Pharm II Test 3

What is the therapeutic level for Lithium?

0.5-1.2

Escitalopram works by: 1.Allowing for the increase of serotonin in the brain 2.Allowing the reuptake of serotonin 3.Decreasing serotonin levels 4.Blocking reuptake of NE and serotonin 5.Blocking MAOs in the brain

1 Action/Purpose: °Block reuptake of serotonin (5HT), thereby increasing the effects of serotonin

What are the primary assessments/interventions when caring for a patient receiving this medication?

1. CNS effects + educate safety precautions 2. HR/BP 3. assess consipation / urinary retention 4. Renal + liver tests = toxicity (get baseline for issues) 5. avoid heat (decrease sweating), could cause overheating because dont sweat

In which patient conditions should the nurse recognize this type of medication should be avoided and why?

1. Liver and Kidney issues 2. Avoid heat could cause overheating because these people do not sweat

What is levodopa/carbidopa commonly used to treat? 1.AZD 2.Myasthenia Gravis 3.Overactive Bladder 4.Parkinson's disease

4

The benzodiazepines are the most frequently used anxiolytic drugs because: A. They are anxiolytic at doses much lower than those needed for sedation or hypnosis. B. They can also be stimulating. C. They are more likely to cause physical dependence than older anxiolytic drugs. D. They do not affect any neurotransmitters.

A

The nurse is aware that it is important to monitor the client with myasthenia gravis being treated with anticholinesterase medication for signs of a cholinergic crisis. Which of the following clinical manifestation is most consistent with a cholinergic crisis? A. Abdominal cramping, nausea, and increased salivation B. Mydriasis and decreased bowel sounds C. Miosis, tachycardia, and dry mucous membranes D. Tachycardia, dilated pupils, and hypertension

A

When benztropine (Cogentin) is ordered for a client, the nurse acknowledges that this drug is an effective treatment for which condition? A.Parkinsonism B.Paralytic ileus C.Motion sickness D.urinary retention

A

Benztropine should be used cautiously in hot weather and during exercise because it can cause: A.Hyperthermia B.Hypothermia C.Hyperglycemia D.Hypoglycemia

A Rationale: Benztropine causes decreased sweating so patients should avoid heat. Being in the heat could cause an overheated crisis because these patients do not sweat.

A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply. A. Dysphagia B. Fluid overload C. Choking D. Constipation

A, C

Sertraline may be used to treat (SATA): 1.Major depressive disorder 2.Anxiety 3.OCD 4.PTSD 5.Bulimia

ALL Therapeutic Uses: °Major depressive disorder °Anxiety °OCD °PTSD/Panic disorders °Bulimia

A client is receiving bethanechol (Urecholine). The nurse realizes that the action of this drug is to treat: A.Glaucoma B.Urinary retention C.Delayed gastric emptying Gastroesophageal reflux disease

B

A family member of a patient with Parkinson's Disease asks about the cause of the neuromuscular changes. The nurse educates the family that the patient's symptoms are due to: A. Decrease in acetylcholine B. Decrease in dopamine C. Increase in testosterone D. Loss of ACh-producing neurons

B

The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter? A.dopamine B.acetylcholine C.cholinesterase D.monnoamine oxidase

B

A client is admitted to an acute care facility after an episode of status epilepticus. After the client is stabilized, which factor is most beneficial in determining the potential cause of the episode? A.The type of anticonvulsant the client is taking for the condition. B.Compliance with the prescribed medication regimen. C.Recent weight gain or weight loss. D.Daily stress level

B #1 reason for epilepticus is abrupt withdrawal of meds

Buspirone is commonly used to: A.Control nicotine addictions B.Treat PTSD C.Decrease depressive symptoms of BPD D.In combination with SSRIs

B Action: °Binds to serotonin and dopamine receptors in the CNS Therapeutic Uses: °Panic disorders °Anxiety disorders °OCD °PTSD

The nurse teaches the client receiving atropine to expect which side effect? A.Diarrhea B.Bradycardia C.Blurred vision D.Frequent urination

C

What is chlordiazepoxide most commonly used to treat? A.Seizures B.Insomnia C.Alcohol withdrawal D.Muscle spams E.Preop prep

C This is a benzo for alc withdrawal

A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include for teaching? SATA A.Expect therapeutic effects in 24 to 48 hours B.Discontinue the medication after a week of improved mood C.Change positions slowly to minimize dizziness D.Decrease dietary fiber intake to control diarrhea Chew sugarless gum to prevent dry mouth

C, E

The nurse is administering a cholinergic agonist and should know that the expected cholinergic effects include which of the following? A.Increased heart rate B.Decreased peristalsis C.Decreased salivation D.Increased pupil constriction

D

A patient with myasthenia gravis is started on Pyridostigmine. What assessment finding demonstrates the drug is working correctly? A. The patient experiences dilation of the pupils. B. The patient experiences a relaxed bladder C. The patient experiences bronchodilation. D. The patient experiences normal muscle function in the face and eyes

D Pyridostigmine is a cholingeric drug used to treat myasthenia gravis. Remember patients with this condition have trouble with control of muscles in the face/eyes etc. This drug will increase the availability of acetylcholine to help those receptors contract those smooth muscles and maintain normal muscle function in the face and eyes

The nurse should teach the patient taking benzos to: A.Stop taking if experiencing hypotension B.Take on an empty stomach C.Assess for CNS stimulation D.Be careful with herbal supplements E.Take naloxone for OD

D Nursing Considerations/ Education: •Assess for CNS depression •Avoid alcohol and other CNS depressants •Do not abruptly stop med •Be careful with herbal supplements •Take with food •Toxicity symptoms •Antidote: °Flumazenil (Romazicon) - reverses CNS depression

• Why is atropine contraindicated in patients with glaucoma?

increase IOP

What is the action of a cholinergic agonist?

· Agonist mimic · Parasympathomimetic, mimic the PNS response *cholinergic, muscarinic agonist, parasymathomimetc

What would indicate the patient is having therapeutic effects related to treatment with pyridostigmine?

· Increase in muscle strength

Why do patients with myasthenia gravis (MG) experience muscle weakness?

· Loss acetylcholine receptors · Antibodies attack this area and cause loss of acetycholine · Develop progressive muscle weakness (respiratory muscles and cause problems with their bleeding) o Serious enough to be put on ventilator

What condition is treated with bethanechol and why?

· Nonobstructive urinary retention · Used in problem with urinary retention · Cannot use in someone with an obstructive process · A patient after surgery (abdominal surgery with urine retention): bladder would not contract after surgery due to anesthesia (urinary retention), so would need to be given meds

What type of medication is used to treat myasthenia gravis and why?

· Parasympathomimetic indirect acting Cholinesterase-inhibitors · *tightly shut eyelid very tight and might pick up where the weakness is because they cannot do this · By increase acetylcholine = increase strength · Antidote: Tensilon test (acetylcholine be there and get better, temporoary does not last very long)

What is a hallmark clinical manifestation of MG?

· Ptosis

• When discharging the patient with Parkinson's from the hospital, what are the key client education points related to taking Levadopa/Carbidopa?

• Involve the family in this and help them understand • Key education points: effects tend to wear off, take with 2nd gen MAOIs (don't block dopamine by itself but also work on serotonin receptors) • MAOI: can cause interaction and high risk of toxic effects • Protein: effects • Vitamin B6

What is the medication classification for atropine?

• Muscarinic (anti-cholinergic) • Is an antidote • Drug of choice for symptomatic bradycardia • do not give everyone this with bradycardia • showing signs of decreased perfusion

• In what situations or conditions is atropine indicated?

• Signs like passing out • LOC • Symptoms of medication • Increase pressure • Dilation of pupils • Change in vision

•What are the primary conditions in which benzodiazepines are used?

•Anxiety

•How do Barbiturates decrease/control seizure activity?

•Bind gabba and calm down brain impulses

•What effect do Tricyclics have on blood pressure and why?

•Block alpha 1 so reduces BP (orthostatic hypotension)

•If given IV, what is critical for the nurse to monitor... and what should be readily available for the nurse to administer?

•CNS depression, cannot get patient awake •Signs of toxicity to monitor for: ataxia (especially in the elderly = potential for falls), slurred speech, altered mental status •Aware herbal substances can make it stronger (St. John's wart, valerian)

•The nurse is aware that phenytoin (Dilantin) is the oldest and most common prescribed anti-seizure medication. What information should the nurse include when teaching a patient about this medication?

•Gingival hyperplasia (long-term side effect) •Oral hygiene, going to the dentist •Do not want them to cause trauma to mouth (soft tooth brush) •Check their levels •Oral contraceptives may be altered, need a barrier method •Foods: eat more of vitamin D and calcium (fatty fish, cheese, broccoli) •Tube feeding: don't do it 2 hours before or 2 hours after

•What is the mechanism of action of benzodiazepines?

•Increase gabba, bind to these, intensity GABA •More of a calming effect

•Which family of antidepressants require strict adherence to diet guidelines and what type of foods would you educate the patient to avoid?

•MAOI •Tyramine - HTN crisis, major patient education point Foods: processed meats, chocolate, "college diet," avocado, banana

What increases a patient's risk for serotonin syndrome?

•Using multiple SSRI, MAOI, tricyclics, lithium •Sexual dysfunction, tremors, HTN •So severe put on mechanical ventilator

Contraindications for prescribing lorazepam include (SATA): 1.Seizure disorders 2.Sleep apnea 3.Liver disease 4.Pregnancy 5. Glaucoma

2345 •Schedule IV Drugs according to Controlled Substances Act •Do not give to patients with sleep apnea, respiratory depression, or glaucoma •Use cautiously in clients with liver disease •Use short term due to risk for dependence •Pregnancy Category D

Adverse effects of Sertraline include (SATA): 1.CNS depression 2.Weight change 3.Hypernatremia 4.GI effects Sexual dysfunction

245 Adverse Effects: •CNS stimulation •Weight change •Sexual dysfunction •Hyponatremia •Withdrawal syndrome •GI effects Serotonin syndrome **

Adverse effects of TCAs include: 1.Cholinergic effects 2.sedation 3.Hypertension 4.Cardiac toxicity 5.seizures

245 Adverse Effects: •Nausea •Orthostatic hypotension •Sedation •Anticholinergic effects •Cardiac toxicity •Seizures •Bone marrow depression

What clinical manifestations experienced by a patient with myasthenia gravis would alert the nurse of a serious complication?

· Respiratory depression · Fall · Cholinergic crisis (PSNS): think of these effects and they will be increased o Hemodynamics: bradycardia, abdominal cramping (intense GI activity), difficulty breathing (bronchoconstriction) o Too much meds has a grand effects o More acetylcholine

What are the two primary neurotransmitters of the ANS?

· SNS = epi and norepinephrine · PSNS = acetylcholine

Bupropion may be used to (SATA): 1.Treat depression 2.Alternative to SSRI 3.Aid in quitting smoking 4.Help with neuropathic pain 5.Off label HTN reduction

1234 Action/Purpose: •Inhibits reabsorption of serotonin and norepinephrine and dopamine Therapeutic Uses: •Depression •Alternative to SSRIs •Aid to quit smoking (bupropion) •Seasonal depression •Neuropathic pain and GAD (duloxetine) Fibromyalgia

Adverse effects of non-benzodiazepines that are given for anxiety include (SATA): 1.Dizziness 2.Nausea 3.Headache 4.Agitation 5.Rebound HTN

1234 Adverse Effects: •Dizziness •Nausea •Headache Agitation

S/S of HTN crisis include (SATA): 1.Vomiting 2.Chest pain 3.Headache 4.Vasodilation 5.Stiff neck

1235 ±Severe vasoconstriction and stimulation of the heart. ±Caused by intake of tyramine, sympathomimetic medications, or TCAs. •Headache •Stiff neck - nuchal rigidity •Nausea/vomiting •Tachycardia/chest pain •Severe hypertension

Adverse effects of phenobarbital include (SATA): 1.Bradycardia 2.Exfoliative dermatitis 3.Drowsiness 4.Hypertension 5.Ataxia

1235 Adverse Effects: •CNS depression •Respiratory depression •Bradycardia/hypotension •Confusion •Increased drowsiness •Impaired mobility (ataxia) •Exfoliative Dermatitis and Stevens-Johnson Syndrome

Adverse effects of Levadopa/carbidopa include (SATA): 1.N/V 2.Worsening dyskinesia 3.Hypertension 4.Psychosis Discoloration of urine + sweat

1245 Nausea, vomiting, drowsinessWorsening dyskinesiasOrthostatic hypotensionCardiovascular effects (tachycardia, palpitations)PsychosisDiscoloration of sweat and urine

Therapeutic uses of Impramine include (SATA): 1.Depression 2.Bipolar disorder (manic episodes) 3.Neuropathic pain 4.Fibromyalgia 5.Anxiety and narcolepsy

134 Therapeutic Uses: •Depression •Bipolar disorder (depressive episodes) •Other uses: °Neuropathic pain °Fibromyalgia °Anxiety disorders and Insomnia

Before giving phenobarbital, priority nursing considerations include (SATA): 1.Assess for respiratory depression 2.Check pedal pulses 3.Take a blood pressure 4.Assess for decreased urinary output 5.Give a dose of diphenhydramine to help with the dermatitis

134 Nursing Considerations/ Education: •Assess for respiratory depression, hypotension, shock symptoms •Do not abruptly stop med •Over sedation and confusion can occur at normal doses

Therapeutic uses of phenelzine include (SATA): 1.Depression 2.Bipolar disorder 3.Anorexia 4.Bulimia 5.Panic disorder

145 Therapeutic Uses: °Depression- Unresponsive to other meds °Bulimia °Panic disorder

Adverse effects of benzos include (SATA): 1.CNS stimulation 2.Anterograde amnesia 3.Hypertension 4.Dizziness 5.Increased appetite

2, 4 •CNS depression •Anterograde amnesia •Hypotension •Dizziness •Anorexia •High risk for toxicity •Withdrawal symptoms if abruptly stopped

The nurse should educate the patient taking buspirone that (SATA): 1.It will start working within the week 2.There is a risk of tolerance and dependence levels increasing with it 3.Patient should take on an empty stomach to avoid potential weight gain 4.It is safe to take while breastfeeding because it is a pregnancy category B 5.Avoid taking with grapefruit juice

2, 5 Nursing Interventions/ Education: •Take with food •Avoid herbal supplements •Do not take with grapefruit juice •Drug may not take effect for 1-3 weeks •Be aware of tolerance level and dependence

Risperidone may be used to treat (SATA): 1.Depression 2.Bipolar disorders 3.Schizophrenia 4.Psychotic episodes 5.Anxiety

234

•A nurse is caring for a 78-year-old female. The client reports she has frequent insomnia and takes a benzodiazepine to help her sleep at night. 1.What concerns would the nurse have for this specific client? 2. What are the high priority assessments; what requires further investigation?

1.Age of this person worried for potential for falls 2.Impaired mobility/confusion 3.Not metabolizing fast 4.Insomnia = does not promote best type of sleep (interfere with REM) 5.Safety of the home environement (get rid of throw rugs, ask climbing stairs, pets under feet) 6.If have glaucoma this is not a good drug to use bc increases IOP 7.Impaired liver function because metabolize in the liver

5 Signs of Lithium Toxicity

1.CNS Changes 2.GI distress 3.Muscle weakness 4.Tinnitus 5.Hypotension

Symptoms of serotonin syndrome include (SATA): 1.Fever 2.Confusion 3.Agitation 4.Hypo-reflexia 5.Depression

123 •Confusion •Fever •Agitation •Anxiety •Hallucinations •Hyper-reflexia •Diaphoresis •Tremors •Hypertension

Nurses should educate patients taking escitalopram (SATA): 1.Take the dose in the morning 2.Assess for bleeding 3.Use barrier contraceptives 4.Expect effects within 1-3 weeks If you notice bruising, stop taking

123 •Take dose in the morning or evening •Avoid caffeine •Regular exercise and healthy diet •Do not abruptly stop •Assess for bruising/bleeding •Use barrier contraceptives •Avoid St. John's Wort •Do not take with another SSRI, MAOI, TCA or Lithium •Monitor for suicidal ideation •All of these take 2-4 weeks to work

Adverse effects of MAOIs include (SATA): 1.CNS over-stimulation 2.Liver toxicity 3.Hypertensive crisis 4.Orthostatic hypotension 5.Bradycardia

1234 Adverse Effects: •CNS over-stimulation •Liver toxicity •Orthostatic hypotension •Hypertensive Crisis**

Nursing interventions for a patient taking phenelzine include (SATA): 1.Monitor BP 2.Monitor HR 3.Advise patient to avoid pepperoni 4.Educate patient that walnuts will help improve heart function 5.Avoid OTC decongestants while taking

1234 •Observe for signs of anxiety agitation, or mania •Monitor BP and HR •Do not eat foods containing tyramine or caffeine •Takes 3-4 weeks for drug to be therapeutic •Avoid OTC decongestants

Which of the following is true? 1.Zolpidem is used for long term insomnia treatment 2.Hydroxyzine is a stimulant 3.Hydroxyzine may be used to decrease the need for narcotics 4.Diphenhydramine is a safe OTC insomnia treatment

3 zolpidem (Ambien) •For short term tx of insomnia hydroxyzine (Vistaril) •Antihistamine - sedative •Pre-op and post-op to decrease need for narcotics diphenhydramine (Benadryl) •Antihistamine - sedative •Short term tx of insomnia

Amitriptyline works by: 1.Allowing the reuptake of NE and Epi 2.Reducing symptoms of sedation 3.Blocking reuptake of serotonin and NE 4.Blocking reuptake of only NE 5.Increasing only serotonin levels in the brain

3 Action/Purpose °Blocks reuptake of norepinephrine (NE) and serotonin (5HT) °Reduces symptoms of panic and anxiety

Phenobarbital works by: 1.CNS stimulant that inhibits neuronal impulses and excite motor output 2.Inducing anesthesia at low doses 3.Inhibit neuronal impulses and depressing motor output 4.Increase the blood pressure in patients with seizure disorders 5.Decreasing the heart rate to help increase motor output

3 Action/Purpose: °CNS depressants that inhibit neuronal impulses and depress motor output ±Therapeutic Uses: °Lower doses - reduce anxiety °Higher doses - induce anesthesia, sedation, treatment of seizures

Nursing interventions for a patient taking imipramine include (SATA): 1.Put the patient on continuous pulse ox 2.Auscultate breath sounds q30 minutes 3.Have patient on telemetry monitoring 4.Educate patient that it may take up to 8 weeks to work Contact provider if the patient has a history of seizures

3, 4,5 •Monitor BP and HR •Timing of Medication •Cardiac monitor •Avoid alcohol, St. John's Wort or other CNS depressants •Can take 4-8 weeks for therapeutic benefits •**Not initial drug of choice Contraindicated in patients withseizures

The nurse is preparing to administer bethanechol to a client admitted with urinary retention. When reviewing the patient's history, which condition would the nurse be most concerned and would require the nurse to notify the provider prior to giving the medication? A. Urinary Stricture B. GERD C. Slow gastric emptying D. Heart rate of 95 E. Dry mouth

A

When the client has a cholinergic overdose, the nurse anticipated administration of which drug as the antidote? A.Atropine B.Bethanechol C.Ambenonium D.metoclopramide

A

•A nurse is caring for a patient who takes sertraline for depression. Upon assessment, the nurse notes that the patient is tremoring, confused to place and time, appears agitated, and keeps telling you that she "sees" a spider in her bed. Which intervention is of highest priority? A.Hold the dose of Sertraline and notify the provider. B.Tell the patient you will look in the bed for "spiders". C. Apply some warm blankets to stop the tremors. D.Explain to the patient this indicates the med side effects will wear off soon.

A

•A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following is the priority nursing action? A. Administer flumazenil (Romazicon) B. Identify the client's level of orientation C. Infuse IV fluids D. Prepare the client for gastric lavage

A

•A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? A.Limit aerobic activity in hot weather B.Avoid the use of acetaminophen for headaches C.Restrict intake of foods rich in sodium D.Decrease fluid intake to less than 1,500 mL daily

A Lithium carbonate MOA: mood stabilizer, alter sodium transport, block norepi + dopamine Patient becomes dehydrated = lithium toxicity, super concentrated, kidneys responsible excreting lithium Don't want to be losing volume and fluids NSAIDs = renal toxicity (acetaminophen) Want them to increase sodium *DO ANYTHING TO AVOID DEHYDRATION

Select all the signs and symptoms a patient can experience when the stimulation of the parasympathetic nervous system: Select all that apply: A. Bradycardia B. Dilated pupils C. Bronchoconstriction D. Constrict pupils E. Bladder contraction F. Dry mouth G. Slow digestion H. Hypertension

A, C, D, E

Select all the signs and symptoms a patient can experience with the stimulation of the sympathetic nervous system: Select all that apply: A. Tachycardia B. Hypotension C. Hyperglycemia D. Dilated pupils E. Urinary incontinence F. Bronchodilation G. Cold and clammy H. Excessive salivation I. Sweating

A, C, D, F, I

A nurse in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following is priority nursing action? A.Administer flumazenil B.Identify the client's level or orientation C.Infuse IV fluids Prepare the client for gastric lavage

B

A nurse is caring for a client with myasthenia gravis. The nurse administers the prescribed pyridostigmine. Which of the following indicate a therapeutic response to the medication? A. Fatigue worsens with activity B. Ptosis is less noticeable C. Lower extremity muscle spasm D. Impaired voluntary movements E. Feelings of euphoria

B

A nurse is caring for a 75-year-old female who is taking gabapentin to help manage symptoms of fibromyalgia. Which of the following should the nurse identify as a high priority nursing diagnosis? A.Risk for fluid volume deficit B.Risk for impaired verbal communication C.Risk for falls D.Risk for constipation

C Gabapentin: effect dizziness and drowsiness

A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following: A.Avoid the use of acetaminophen for headaches B.Restrict intake of foods rich in sodium C.Decrease fluid intake to less than 1,500 mL daily Limit aerobic activity in hot weather

D

The nurse is caring for a patient who weighs 50 kg. The patient is receiving bethanechol. Which of the following is an adverse medication effect? A. Apical HR rate is 99-100 beats per minute B. No bowel movement over past 48 hours C. Urine output is 1 mL/kg/hour (this is good output for an adult to make sure the kidneys have been perfused D. Radial pulse is 55 beats per minute E. Cracked dry lips

D

A nurse is providing teaching to a client who has a new prescription to start buspirone. The client asks why his provider is changing his medication from diazepam to this. Which of the following statements is an appropriate response by the nurse? A. Diazepam can cause seizures as an adverse effect B. Diazepam is not indicated for the treatment of panic disorder C. Buspirone is a safe medication for clients who have liver dysfunction D. Buspirone has less risk for dependency than other treatment options

D Why is that: is it a non-barb and does not have increased effects, not as likely to cause dependence as benzos, don't use with MAOI or liver problems

What happens with the muscarinic receptor response?

located in the target tissues and effected by PSNS (activated = s/s PSNS)

What is the purpose of benztropine in patients with Parkinson's disease?

oppose effects of Ach in CNS -adjunct to those who dont respond to levodopa -decrease EPS s/s associated with antipsychotic drug (reverse EPS)

What should the nurse include as key points when teaching a patient who is taking oxybutynin?

· Anticholinergic · CNS effects · Not great for glaucoma = make intraocular pressure increase · Constipation = increase fiber and fluids · Dry mouth = don't use alcohol-based rinses (drier), loosengens · Worried about Increase HR and BP, palpitations

Why would oxybutynin be prescribed for a patient with urinary urgency and frequency?

· Antispasmodic · Antagonist · Help relax the bladder · May have taken care of patients that have overactive bladder and have to void all the time, incontinence helps relax the muscles in the bladder and calm it down · Inhibit acetylcholine

How do the the parasympathetic and sympathetic nervous system responses differ?

· Counteract and balance for homeostasis o Sometimes this doesn't happen because 1 may override the other o Different medication effects · PNS = rest and digest, · SNS = increase BP, increase HR, see really well (dilate), bronchi dilate (breathe better)

Discuss differences between direct acting and Indirect acting.

· Direct acting: meds are not effected by the enzyme acetylcholinesterase, bind to R and mimic acetylcholine and not being destroyed by the enzyme · Indirect: inhibits the action of acetocholinesterase enzyme, natural binding of achetycholine, inhibitors

For which conditions is oxybutynin medication contraindicated?

· Glaucoma o Don't want pupils to dilate = increase IOP and detrimental to their glaucoma · Mycinogravis: further block the acetycholine · Don't chew it = cause immediate release and bolus of the medication

What are the high priority assessments/ interventions when administering the medication Bethanechol?

· I/O · HR/BP · Watch for parasympathetic activity · Aging adults would need this drug after surgery · Antidote: atropine

What medication should be administered to reverse a cholinergic crisis... and if given, what should be monitored?

· Low doses · At the same time · Medication alert bracelet - have this problem and are taking meds · Antidote on hand: atropine

What would the nurse evaluate to determine if the medication Levadopa/Carbidopa is having the desired effect?

• Increase in ability to perform ADLs • These are combined • Cabidopa: prevents further breakdown of the levodopa nad makes it stay around longer • Levodopa taken on its own dopamine and cannot cross the brain barrier • Carbidopa prevents from breaking down into dopamine until after the blood brain barrier

•What are the major education points that a nurse should discuss with a patient who is prescribed a barbiturate for seizure management?

•Don't abruptly stop (#1 reason for status eclipticus) •SJ syndrome (necrotic skin reaction) = monitor their skin •Long acting meds •Several weeks for it to be effective

What medication classification is commonly known as the "drug of choice" for treating depression and WHY?

•Drug of choice = SSRI because low risk side effects than MAOI and tricyclics

What is a common reason for non-compliance with this specific med classification?

•Sexual dysfunction (decreased libido) •Weight gain •Headaches, nausea •Need to use a barrier method because effects birth control

•What should the nurse include when providing education about this type of medication?

•Take it at night •No alc •Move slowly because orthostatic hypotension •Sedative effects wear off as take meds •Anticholinergic effects: fluids fiber, sugar losengens •Cardiac problems = need to be on cardiacmonitor, do gastric lavage for this patient