Pharm exam 2
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
