotic that as a low risk of causing EPS. Risperidone and aripiprazole have a low risk of causing EPS.
For a client receiving morphine sulfate, which action would the nurse IMMEDIATELY take when noting the pts respiratory rate is 8 breaths per min? A Measure other vital signs B Stop admin of medication C Elevate the head of the bed D Report to PCP
B Rationale: Morphine is an opioid analgesic and depress CNS which results in resp. depression. RR of 8/min indicates resp depression. RN can measure vital signs after stopping medication. RN would elevate head of bed after stopping medication to ensure proper breathing. RN would report to PCP for appropriate antidote after stopping med admin.
Which life threatening complication may occur in clients taking high dose or long-term ibuprofen? A Anaphylaxis B GI bleeding C Cardiac dysrhythmia D Disulfiram reaction
B Rationale: Ibu irritates the GI mucosa. And can cause mucosal erosion while decreasing platelet activity, which can result in GI hemorrhage.
The nurse teaches dietary guidelines to a pt who will be taking tranylcypromine (MAOI). Patient compiles a list of foods to avoid. Which foods included on the list indicate that the teaching has been effective? Select all that apply. A French fries B Pepperoni Pizza C Bologna Sandwich D Hamburger on a bun E Hash browns potatoes
B,C Rationale: Cheese and processed meats contain tyramine. which is contraindicated in MAOIs. Tyramine a precursor in the synthesis of norepinephrine, taken in the presence of MAOIs can lead to a sharp increase in norepinephrine and a potentially fatal hypertensive crisis.
What are some adverse or side effects of benzos?
BLACK BOX WARNING: profound sedation. respiratory depression, coma,death Fall risk-unsteadiness OD causes coma or death Flumazenil used for OD
Admin Considerations for Ritalin
BLACK Box: High risk for abuse Avoid alcohol and caffeine Monitor BP and HR Monitor weight and growth in children Approved for children over age 6 Contraindicated with MAOIs or use of MAOI within 14 days
MOA for Ativan and class?
Bind to specific GABA receptors to potentiate effects of GABA BENZODIAZEPINES
Rn teaches a pt about the side effects and precautions associated with antipsychotic medication HALOPERIDOL. Which statement indicates the pt has understood the teaching? A I will call my healthcare provider right away if i have any diarrhea or vomiting. B I wont eat anything containing tyramine while taking this med. C I will avoid direct sunlight and make sure to use sunscreen while outside. D I will be sure to drink enough fluids.
C Rationale: Photosensitivity is a side effect of many antipsychotics. Diarrhea and vomiting are side effects of lithium not haloperidol.
Which effect of lorazepam is the reason it is given to a client with status epilepticus? A Decreases anxiety associated with seizures B Promotes rest after the seizure episode C Depresses the CNS D Provides amnesia for the convulsive pt.
C Rationale: Lorazepam is used to treat status epilepticus because it depresses the CNS. IT also functions as a anxiolytic and sedative can cause cause anterograde amnesia, however these are not the reasons its prescribed for status epilepticus.
What are some administration considerations for Phenobarbital?
Can be given PO, IM, IV High abuse risk Cannot be combined with other CNS Depressants Tapered dose when discontinuing
What are the nursing considerations for Lorazepam (ATIVAN)?
Can cause fetal harm Children and Elderly-paradoxical reactions Elderly: Susceptible to sedative and respiratory distress Hepatic Insufficiency may need dosage adjustment \
Which medication can go past the BBB to treat Parkinsons?
Carbidopa- Levodopa piggybacks on carbidopa
What is the mechanism of action for Phenobarbital? (LUMINOL)
Produce sedation and drowsiness by altering cerebellar function and depressing the brain and sensory cortex.
What would the nurse say for patient education of anxiety using non pharmacological techniques?
Relaxation, deep breathing, exercise, psychotherapy, support groups, cognitive behavior therapy.
What is the DX for schizophrenia?
Severe, disabling psychiatric disorders marked by withdrawal from reality, illogical thinking, delusions, hallucinations, and flat affect.
The nurse admins tylenol to peds patient after surgery for CC of abdominal pain. Mom asks nurse why ibuprofen isnt being given. Which response is the most appropiate? A It could prolong bleeding time B Its contraindicated for children C It can suppress the healing time D It becomes ineffective when given for long periods
A Rationale: Tylenol is not associated with bleeding complications like ibuprofen.
Therapeutic levels of lithium in the blood are what?
0.8 to 1.5 mEq
The serum lithium blood level of a client with a mood disorder, manic episode, is 2.3 mEq/L. What should the nurse expect when assessing this client? 1 Elevation in mood 2 Nausea, thirst, and fine hand tremor 3 Decrease in manic signs and symptoms 4 Vomiting, diarrhea, and decreased coordination
4 These are all symptoms of toxic levels of lithium in the blood.
What medication class includes amitriptyline? A Tricyclics B Monoamine Oxidase Inhibitors C SSRIs D SNRIs
A
Which substance would a client taking tylenol routinely be advised to avoid? A Alcohol B Caffeine C Diphenhydramine D Ibuprofen
A Rationale: Tylenol and alcohol are both hepatotoxic substances. Metabolites of tylenol and alcohol can cause irreversible liver damage.
Which manifestation is an adverse effect of IV lorazepam? Select all that apply. A Amnesia B Drowsiness C Sleep driving D Blurred vision E Respiratory Depression
ALL OF THEM Rationale: Benzodiazepines such as lorazepam have a range of side effects which are related to CNS depression. These are all potential side effects of lorazepam.
Which property of acetylsalicylic acid would a nurse recall when administering to a client?
ANALGESIC Rationale: Aspirin acts as analgesic by inhibiting the production of inflammatory mediators. It does not act as a sedative to calm people. it does not act as a hypnotic to put people to sleep. Does not destroy or control microorganisms
What age range does schizophrenia usually appear?
Appears between ages 15 and 30.
What medications are used to treat seizures? General classification
CNS depressants, benzos, barbiturates, anticonvulsants
What are some adverse and side effects of Luminol?
CNS depression OD can cause death Suicidal thoughts or behavior GI: Nausea and vomiting
Non-motor S/S of Seizures
Changes in sensation, emotions, thinking or autonomic functions or lack of movement.
What is ADHD?
Hyperactivity, lack of impulse control, and or lack of attention that interferes with how a person functions. Difficulty sitting still and focusing.
What does the medication do to treat parkinsons?
Increases dopamine in the brain and treats S/S
What are treatment options for BPD?
Medications, Support groups, ECT (electroconvulsive therapy) safety initiatives during acute mania, psychotherapy. Lithium is the medication of choice
CNS stimulants
Methylphenidate (Ritalin)
Nursing Process: how is the evaluation process different than normal?
Most of the evaluation is based on subjective data. Remember to use therapeutic techniques to get the best response. Some CNS meds need labs drawn to monitor therapeutic levels.
Motor Signs or symptoms of Seizures
Motor: jerking (clonic), muscles becoming limp or weak (atonic), tense or rigid muscles (tonic), brief muscle twitching (myoclonus), epileptic spasms
What is Parkinson's disease?
Movement disorder caused by the death of cells that generate dopamine in the basal ganglia and substantial nigra. Characterized by resting tremor, slowed movement, rigidity of facial muscles, and shuffling gait, and reduction in capacity for language There is NO CURE
Positive Symptoms of Schizophrenia
Outside normal delusions/hallucinations Hallucination: seeing something that is not normal Delusion: Hearing or thinking things that are not in reality Thought withdrawal: ppl are reading their minds, passages or newspapers are for them and about them.
Tremors, agitation or visual hallucinations are called what in relation to Ativan?
Paradoxical reactions
How many classifications of seizures are there? And what are they?
Partial: focus onset on some side of the brain Generalized: Bilateral onset on both sides of the brain Status Epilepticus: Single seizure lasting more than 20 mins or repeated seizures without recovery.
What are the clinical signs of depression? How long must they last to be diagnosed with clinical depression? How many symptoms must they have?
S/S: depressed mood, feeling of worthlessness, inappropriate guilt, agitation, insomnia or hypersomnia, weight loss without trying. May have affect-flat facial expressions. (CLINICALLY SIGNIFICANT DISTRESS OR SOCIAL, OCCUPATIONAL OR OTHER AREAS OF LIFE) Cant be due to substance or bereavement Must have 5 S/S during the same 2 week period.
Indications for use of Phenobarbital (therapeutic Effects) (LUMINOL)
Sedation and Seizures Primarily used as an anticonvulsant May also be used a preanesthetic agent
What are some indications for use of Lorazepam? (BENZOS) (ATIVAN)
Sedation, Anti-anxiety, and anticonvulsant Oral-anxiety IM: Status epilepticus
What is bipolar disorder? What are some S/S?
Serious Mood Swings: Extreme high (mania or hypomania) Extreme lows (depression) S/S: Rapid speech, risque behavior, reduce need for sleep, grandiosity, poor judgement, behavior out of control, decreased impulse control, neglect basic self-care (swing from way down to way up in weeks or months)
What class of antidepressants do you have to worry the most about overdose? THINK CYCLE
Tricyclic Antidepressants
What is a neurotransmitter?
a chemical that travels from one neuron to another, it binds with a target cell.
Side Effects of Methylphenidate
decreased appetite, weight loss, insomnia, upper abdominal pain, headache, Gynecomastia
