Pharmacology: Exam IV

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A 17-year-old client is taking phenytoin (Dilantin) for the treatment of seizures. Phenytoin blood level reveals to be 25 mcg/ml. Which of the following symptoms would be expected as a result of the laboratory result? A. No symptoms, because the value is within the normal range. B. Hyperactivity. C. Tremors. D. Nystagmus.

A 9-year-old child has been prescribed with lithium as a mood stabilizer. His lab results shows his lithium level of 1.5 mEq/L. The priority nursing diagnosis for this child should be: a. Activity Intolerance b. Risk for Aspiration c. Ineffective Therapeutic Regimen Management d. Disturbed Thought Process

A client diagnosed with bipolar disorder has been prescribed with lithium (carbonate) by his physician. Which question will help the nurse identify signs of early lithium toxicity? a. Have you been experiencing any nausea, vomiting or diarrhea? b. Do you have frequent headache? c. Have you been urinating excessively/frequently? d. Do you experience leg aches over the past few days?

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? a. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications b. Agranulocytosis and treat by administration of clozapine (Clozaril) c. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) d. Tardive dyskinesia and treat by discontinuing antipsychotic medications

b, e

A client is prescribed gabapentin. Which of the following statements by the client demonstrates to the nurse a need for further teaching? Select all that apply a. "I will wear a medical alert bracelet at all times." b. "Once my seizures stop I can stop taking this medication." c. "If I feel dizzy or drowsy, I will make sure to not drive." d. "I'll keep a journal that details my seizures." e. "I should take this medication on an empty stomach."

A client is prescribed with carbamazepine (Tegretol) for the treatment of bipolar disorder. Which of the following laboratory results indicates that the client is experiencing a side effect of this medication? A. Neutrophil count of 1,200/mm3. B. Platelet count of 160,000/mm3. C. Uric acid level of 4mg/dl. D. SGPT (ALT) level 50 units per liter of serum.

A client receiving lithium therapy for the treatment of his bipolar disorder has a lithium level of 0.85 mEq/L. The appropriate nursing action is: a. Notify the physician immediately b. Observe the client for signs of toxicity c. Record the laboratory result in the client's chart d. Hold the next dose of lithium

A client taking Tamsulosin returns to the outpatient department for a follow-up. Which of the following statements made by the client indicates the need for further assessment? a. "I get out of bed by sitting for a while first before standing up." b. "I always have my blood pressure taken by my niece who is taking up nursing." c. "Yesterday I was feeling tired and sleepy while driving to the laundromat." d. "I take this medication ever day at 10, 30 minutes after I have my breakfast."

A client under lithium medication reduce his dietary salt intake. Which of the following is expected to show in his blood work? a. Decreased lithium level b. Increased lithium level c. Increased then decrease in the next result of the lithium blood work d. No significant changes

A female client who has a history of seizures went to a healthcare facility to ask the nurse regarding the use of birth control pills while on phenytoin therapy. The nurse correctly states to the client that: A. Taking phenytoin decreases the effectiveness of birth control pills. B. Pregnancy is not allowed while taking phenytoin. C. There is no known interaction between these medicines so there is nothing to worry about. D. To discontinue phenytoin and proceed with the oral contraceptive.

A female patient arrives to the clinic for counseling on potential hormone replacement therapy. When taking the patient's history, which condition would the nurse consider as a contraindication to use of hormone replacement therapy for the patient? a. Osteoporosis b. Hyperlipidemia c. Thromboembolic events d. Early onset of menarche

b, e

A patient has been given a prescription for levodopa-carbidopa (Sinemet) for a new diagnosis of Parkinson's disease. The patient asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact(s). Select all that apply. a. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system. b. Carbidopa prevents the breakdown of levodopa in the periphery. c. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy. d. Carbidopa allows for larger doses of levodopa to be given. e. Carbidopa can treat nausea associated with Sinemet.

A patient taking oral contraceptives is being treated for a urinary tract infection with antibiotics. Which information should the nurse include as education related to the oral contraceptives? a. "Report any abdominal pain, blood in the urine, or changes in vision." b. "There is no drug interaction between oral contraceptives and antibiotics." c. "Use an alternative method of birth control for up to 1 month during and after antibiotic use." d. "Your sexual partner should use a nonprescription test kit that will detect a urinary tract infection."

A patient who has been taking carbidopa-levodopa for Parkinson's disease for over 1 year wants to start a low-carbohydrate, high-protein weight loss diet. The nurse tells the patient that this type of diet may have what effect on his drug therapy? a. "There will be no problems with this diet while on this medication." b. "The high-protein diet can slow or prevent absorption of this medication." c. "The high protein diet may cause increased blood levels of this medication." d. "The high-protein diet will cause no problems as long as the patient also takes pyridoxine (vitamin B6).

A patient who has been taking lithium for 5 years presents to the clinic with complaints of fatigue, cold intolerance, and weight gain. The nurse suspects the patient has developed which of the following complications associated with long-term lithium use? a. Addison's disease b. Diabetes c. Hypothyroidism d. Hyperthyroidism

A patient with Alzheimer's disease accidentally took 2 weeks' worth of a cholinergic medication. He is brought to the emergency department, is going into shock, and experiencing severe hypotension and vomiting. The nurse will expect which initial treatment? a. Administration of physostigmine b. Administration of atropine c. Administration of epinephrine d. Cardiovascular support with dopamine

Adverse effects of carbamazepine include, all EXCEPT a. Skin rashes b. Drowsiness c. Diplopia d. Hair loss

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? a. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) b. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication c. Dystonia and treat by administering trihexyphenidyl (Artane) d Dystonia and treat by administering bromocriptine (Parlodel)

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? a.Norepinephrine b. Acetylcholine c. Serotonin (5-HT) d. Gamma-aminobutyric acid (GABA)

Alprazolam is associated with which of the following symptoms? a. Diarrhea b. Diaphoresis c. Ataxia d. Lethargy

Serotonin Syndrome

An adverse effect associated with the use or concurrent use of serotoninergic agents like SSRIs and MAOIs. Symptoms Common: -Delirium -Agitation -Tachycardia -Sweating -Myoclonus -Hyperreflexia -Shivering -Coarse tremors -Extensor planta muscle responses ---------------- Severe: -Hyperthermia -Seizures -Rhabdomyolysis -Renal failure -Cardiac dysrhythmias -Disseminated intravascular coagulation

As a nurse, you must know the diseases that Tamsulosin treats: a. Hypertension b. Benign Prostatic Hyperplasia or BPH c. Raynaud's Disease d. Pheochromocytoma

flumazenil

Benzodiazepine antagonist; antidote for benzodiazepine overdose -May cause acute withdrawal syndrome (ex: seizures), especially with long-term benzodiazepine therapy

finasteride

CLASS: 5-alpha Reductase Inhibitors ------------------- MOA: inhibits 5-alpha reductase--> prevents thinning of hair caused by increased DHT and helps to reduce the size of the prostate which eases urine passage ------------------- INDICATIONS: -Benign prostate hyperplasia (high strength) -Male pattern baldness (low strength) -------------------- CONTRAINDICATIONS: -Women, especially pregnant women (wear gloves if handling) -Children -Caution: liver impairment, obstructive uropathy or obstruction within the urinary system -------------------- ADRs: -Reduced libido and ejaculate volume -Hypersensitivity reactions -Gynecomastia -Severe myopathy* -Hypotension -Dizziness -Drowsiness -50% decrease in PSA concentrations: encourage patients to screen for prostate cancer if this level does not decrease -------------------- INTERACTIONS: -No known interactions -------------------- IMPLICATIONS: -Perform baseline assessment for urinary patterns; pay attention to frequency, urgency, and flow with micturition -Use gloves when administering if a woman due to teratogenic effects -Monitor for adverse effects -Assess baseline sexual functioning and libido; inform patients about reductions in libido and ejaculation volume as a side effect -Can be given without regard to meals -Re-evaluate for BPH every 3-6 months -Expect PSA levels to decline; evaluate any increase in PSA as it can indicate prostate cancer or nonadherence to therapy -Monitor for gynecomastia and evaluate for body image concerns -------------------- EDUCATION: -Protect medication from heat and sun exposure -Women of childbearing age should not handle this drug especially when crushed and if pregnant; caregivers and female family members should wear gloves if handling -Full therapeutic effects may take up to 12 months -Therapy is usually life-long -Undergo regular prostate cancer screenings -Report breast enlargement to provider

Tamsulosin (Flomax)

CLASS: Alpha1-Adrenergic Blockers ------------------- MOA: antagonizes alpha-adrenergic receptors---> causes relaxation of smooth muscle in the prostate gland and the bladder outlet--> increases urine flow and decreases BPH symptoms ------------------- INDICATIONS: -Benign prostate hyperplasia -------------------- CONTRAINDICATIONS: -Concurrent use with erectile dysfunction drugs like sildenafil -Women and children -Caution: hypotension, renal impairment, history of syncope -------------------- ADRs: -Cardio: Tachycardia, hypotension, syncope -CNS: depression, drowsiness, dizziness, visual changes, headache -Dyspnea -Urinary frequency -Rash -Impotence -Retrograde ejaculation -------------------- INTERACTIONS: -Antihypertensives: additive hypotensive effects -Cimetidine: may worsen orthostatic hypotension -Azole antifungals, erythromycin, nefazodone, clarithromycin, propranolol, verapamil, protease inhibitors: increases effects of this drug -Sildenafil and other erectile dysfunction drugs: hypotension -------------------- IMPLICATIONS: -Assess presenting symptoms and obtain a complete history of past and present conditions -Assess and document the patient's urinary elimination patterns and difficulties -Perform rectal exam to palpate for prostate enlargement; anticipate a PSA test if enlargement exists; monitor PSA levels for baseline and comparative reasons -Monitor for headache and treat with mild analgesic -Monitor blood pressure and report significant changes in BP and HR to provider. -------------------- EDUCATION: -Take medication at the same time each day, 30 minutes after the same meal -Swallow tablets whole and DNC -Decreases in ejaculate volume and ejaculation failure may occur -Report headaches not relieved by mild OTC analgesics -Monitor BP regularly; change positions slowly -Report dizziness or fainting; do not engage in dangerous activities if this occurs or recurs -Drug therapy is for life

lithium

CLASS: Antimanics ------------------- MOA: alter sodium ion transport in nerve cells--> results in shift in catecholamine metabolism ------------------- THERAPEUTIC DRUG LEVELS: 1-1.5 mEq/L; maintenance: 0.6-1.2 mEq/L *levels exceeding 1.5-2.5 mEq/L produce toxicities (GI discomfort (vomiting)*, tremor* , significant hypotension, muscle weakness*, confusion*, somnolence*, seizures*, coma and possible death*) ------------------- INDICATIONS: -Bipolar disorder (mania) -------------------- CONTRAINDICATIONS: -Pregnancy; lactation -Dehydration -Hyponatremia*: ensure patient has proper sodium levels (135-145 mEq/L) to help maintain therapeutic levels -Concurrent diuretic use -Low-sodium diet -History of angioedema -Major renal or cardiovascular disease -Caution: diabetes, hx of thyroid or seizure disorders, urinary retention, suicidal ideation, older adults -------------------- ADRs: occur with toxic levels* -GI: discomfort -Tremors, muscle weakness -CNS: confusion, somnolence, seizures, drowsiness, slurred speech, ataxia, headache, memory impairment, transient fatigue -Cardiac dysrhythmias* -Choreoathetotic movements (wavelike movements of extremities) -Polyuria -Hypotension -Hypothyroidism with long-term use** -Levels exceeding 1.5-2.5 mEq/L produce toxicities (GI discomfort, vomiting, tremor, ECG changes, incoordination, blurred vision, , significant hypotension, confusion, somnolence, seizures, coma and possible death) -------------------- INTERACTIONS: -Thiazide diuretics, ACE inhibitors, NSAIDs, tetracyclines, methyldopa, probenecid: increased risk for toxicity -Haloperidol: increased risk for dyskinesias and urinary retention -------------------- IMPLICATIONS: -Monitor electrolyte levels, especially sodium-->toxicities are potentiated with hyponatremia and hypovolemia -Ensure adequate hydration status -Monitor drug levels (0.6-1.2 mEq/L); maintain below 1.0 mEq/L -Perform a neurological assessment prior to administration -Monitor vitals, especially BP, along with hydration status, dietary intake, skin tone, and presence of edema -Obtain baseline levels of consciousness and alertness, gait and mobility levels, and overall motor function -Assess serum drug levels every 3-4 days at beginning of therapy -Obtain urinalysis with specific gravity to assess volume status, as needed; monitor kidney function -Lower doses may be needed for older adults due to decreased drug metabolism; CNS toxicity, goiter, and hypothyroidism are more common with this population -Monitor thyroid hormone levels; monitor for s/s of hypothyroidism -Monitor for toxicities; early signs may include nausea and muscle weakness -------------------- EDUCATION: -Report excessive tremors, seizures, confusion, ataxia, and excessive sedation immediately to provider--> toxicity -Maintain adequate hydration (2-3L/day); avoid overhydration and dehydration -Do not drastically change sodium intake -Can be taken with meals or milk to prevent adverse GI effects; report if GI symptoms do not subside with food or beverages -Do not drive or perform hazardous tasks if drowsy -Avoid caffeine and stressors (tremors) -Report symptoms of hypothyroidism (fatigue, lethargy, cold intolerance)

Chlorpromazine (Thorazine)

CLASS: Antipsychotics ------------------- MOA: Block dopamine receptors postsynaptically in areas of the CNS like the limbic system and basal ganglia---> induces a tranquilizing effect in psychotic patients ------------------- INDICATIONS: -Schizophrenia (positive symptoms: hallucinations, delusions, disorganization; negative symptoms: apathy, social withdrawal, blunted effect, monotone speech, catatonia--> less effective with negative symptoms) -Tourette's syndrome -BPD -Depression resistant to other therapies -Intractable hiccups -Autism -Drug-induced psychoses -Severe refractory behavioral problems/hyperactivity -------------------- CONTRAINDICATIONS: -Hypersensitivity -Parkinson's disease (due to antagonistic dopamine effects) -Large doses of CNS depressants -Alcohol withdrawal -Myelosuppression -Pregnancy/lactation -Caution: COPD, glaucoma, diabetes, hypertension, prostatic hypertrophy; thyroid, cardiac, or liver disorders -------------------- ADRs: -Neuroleptic malignant syndrome: high fever (hyperpyrexia), unstable BP, myoglobinemia, loss of consciousness -CNS: tardive dyskinesia, extrapyramidal symptoms, akathisia (restlessness) confusion, headache, visual disturbances -GI: mild GI disturbance, dry mouth -Genitourinary: urinary retention -Endocrine: amenorrhea, gynecomastia, weight gain, sexual dysfunction (decreased libido, ED, inability to achieve orgasm) -Integumentary: rash, photosensitivity -Edema -Severe dysrhythmias -------------------- INTERACTIONS: -Alcohol, CNS depressants: additive sedative effects -Antacids, antidiarrheals (2 hours before or after): decrease absorption -Antiseizure medications: can decrease serum levels of antiseizure drugs -------------------- IMPLICATIONS: -Obtain baseline motor, sensory, and neurologic functioning prior to beginning therapy; monitor throughout -Monitor CBC -Treat akathisia with a beta blocker or benzodiazepine-->lower dosage or switch to low potency antipsychotic -Treat pseudoparkinsonism (extrapyramidal symptoms) with anti-Parkinson drugs -Acute dystonia: administer emergency IM or IV injection of anticholinergics like diphenhydramine -Tardive dyskinesia: stop antipsychotic and switch to an atypical antipsychotic drug -Monitor patient for anticholinergic effects -Encourage patient to take sips of water and suck on hard candy for dry mouth -Monitor I&O for urinary retention -Monitor bowel movements; encourage fluid intake and fiber, as tolerated -Monitor vitals, especially the pulse (take apically) -Monitor ECGs periodically -Monitor serum potassium levels -Wear gloves when handling to avoid dermatitis -Use cooling blanket, administer aspirin or acetaminophen for fever, and maintain hydration while administering IV dantrolene and bromocriptine with neuroleptic syndrome -Give with 8 oz of water or food to prevent GI effects -Keep patients recumbent for 30 minutes after an IM or IV dose due to hypotensive effects -Check compatibility before mixing with other IV drugs; do not administer bolus IV no faster than 1 mL/min -Monitor weight -Monitor for declines in mental health/suicidal ideations -------------------- EDUCATION: -Change positions slowly -Do not abruptly discontinue -Minimize suicide attempts by dispensing small amounts of medication at a time -Avoid concurrent use with alcohol and other CNS depressants -Avoid antacids or antidiarrheal preparations within 1 hour of a dose* -Report tremors, nausea, vomiting, uncontrollable shaking of small muscle/facial groups to provider** -Chew on gum or suck on hard candy for dry mouth -Increase fluid and fiber intake for constipation -Urinate just before taking the drug -Report decreased libido, erectile dysfunction, or the inability to orgasm -Report palpitations, fainting spells, and other cardiac symptoms immediately -Immediately report sudden fevers -Wear sunscreen, sunglasses, and protective clothing when outside* -Take medication with food or 8 oz water to minimize GI effects -Monitor weight -Immediately report feelings of suicide and other mental health issues

haloperidol (Haldol)

CLASS: Antipsychotics (first-gen) ------------------- MOA: Block dopamine receptors postsynaptically in areas of the CNS like the limbic system and basal ganglia---> induces a tranquilizing effect in psychotic patients ------------------- INDICATIONS: -Schizophrenia (positive symptoms: hallucinations, delusions, disorganization; negative symptoms: apathy, social withdrawal, blunted effect, monotone speech, catatonia--> less effective with negative symptoms) -Tourette's syndrome -BPD -Depression resistant to other therapies -Intractable hiccups -Autism -Drug-induced psychoses -Severe refractory behavioral problems/hyperactivity -------------------- CONTRAINDICATIONS: -Hypersensitivity -Parkinson's disease (due to antagonistic dopamine effects) -Large doses of CNS depressants -Alcohol withdrawal -Myelosuppression -Pregnancy/lactation -Caution: COPD, glaucoma, diabetes, hypertension, prostatic hypertrophy; thyroid, cardiac, or liver disorders -------------------- ADRs: -Neuroleptic malignant syndrome: high fever (hyperpyrexia), unstable BP, myoglobinemia, loss of consciousness -CNS: tardive dyskinesia, extrapyramidal symptoms, akathisia (restlessness) confusion, headache, visual disturbances -GI: mild GI disturbance, dry mouth -Genitourinary: urinary retention -Endocrine: amenorrhea, gynecomastia, weight gain, sexual dysfunction (decreased libido, ED, inability to achieve orgasm) -Integumentary: rash, photosensitivity -Edema -Severe dysrhythmias -Agranulocytosis and hemolytic anemia -------------------- INTERACTIONS: -Alcohol, CNS depressants: additive sedative effects -Antacids, antidiarrheals (2 hours before or after): decrease absorption -Antiseizure medications: can decrease serum levels of antiseizure drugs -------------------- IMPLICATIONS: -Obtain baseline motor, sensory, and neurologic functioning prior to beginning therapy; monitor throughout -Monitor CBC -Treat akathisia with a beta blocker or benzodiazepine-->lower dosage or switch to low potency antipsychotic -Treat pseudoparkinsonism (extrapyramidal symptoms) with anti-Parkinson drugs -Acute dystonia: administer emergency IM or IV injection of anticholinergics like diphenhydramine -Tardive dyskinesia: stop antipsychotic and switch to an atypical antipsychotic drug -Monitor patient for anticholinergic effects -Encourage patient to take sips of water and suck on hard candy for dry mouth -Monitor I&O for urinary retention -Monitor bowel movements; encourage fluid intake and fiber, as tolerated -Monitor vitals, especially the pulse (take apically) -Monitor ECGs periodically -Monitor serum potassium levels -Wear gloves when handling to avoid dermatitis -Use cooling blanket, administer aspirin or acetaminophen for fever, and maintain hydration while administering IV dantrolene and bromocriptine with neuroleptic syndrome -Give with 8 oz of water or food to prevent GI effects -Keep patients recumbent for 30 minutes after an IM or IV dose due to hypotensive effects -Check compatibility before mixing with other IV drugs; do not administer bolus IV no faster than 1 mL/min -Monitor weight -Monitor for declines in mental health/suicidal ideations -------------------- EDUCATION: -Change positions slowly -Do not abruptly discontinue -Minimize suicide attempts by dispensing small amounts of medication at a time -Avoid concurrent use with alcohol and other CNS depressants -Avoid antacids or antidiarrheal preparations within 1 hour of a dose* -Report tremors, nausea, vomiting, uncontrollable shaking of small muscle/facial groups to provider** -Chew on gum or suck on hard candy for dry mouth -Increase fluid and fiber intake for constipation -Urinate just before taking the drug -Report decreased libido, erectile dysfunction, or the inability to orgasm -Report palpitations, fainting spells, and other cardiac symptoms immediately -Immediately report sudden fevers -Wear sunscreen, sunglasses, and protective clothing when outside* -Take medication with food or 8 oz water to minimize GI effects -Monitor weight -Immediately report feelings of suicide and other mental health issues

Diazepam (Valium)

CLASS: Benzodiazepines ------------------- MOA: increase action of GABA (inhibitory neurotransmitter that blocks nerve transmission in the CNS)--> depresses activity in the brainstem and limbic system---> reduce anxiety ------------------- INDICATIONS: -Anxiety* -Ethanol (alcohol) withdrawal -Insomnia -Muscle spasms -Management of seizure disorders/status epilepticus -Adjunct anesthesia treatment -Adjunct treatment for depression -------------------- CONTRAINDICATIONS: -Hypersensitivity -Narrow-angle glaucoma -Pregnancy* -Hepatic compromise*: can accumulate in those with hepatic impairment -------------------- ADRs: -Confusion* -Slurred speech* -*CNS depression, sedation* -Hypotension* -Tachycardia -Drowsiness, lethargy loss of coordination, dizziness, headache* -GI: nausea, vomiting, dry mouth, constipation -Paradoxical effects (hyperactivity, anxiety, aggression): more likely to occur in children, adolescents, and older adults with dementia -Rebound disinhibition: marked sedation for 1-2 hours following by mark agitation and confusion for several hours; occurs especially in older adults who are tapering their dose or discontinuing benzodiazepine therapy -Addiction--> use lowest effective dose -Sedation, especially with older adults -Toxicity: overdose most likely when taken in conjunction with alcohol and other CNS depressants--> s/s include somnolence, confusion, coma, and respiratory depression--> flumazenil is the antidote -------------------- INTERACTIONS: -Alcohol, CNS depressants: additive CNS depression, death -Oral contraceptives, azole antifungals, SSRIs, verapamil, diltiazem, opioids, valproic acid: impaired hepatic elimination--> enhances benzodiazepine effects like CNS depression -Rifampin: enhances benzodiazepine clearance--> reduces therapeutic effects -Theophylline: antagonistic effects--> reduced sedative effects -Phenytoin: reduced clearance--> toxicity -------------------- IMPLICATIONS: -Frequently monitor vitals with special attention to BP -Encourage use of elastic compression stockings and changing positions slowly -Create a therapeutic environment for open communication, especially for thoughts of suicide and other disturbing thoughts -Check patient's oral cavity for hoarding or cheeking of drugs -Monitor for adverse effects like hypotension, lethargy, fatigue, drowsiness, and confusion -Assess for seizures and preoperative sedation as this is one of the main uses for this drug -Closely observe older adults for oversedation and profound CNS depression -Obtain baseline visual testing using a Snellen chart or eye exam -Obese patients may experience toxicity in a shorter period of time since these drugs are lipid soluble and have a greater affinity for fatty tissues -Double and triple check labels and many drugs in this class sound similar to other drugs -Administer flumazenil with toxicity -------------------- EDUCATION: -Take as directed; do not discontinue abruptly -Report thoughts of suicide and other changes in mental health immediately -Avoid operating heavy machinery and driving until ADRs have resolved -Educate about tolerance to sedative properties -Do not take other medications without consulting your provider -Keep out of reach of children -Avoid concurrent use with alcohol and other CNS depressants -Wear medical alert bracelet -Update drug list every 3 months on medical alert bracelet -Taper dose

Alprazolam (Xanax)

CLASS: Benzodiazepines ------------------- MOA: increase action of GABA (inhibitory neurotransmitter that blocks nerve transmission in the CNS)--> depresses activity in the brainstem and limbic system---> reduce anxiety ------------------- INDICATIONS: -Anxiety, especially generalized anxiety disorder (GAD) -Panic disorder -Anxiety associated with depression -Ethanol (alcohol) withdrawal -Insomnia -Muscle spasms -Management of seizure disorders/status epilepticus -Adjunct anesthesia treatment -Adjunct treatment for depression -------------------- CONTRAINDICATIONS: -Hypersensitivity -Narrow-angle glaucoma -Pregnancy* -Hepatic compromise*: can accumulate in those with hepatic impairment -------------------- ADRs: -Confusion* -Ataxia* -*CNS depression, sedation* -Hypotension* -Tachycardia -Drowsiness, lethargy loss of coordination, dizziness, headache* -GI: nausea, vomiting, dry mouth, constipation -Paradoxical effects (hyperactivity, anxiety, aggression): more likely to occur in children, adolescents, and older adults with dementia -Rebound disinhibition: marked sedation for 1-2 hours following by mark agitation and confusion for several hours; occurs especially in older adults who are tapering their dose or discontinuing benzodiazepine therapy -Addiction--> use lowest effective dose -Sedation, especially with older adults -Toxicity: overdose most likely when taken in conjunction with alcohol and other CNS depressants--> s/s include somnolence, confusion, coma, and respiratory depression--> flumazenil is the antidote -------------------- INTERACTIONS: -Alcohol, CNS depressants: additive CNS depression, death -Oral contraceptives, azole antifungals, SSRIs, verapamil, diltiazem, opioids, valproic acid: impaired hepatic elimination--> enhances benzodiazepine effects like CNS depression -Rifampin: enhances benzodiazepine clearance--> reduces therapeutic effects -Theophylline: antagonistic effects--> reduced sedative effects -Phenytoin: reduced clearance--> toxicity -------------------- IMPLICATIONS: -Frequently monitor vitals with special attention to BP -Encourage use of elastic compression stockings and changing positions slowly -Create a therapeutic environment for open communication, especially for thoughts of suicide and other disturbing thoughts -Check patient's oral cavity for hoarding or cheeking of drugs -Monitor for adverse effects like hypotension, lethargy, fatigue, drowsiness, and confusion -Closely observe older adults for oversedation and profound CNS depression -Obtain baseline visual testing using a Snellen chart or eye exam -Obese patients may experience toxicity in a shorter period of time since these drugs are lipid soluble and have a greater affinity for fatty tissues -Double and triple check labels and many drugs in this class sound similar to other drugs -Administer flumazenil with toxicity -------------------- EDUCATION: -Take as directed; do not discontinue abruptly -Report thoughts of suicide and other changes in mental health immediately -Avoid operating heavy machinery and driving until ADRs have resolved -Educate about tolerance to sedative properties -Do not take other medications without consulting your provider -Keep out of reach of children -Avoid concurrent use with alcohol and other CNS depressants -Wear medical alert bracelet -Update drug list every 3 months on medical alert bracelet -Taper dose

oral contraceptives

CLASS: Contraceptives ------------------- MOA: prevent ovulation by inhibiting the release of gonadotropins and by increasing uterine mucous viscosity--->decreases sperm movement and fertilization, as well as the implantation of a fertilized egg -improve menstrual cycle regularity -decrease blood loss during menstruation -decrease incidence of functional ovarian cysts and ectopic pregnancies ------------------- INDICATIONS: -Pregnancy prevention -Endometriosis -Hypermenorrhea -Producing cyclic withdrawal bleeding in those with amenorrhea -Postcoital emergency contraception (within 72 hours, and then a 12 hour follow-up after the first dose) -------------------- CONTRAINDICATIONS: -Know drug allergy -Breast and endometrial cancer -Pregnancy -Active thromboembolic disorder or history* -------------------- ADRs: -Thrombolytic events like PE , MI, and DVT* -CNS: headache, dizziness, migraines, depression, stroke -Cardiovascular: hypertension, edema, thromboembolism, pulmonary embolism, myocardial infarction -GI: nausea, vomiting, diarrhea, anorexia, cramps, constipation, weight gain, increased appetite -Photosensitivity, chloasma -Genitourinary: amenorrhea, cervical erosion, breakthrough uterine bleeding, tender breasts/breast changes -Alterations in carbohydrate and lipid metabolism -Increases in serum hormone concentrations -Alterations in serum metal and plasma protein levels -Endometrial cancer, cardiovascular disease, breast cancer, and dementia are serious adverse effects -------------------- INTERACTIONS: -Oral anticoagulants:, warfarin, tricyclic antidepressants, antidiabetic drugs, anticonvulsants, theophylline, vitamins, and beta blockers: can reduce effectiveness of these drugs -Antibiotics (especially penicillins and cephalosporins), barbiturates, isoniazid, rifampin, St. John's wort: decrease effectiveness --> use backup birth control for at least 1 month during and after drug therapy -Smoking: increased risk for clots -------------------- IMPLICATIONS: -Perform a pregnancy test prior to therapy -Assess for history of vascular and/or -------------------- EDUCATION: -Report hypertension, edema, thromboembolic events, migraines, depression, and breakthrough bleeding or changes in menstrual flow -Perform monthly breast exams 7-10 days after the start of menstruation or 2-5 days after the menses end; have follow-up appointments -Avoid sunlight and tanning beds; use sunscreen at all times

levodopa/carbidopa (Sinemet)

CLASS: Dopamine replacement drugs ---------------------- MOA: cross the blood-brain barrier-->taken up by the remaining dopaminergic neurons in substantia nigra--> converts to dopamine which is available for use -Carbidopa prevents breakdown of levodopa in the periphery, allowing for more of it to cross the blood-brain barrier -Gets more difficult to control PD as the disease progresses (5-10 years after initiation of therapy ----------------------- INDICATIONS: -Parkinson's disease (increases "on" time and decreases "off" time) ----------------------- CONTRAINDICATIONS: -Angle-closure glaucoma -History of melanoma, psychosis, or suicidal thoughts -Caution: older adults, renal, hepatic, respiratory, or endocrine disorders; wide-angle glaucoma, peptic ulcer disease, depression, bipolar disorder ----------------------- ADRS: -Nausea, vomiting -Orthostatic hypotension -Dark sweat and urine -Dyskinesias (movement disorders; common at initial phase of treatment) -Chorea -Cardiac dysrhythmias -GI distress -Muscle cramps ------------------------ INTERACTIONS: -Dietary protein: can slow or prevent drug absorption -Pyridoxine (vitamin B6): reduces drug effectiveness -Nonselective MAOIs: additive toxicity--> hypertensive reactions -Benzodiazepines, antipsychotics: reduces therapeutic effects ------------------------ IMPLICATIONS: -Obtain baseline vitals and labs -Monitor for adverse effects (ataxia, depression) -Assess vitals with supine and standing blood pressure, height, weight, medication and medical history, and nursing history -Assess motor skills -Assess for presence of TRAP (tremors, rigidity, akinesia, bradykinesia, postural instability); also look for staggering gait and drooling -Assess for changes in urinary patterns due to drug-induced urinary retention -Monitor liver and renal studies -Fall precautions: assist patient if dizziness or syncope occur; instill fall prevention tactics -Give medication several hours before bedtime to prevent insomnia ------------------------ EDUCATION: -Taken on an empty stomach, ideally, but can be taken with food to minimize GI effects* -Use portion control with proteins (size of a deck of cards) and take drug 30 minutes before eating protein or 1 hour after; emphasize eating protein later in the day or in small amounts over the course of a day* -Increase fluid intake to 3000 mL/day if not contraindicated; encourage fiber-rich foods -Avoid switching drug brands without consulting provider, especially during later stages of the disease -Report abnormal contractions of the head, neck, or trunk as well as syncope, falls, itching, and/or jaundice immediately -Take exactly as ordered -Avoid alcohol, OTC drugs, and herbals unless approved by provider -Notify provider if you have missed a dose and await further instruction -DNC sustained-release forms -Report changes in vision, decline in mental alertness, confusion, or lethargy, as well as difficulty urinating, dysrhythmias, or severe, uncontrolled movements of the limbs -Encourage aerobic exercise; can help the patient feel better mentally and physically -Fall risk reduction: shower and tub grab-bars, adequate lighting, removing/securing loose rugs

St. John's Wort

CLASS: Herbal therapies ------------------- INDICATIONS: -Depression -Anxiety -Sleep disorders -Nervousness -------------------- CONTRAINDICATIONS: -Bipolar disorder -Schizophrenia -Alzheimer's disease -------------------- ADRs: -GI upset -Hypersensitivity reactions -Fatigue -Dizziness -Confusion -Dry mouth -Photosensitivity -------------------- INTERACTIONS: -MAOIS -SSRIs -Tricyclic antidepressants -Benzodiazepines -Phenytoin -Valproic acid -Phenobarbital -Zolpidem and other hypnotic drugs -Cyclosporine and other immunosuppressants -Theophylline -Warfarin -Triptans -Dextromethorphan -Loratadine -Cetirizine -Fexofenadine -HIV drugs -Oral contraceptives

Sildenafil (Viagra)

CLASS: PDE-5 Inhibitors ------------------- MOA: inhibits PDE-5, which relaxes the smooth muscle in the corpora cavernosa--> permits inflow of blood which helps sustain an erection. ------------------- INDICATIONS: -Erectile dysfunction -Pulmonary hypertension -------------------- CONTRAINDICATIONS: -Nitroglycerin use -Children -Caution: cardiovascular events in the last 6 months like MIs, CVAs, and fatal dysrhythmias, unstable angina, heart failure, hepatic or renal disease -------------------- ADRs: -Priapism: erection lasting longer than 4 hours--> can lead to permanent tissue damage and impotence -Headache -Flushing -Dyspepsia -Hypotension, especially with nitrates* -Fainting, dizziness -Sudden hearing or vision loss -------------------- INTERACTIONS: -Nitroglycerin and other nitrates/isosorbide nitrates: severe hypotension with concurrent use* -CYP3A4 inhibitors like grapefruit juice, ketoconazole, erythromycin, itraconazole, and cimetidine: increase plasma levels -Alpha adrenergic antagonists like doxazosin, drugs that treat BPH: orthostatic hypotension can occur -Rifampin: can decrease drug levels -------------------- IMPLICATIONS: -Priapism education; treatment involves aspirating blood from the corpus cavernosum and irrigating with a vasoconstrictor -Monitor for headache, hypotension, hearing loss, and vision changes -------------------- EDUCATION: -Take 1 hour orally before sexual activity; limit to once a day -Can be taken with or without food; high-fat foods can delay effects and reduce peak effects -Effects can last up to 4 hours -Do not take within 24 hours of receiving nitrates for chest pain; avoid if possible -Report headache, dizziness, and fainting to provider -Immediately seek medical care for an erection lasting longer than 4 hours -Take OTC analgesics to relieve headache -Monitor blood pressure regularly -Discontinue if experiencing hearing or vision loss; notify provider

gabapentin (Neurontin)

CLASS: anticonvulsants ---------------------- MOA: increases the synthesis and synaptic accumulation of GABA between neurons ----------------------- INDICATIONS: -Partial seizures -Neuropathic pain (most common use)* -New-onset epilepsy ----------------------- CONTRAINDICATIONS: -Known drug allergy ----------------------- ADRS: -CNS effects: dizziness, drowsiness, visual and speech changes -GI: nausea -Edema ------------------------ INTERACTIONS: -Alcohol and other CNS depressants: additive CNS depression effects ------------------------ IMPLICATIONS: -Provide a thorough neurological assessment with attention to baseline energy levels, visual intactness, sensory and motor functioning, and any changes in speech -Understand the rationale for this drug's use so that appropriate education can be shared with the patient -Provide a thorough physical assessment -Obtain a comprehensive health and medication history -Assess the patient for seizures and note the occurrence of an aura, precipitating events, location of symptoms, duration, frequency, and intensity. -Assess patient status before, during, and after a seizure -Question the patient about the occurrence of panic attacks--> can precipitate seizures -Assess patient for ANS responses associate with anxiety or stress like cold, clammy hands, diaphoresis, agitation, and trembling of the extremities -Assess CNS functioning before administration (deep tendon reflexes, upper and lower extremity sensory and motor testing, headaches, photosensitivity, auras, or visual changes) -Review lab results: CBC, clotting studies, hepatic and renal studies -Assess for urinary output of at least 30 mL/hr and urine specific gravity -Assess for conditions other than epilepsy or seizure disorders like syncope, transient ischemic attacks, drug use, metabolic disorders, infections, head trauma, tumors, and psychogenic problems; EEG may be ordered as well as an MRI -Taper dosage when discontinuing for at least 1 week to avoid rebound seizures ------------------------ EDUCATION: -Do not drive until a steady state is achieved or until instructed by provider -Report any suicidal thoughts or ideas immediately -Do not discontinue abruptly -Take with food and/or 6-8 oz of fluid to help minimize GI upset unless otherwise noted -Adhere to medication regimen and that recurrence of seizure activity is usually because of lack of adherence -Therapy is lifelong -Safety measures: electric stove with no open flame, oven mitts, cook on rear burners; cook in microwave whenever possible; have heat-controlled faucets installed; carpet floors to help cushion falls; use plastic dishes and containers instead of glassware whenever possible; do not put a lock on the bathroom door; bathe with only a few inches of water and bathe with someone present in the home; have someone with you when engaging in sports, use a helmet -Wear medical alert bracelet -Keep daily journal of symptoms, triggers, and duration, location, and occurrence of seizure activity

carbamazepine (Tegretol)

CLASS: anticonvulsants ---------------------- MOA: inhibit the influx of sodium through sodium channels---> decrease the discharge of neurons around areas of increased activity ----------------------- INDICATIONS: -Partial and generalized tonic-clonic seizures -Mood stabilizer (bipolar disorder) -Trigeminal neuralgia (reduces pain) ----------------------- CONTRAINDICATIONS: -Pregnancy -Treatment of absence and myoclonic seizures -Hematologic disorders -Heart failure -Myelosuppression -Known drug allergy -Caution: cardiac or hepatic disease, positive HLA-B*1502 gene, alcoholism ----------------------- ADRS: -GI: nausea, abdominal pain, GI upset -CNS: headache, dizziness, nystagmus, visual changes, behavioral changes, abnormal gait -Fluid retention -Skin: rash, Stevens-Johnson, epidermal necrolysis--> discontinue; photosensitivity -Myelosuppression ------------------------ INTERACTIONS: -Grapefruit juice, pomegranate juice: increases plasma levels -Azole antifungals, diltiazem, isoniazid, macrolides, protease inhibitors, antiretrovirals, SSRIs, valproic acid, verapamil: increase drug levels---> toxicity -Barbiturates, hydantoins, rifampin, succinimides, theophylline: reduce levels and efficacy -Acetaminophen: increased hepatic metabolism of acetaminophen and toxicity risk; reduce efficacy -Antipsychotics, antidepressants, benzodiazepines, cyclosporine, oral contraceptives: reduce efficacy--> monitor patient response -MAOIs: increased risk for MAOI toxicity ------------------------ IMPLICATIONS: -Begin with low dose, gradually increase to prevent CNS effects -Split dose; larger dose at bedtime to minimize side effects -Monitor WBC and CBC throughout therapy; withhold for values below the expected range and notify provider -Test patients of Asian descent for HLA-B*1502 gene before therapy (increased risk for severe skin reactions) -Protect from sun exposure -Administer with meals to reduce gastric upset -Give oral suspensions separately from other oral drug suspensions -Monitor serum levels to avoid recurrence of seizure activity -Give drug with sip of water if patient is NPO prior to surgery -Document baseline vision testing -Pay attention to potential interactions with other medications that have myelosuppressive effects -During seizure activity, provide safety measures and secure the patient's ABCs; airway maintenance is especially important because the tongue can fall back and block the airway; use chin lift and jaw thrust method, provide rescue breathing if patient is not breathing at a rate of 1 breath every 5 seconds -Maintain seizure precautions (side-lying position, bed rails up, lowest bed position, padding); ensure quick access to oxygen and suctioning equipment at all times -Administer at same time each day; administer with 6-8 oz of water and with food or meals to minimize GI effects -Avoid citrus juices like grapefruit and pomegranate juice with this drug*--> can increase toxicity ------------------------ EDUCATION: -Monitor for CNS effects like visual disturbances or incoordination; do not drive and instill fall precautions if these occur -Monitor for lower than expected drug levels because of autoinduction of hepatic enzymes -Report skin rashes immediately -Report decreased urine output, edema, or shortness of breath to prevent further development of heart failure -Wear sunscreen and protective clothing when out in the sun -Report fever, sore throat, and easy bruising to provider -Avoid grapefruit juice and other citrus juices as well as pomegranate juice -Do not drive until a steady state is achieved or until instructed by provider -Report any suicidal thoughts or ideas immediately -Do not discontinue abruptly -Take with food and/or 6-8 oz of fluid to help minimize GI upset unless otherwise noted -Adhere to medication regimen and that recurrence of seizure activity is usually because of lack of adherence -Therapy is lifelong -Safety measures: electric stove with no open flame, oven mitts, cook on rear burners; cook in microwave whenever possible; have heat-controlled faucets installed; carpet floors to help cushion falls; use plastic dishes and containers instead of glassware whenever possible; do not put a lock on the bathroom door; bathe with only a few inches of water and bathe with someone present in the home; have someone with you when engaging in sports, use a helmet -Wear medical alert bracelet -Keep daily journal of symptoms, triggers, and duration, location, and occurrence of seizure activity

donepezil (Aricept)

CLASS: cholinesterase inhibitors ---------------------- MOA: inhibits acetylcholinesterase--> increases available acetylcholine at receptor sites---> can provide modest improvements in cognitive function ----------------------- INDICATIONS: -mild-moderate Alzheimer's disease ----------------------- CONTRAINDICATIONS: -Know drug allergy -GI bleed history -Caution: cardiac, GI, or pulmonary disorders; hyperthyroidism; seizure history ----------------------- ADRS: -GI: GI upset, ulcer risk, GI bleeding, nausea -CNS: drowsiness, dizziness, insomnia, headache -Musculoskeletal: muscle cramps -Cardiovascular: bradycardia with reflex tachycardia-->syncope*, loss of consciousness, hypotension*, hypertension -Spread doses evenly to optimize effects -SLUDGE: ------------------------ INTERACTIONS: -Anticholinergics, antihistamines: decrease therapeutic effects -NSAIDs: increased risk for GI bleeding ------------------------ IMPLICATIONS: -Monitor patient for dizziness and gait imbalances--> fall precautions -Assess BP and heart rate before, during, and after administration; monitor vitals and ECG throughout therapy -Monitor for SLUDGE: salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, and emesis--> early signs of cholinergic crisis; other signs include flushing, nausea and vomiting, syncope, transient complete heart block, dyspnea, and orthostatic hypotension -Administer atropine in early phase of cholinergic crisis -Administer epinephrine with severe cardiovascular reactions or bronchoconstriction ------------------------ EDUCATION: -Take exactly as ordered; Do not adjust dosage unless directed -Therapeutic effects may not occur for up to 6 weeks -Take with food to decrease GI upset -Do not discontinue abruptly; taper dose -Keep journal detailing daily recording of drug dosing, level of independence with ADLs, motor ability, gait, mental status, cognition, and any adverse effects

estrogen

CLASS: estrogen replacement ------------------- MOA: bind to estrogen receptors on estrogen-responsive tissues (female genitals, breasts, pituitary gland, and hypothalamus) -------------------- INDICATIONS: -Vasomotor symptoms of menopause -Vaginal atrophy -Hypogonadism -Oral contraception (with progestin)* -Ovarian failure or castration -Uterine bleeding -Breast or prostate cancer (palliative treatment for advanced cases) -Osteoporosis (treatment and prophylaxis)* -------------------- CONTRAINDICATIONS: -Know drug allergy -Breast and endometrial cancer -Pregnancy -Undiagnosed abnormal vaginal bleeding -Active thromboembolic disorder or history* -------------------- ADRs: -Thrombolytic events like PE , MI, and DVT* -Cardiovascular: hypertension, edema, thromboembolism, pulmonary embolism, myocardial infarction, thrombophlebitis -GI: nausea, vomiting, diarrhea, constipation, abdominal pain -Dermatologic: photosensitivity, chloasma, hirsutism, alopecia -Genitourinary: amenorrhea, breakthrough uterine bleeding -Tender breasts -Fluid retention -Headache -Increased risk for endometrial hyperplasia--> can develop into endometrial cancer (progestin reduces this risk) -------------------- INTERACTIONS: -Oral anticoagulants, tricyclic antidepressants, antidiabetic drugs, anticonvulsants, theophylline, vitamins, and beta blockers: can reduce effectiveness of these drugs -Rifampin: decrease effectiveness of rifampin -Rifampin, St. John's wort: decrease effectiveness -Smoking: increased risk for clots and decreases estrogenic effect -------------------- IMPLICATIONS: -Only administer once the following conditions have been ruled out: estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, active thromboembolic disorders (or history) -Use smallest dose possible -Question about breast self-examination practices and the dates of their last complete exam as well as with Pap smears -Assess for potential drug interactions like with tricyclic antidepressants (toxicities) -Advise patient to avoid smoking as it can reduce the therapies effectiveness and increase the patient's risk for thromboembolic events; assess smoking history -Thoroughly assess for history or diagnosis of endometrial or breast cancer -Monitor bone density with therapy discontinuation -Monitor for adverse effects such as hypertension, thromboembolism, edema, amenorrhea, vomiting, chloasma (facial discoloration), hirsutism, breast tenderness, and headache -Provide precise and thorough instructions to patients when a self-administration hormone is ordered -Give at the same time every day -Understand the indication and rationale for this hormone's use so that accurate facts can be provided to the patient -Assess patient's knowledge base and level of understanding for therapy use -------------------- EDUCATION: -Avoid smoking -Take at the same time each day -May be taken with meals or a snack to decrease GI upset -Understand reasoning behind therapy use -Report hypertension, severe headaches with changes in vision or vomiting, abdominal pain, and edema -Expected adverse effects include: nausea, diarrhea/constipation, breakthrough uterine bleeding, chloasma (facial discoloration), upset stomach, dizziness, hirsutism, tender breasts, and headache -Report weight gain of 2 lbs or more in 24 hours or more than 5 lbs in a week -Perform monthly breast exams 7-10 days after the start of menstruation or 2-5 days after the menses end; have follow-up appointments for Pap smears and breast exams -Wear sunscreen -If using the patch, apply as ordered; usually applied once or twice weekly to the lower abdomen, NOT the breast or chest.

menopausal hormone therapy (MHT)

CLASS: hormone replacement therapy ------------------- MOA: binds to estrogen receptors in target tissues (genitals, breasts, hypothalamus, pituitary)--> maintains reproductive function and feminization and helps treat vasomotor symptoms of menopause ------------------- INDICATIONS: -Menopause -------------------- INDICATIONS: -Vasomotor symptoms of menopause -Vaginal atrophy -Hypogonadism -Ovarian failure or castration -Uterine bleeding -Breast or prostate cancer (palliative treatment for advanced cases) -Osteoporosis (treatment and prophylaxis)* -------------------- CONTRAINDICATIONS: -Know drug allergy -Breast and endometrial cancer -Pregnancy -Undiagnosed abnormal vaginal bleeding -Active thromboembolic disorder or history* -------------------- ADRs: -Thrombolytic events like PE , MI, and DVT* -Cardiovascular: hypertension, edema, thromboembolism, pulmonary embolism, myocardial infarction, thrombophlebitis -GI: nausea, vomiting, diarrhea, constipation, abdominal pain -Dermatologic: photosensitivity, chloasma, hirsutism, alopecia -Genitourinary: amenorrhea, breakthrough uterine bleeding -Tender breasts -Fluid retention -Headache -Increased risk for endometrial hyperplasia--> can develop into endometrial cancer (progestin reduces this risk)* -------------------- INTERACTIONS: -Oral anticoagulants, tricyclic antidepressants, antidiabetic drugs, anticonvulsants, theophylline, vitamins, and beta blockers: can reduce effectiveness of these drugs -Rifampin: decrease effectiveness of rifampin -Rifampin, St. John's wort: decrease effectiveness -Smoking: increased risk for clots and decreases estrogenic effect --------------------- IMPLICATIONS: -Recommendations support the initiation of hormone replacement therapy (HRT) around the time of menopause to treat menopause-related symptoms but not for the prevention of certain disorders, such as osteoporosis or fractures.* -Only administer once the following conditions have been ruled out: estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, active thromboembolic disorders (or history) -Question about breast self-examination practices and the dates of their last complete exam as well as with Pap smears -Assess for potential drug interactions like with tricyclic antidepressants (toxicities) -Advise patient to avoid smoking as it can reduce the therapies effectiveness and increase the patient's risk for thromboembolic events; assess smoking history -Thoroughly assess for history or diagnosis of endometrial or breast cancer -Monitor bone density with therapy discontinuation -Monitor for adverse effects such as hypertension, thromboembolism, edema, amenorrhea, vomiting, chloasma (facial discoloration), hirsutism, breast tenderness, and headache -Provide precise and thorough instructions to patients when a self-administration hormone is ordered -Give at the same time every day -Understand the indication and rationale for this hormone's use so that accurate facts can be provided to the patient -Assess patient's knowledge base and level of understanding for therapy use; encourage open discussion of questions and concerns -------------------- EDUCATION: Avoid smoking -Take at the same time each day -May be taken with meals or a snack to decrease GI upset -Understand reasoning behind therapy use -Report hypertension, severe headaches with changes in vision or vomiting, abdominal pain, and edema -Expected adverse effects include: nausea, diarrhea/constipation, breakthrough uterine bleeding, chloasma (facial discoloration), upset stomach, dizziness, hirsutism, tender breasts, and headache -Report weight gain of 2 lbs or more in 24 hours or more than 5 lbs in a week -Perform monthly breast exams 7-10 days after the start of menstruation or 2-5 days after the menses end; have follow-up appointments

phenytoin (Dilantin)

CLASS: hydantoins; anticonvulsants ---------------------- MOA: inhibit the influx of sodium through sodium channels---> decreases neuronal activity of seizure-generating cells ----------------------- INDICATIONS: -Tonic-clonic seizures -Partial seizures ----------------------- CONTRAINDICATIONS: -Pregnancy; lactation -Skin rash -Bradycardia; Heart block -Hypersensitivity -Hypoglycemic seizures -Caution: liver or kidney disease, cardiac dysfunction, diabetes, respiratory dysfunction; older adults, debilitated patients, and those with alcoholism should be monitored (high risk of toxicity) -Monitor patients with low albumin as phenytoin is a protein bound drug and low albumin= more unbound, active phenytoin in the blood--> toxicity risk ----------------------- THERAPEUTIC LEVEL: 10-20 mcg/mL ----------------------- ADRS: -Gingival hyperplasia* -Rash -Acne -Hirsutism -Dilantin facies -Suicidal thoughts and behavior -Drowsiness; CNS effects (possible toxicity) -Osteoporosis ------------------------ INTERACTIONS: -Dextrose solutions, other IV drugs -Diazepam, isoniazid, cimetidine, valproic acid: increase drug levels -CNS depressants: increased sedative effects -Phenobarbital, carbamazepine: decrease drug levels -Oral contraceptives: decrease the effectiveness of oral contraceptives *New prescriptions and OTC meds should always be double checked for possible interactions ------------------------ IMPLICATIONS: -Monitor for excessive drowsiness and other CNS effects (mild if therapeutic; excessive/exaggerated symptoms may indicate toxicity) -Observe gingiva of children and adolescents for hyperplasia -Perform skin assessment and document intactness and presence or absence of any rashes -Slowly infuse into a large vein with a large-gauge (20-gauge or larger) venous catheter (Cardiac collapse can occur if infused too quickly due to the influx of sodium; inject no more than 50 mg /min or 25 mg/min if they are older) -Dilute IV solutions in normal saline and use filter; flush with saline -Monitor vitals during infusion, especially for cardiac dysrhythmias and hypotension -Monitor plasma drug levels carefully on a regular basis -Can be given with meals to decrease GI distress -Monitor for toxicity (nystagmus, ataxia, sedation, blurred or double vision) -Monitor albumin levels and maintain drug levels well below 20 mcg for patients that are malnourished. -Obtain baseline dental hygiene habits and oral assessment (teeth and gum status) -Obtain a baseline neurological assessment with a focus on vision, baseline neuromuscular stability with attention to coordinated movements, gait, and reflexes, and speech (clarity and ability to form and express words appropriately) -Obtain baseline CBC and liver function studies; monitor throughout therapy ------------------------ EDUCATION: -Avoid driving or participating in activities that require mental alertness when experiencing CNS depressant effects; report effects to provider -Obtain regular dental checkups -Brush with a soft-bristled toothbrush, massage gums, and floss between teeth to decrease incidence of gingivitis -Report rash -Do not drive until a steady state is achieved or until instructed by provider -Report any suicidal thoughts or ideas immediately -Do not discontinue abruptly -Take with food and/or 6-8 oz of fluid to help minimize GI upset unless otherwise noted -Adhere to medication regimen and that recurrence of seizure activity is usually because of lack of adherence -Therapy is lifelong -Safety measures: electric stove with no open flame, oven mitts, cook on rear burners; cook in microwave whenever possible; have heat-controlled faucets installed; carpet floors to help cushion falls; use plastic dishes and containers instead of glassware whenever possible; do not put a lock on the bathroom door; bathe with only a few inches of water and bathe with someone present in the home; have someone with you when engaging in sports, use a helmet -Wear medical alert bracelet -Keep daily journal of symptoms, triggers, and duration, location, and occurrence of seizure activity

selegiline

CLASS: monoamine oxidase inhibitors (MAOIs); specifically MAO-B inhibitor ---------------------- MOA: increases levels of dopaminergic stimulation in the CNS; inhibit the action of MAO-B (which inactivates dopamine) ----------------------- INDICATIONS: -Parkinson's disease -Can be used in conjunction with levodopa to allow a reduction in its dose -Depression ----------------------- CONTRAINDICATIONS: -Known drug allergy -Concurrent use with opioid analgesic meperidine -Suicidal ideation -Renal failure -Liver disorders -Cardiac disease -Patients older than 60 or younger than 6 -Concurrent SSRI use -Glaucoma history -History of drug or alcohol addiction -Caution: epilepsy, diabetes, schizophrenia, mania ----------------------- ADRS: -Insomnia -Hypertensive crisis, especially with consumption of tyramine-containing foods (Aged cheeses, processed meats) -Irritation of mucous membranes -CNS: headaches, dizziness, confusion, somnolence, impulse control disorders (gambling, hypersexuality), dyskinesia, orthostatic hypotension, suicidal ideation -Weight loss -GI: nausea, diarrhea, stomatitis, constipation, vomiting -Back pain -Toxicity: hyperthermia, seizures, tachycardia ------------------------ INTERACTIONS -Meperidine and other opioids, tramadol, cyclobenzaprine, dextromethorphan, other MAOIs, SSRIs, tricyclic antidepressants, oxcarbazepine: additive CNS stimulation--> increased risk for serotonin syndrome -Carbamazepine, oral contraceptives: reduced drug clearance--> potential toxicities -Buspirone: hypertensive effects -Tyramine-containing foods (sausage, aged cheese, sour cream, draft beer), St. John's wort, gingseng, ma huang: hypertensive crisis can occur with concurrent consumption* -Antihypertensives, diuretics, general anesthetics: hypotension ------------------------ IMPLICATIONS: -Give several hours before bedtime to reduce occurrence of insomnia -Give twice a day with breakfast and lunch -Give with food to minimize GI effects -Monitor blood pressure closely for hypertension; monitor for headache, nausea, and vomiting as this can indicate a hypertensive crisis -Assist with menu selections so patients know which foods and beverages contain tyramine or caffeine; instruct to avoid -Carefully evaluate concurrent drug use, especially with MAOIs or meperidine -Inspect oral cavity and tongue for irritation on a regular basis -Give exactly as ordered -Monitor for adverse effects (nausea, insomnia, hallucinations, dizziness, GI effects, and worsening thoughts of suicide or depression) -Prepare IV phentolamine or sublingual nifedipine if hypertensive crisis occurs to help reduce BP ------------------------ EDUCATION: -Take twice a day with breakfast and lunch -Avoid tyramine-containing foods (sausage, draft beer, aged cheeses) as well as caffeine containing beverages -Do not start any new medications without consulting your provider -Report irritation of the mouth -Take exactly as ordered; do not discontinue abruptly -Do not swallow oral disintegrating forms; take without liquids or foods within 5 minutes of this drug -Change positions slowly ; report severe dizziness and hallucinations to provider and wait for further instruction -Avoid OTC flu and cold medication -Anxiety and insomnia may occur -Report extreme agitation to provider as well as an increase in depression or suicidal thoughts

Carbamazepine is indicated for all of the following EXCEPT: a. Partial seizures b. Trigeminal neuralgia c. Bipolar disorder d. Myoclonic seizures

Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson's disease. The nurse informs the patient that which common adverse effects can occur with this medication. a. Drowsiness, headache, weight loss b. Peripheral edema, fatigue, syncope c. Heart palpitations, hypotension, urinary retention d. Dizziness, insomnia, nausea

SSRIs (selective serotonin reuptake inhibitors)

Citalopram (Celexa), Fluoxetine (Prozac) ------------------- MOA: inhibit serotonin reuptake; weak effects on norepinephrine and dopamine reuptake--> strengthens serotonin transmission at synapses--> resolution of depressive and other psychogenic symptoms ------------------- INDICATIONS: -Depression -Bipolar disorder -Eating disorders -Obesity -OCD -Panic attacks/disorders -Social anxiety disorder -PTSD -PMDD -Myoclonus -Substance abuse disorders -------------------- CONTRAINDICATIONS: -Known drug allergy -Concurrent use with MAOIs in the previous 14 days -Children under 7 -Certain antipsychotics like thioridazine and mesoridazine -Seizure disorders (bupropion) -Caution: older adults, diabetes, liver disease, peptic ulcer disease, hyponatremia, cardiac disease, suicidal tendencies -------------------- ADRs: -CNS: anxiety, dizziness, drowsiness, headache =Tremor -Insomnia* -Weight gain* -Sexual dysfunction* -Headache -Hyponatremia (especially with older adults and those taking diuretics) -Serotonin syndrome*: symptoms include delirium, agitation, tachycardia, sweating, myoclonus, hyperreflexia, shivering, coarse tremors, extensor plantar responses, hyperthermia, seizures, rhabdomyolysis, renal failure, cardiac dysrhythmias, disseminated intravascular coagulation -Withdrawal syndrome: slowly taper off; symptoms include flulike symptoms, difficulty concentrating, faintness, and GI symptoms -------------------- INTERACTIONS: -Protein-bound drugs like warfarin and phenytoin: compete for binding sites--> more free, unbound drug--> more pronounced drug effect with warfarin and phenytoin i.e. toxicities -Linezolid, MAOIs, other SSRIs, lithium, metoclopramide, buspirone, sympathomimetics, tramadol: additive effects--> risk for serotonin syndrome* -Benzodiazepines: reduced metabolism--> benzodiazepine toxicity Propafenone: increases propafenone levels--> toxicities -------------------- IMPLICATIONS: -Assess and document findings associated with the neuromuscular and GI systems -Caution use in older adults due to increased risk for toxicity -Monitor for serotonin syndrome (tachycardia, agitation, sweating, muscle tremors) -Do administer if the patient has used a MAOI in the last 14 days, along with some antipsychotic drugs -Assess for significant drug interactions like with warfarin and phenytoin -Monitor liver function studies -Assess family support systems -Administer exactly as ordered -Know that the period before therapeutic effects take place is the highest risk for self-harm and suicide -Assist with ambulation and other activities if the patient is weak, an older adult, or dizzy -------------------- EDUCATION: -It may take 4-6 weeks for therapeutic effects to take place -Take with food and at least 4-6 oz of fluid -Counsel about potential sexual dysfunction -Consult provider before discontinuing; taper -Consume fiber supplements at least 2 hours before or after administration to avoid interference with absorption -Avoid cold products, SSRIs, MAOIs, and St. John's Wort -Immediately report suicidal thoughts and other mental health changes to provider -Tapering period can take 1-2 months; discontinuation syndrome may occur (flulike symptoms, diarrhea, difficulty concentrating, dizziness, fainting)--> citalopram is the most commonly associated with discontinuation syndrome -Immediately contact provider or seek EMS if there is a doubt over taking too much of an antidepressant -Avoid hot baths, saunas, hot climates -Report nervousness and insomnia, as well as impotence, decreased libido, and headache -OTC analgesics like acetaminophen can be used for headaches; avoid NSAIDs -Eat a healthy diet and increase activity levels -Take in morning to avoid sleep interference -Report signs of hyponatremia (lethargy, abdominal cramps, diarrhea, nausea) -Report signs of serotonin syndrome (anxiety, fever, excessive sweating, tremors, hallucinations)--> discontinue and call provider

a, b

Diazepam is associated with which of the following adverse effects? Select all that apply. a. Confusion b. Slurred speech c. Diarrhea d. Hyperhidrosis e. Insomnia

a, c, d

Long-term haloperidol therapy may result in which of the following? Select all that apply. a. Tremors b. Diarrhea c. Uncontrollable shaking of small muscle groups d. Vomiting

Patients prescribed sildenafil (Viagra) should be instructed regarding the potential life-threatening drug interaction with which medication? a. Warfarin (Coumadin) b. Nitroglycerin (Nitrostat) c. Acetaminophen (Tylenol) d. Aspirin (Acetylsalicylic acid)

Phenytoin levels must be monitored carefully as there is a narrow therapeutic range. Which result is within therapeutic range? a. 8 mcg/mL b. 18 mcg/mL c. 28 mcg/mL d. 38 mcg/mL

St. John's wort can be used for the management of all of the following EXCEPT: a. Depression b. Bipolar disorder c. Anxiety d. Sleep disorders e. Nervousness

a, c, d, f, g, h

Tamsulosin is associated with which of the following adverse effects? Select all that apply. a. Hypotension b. Bradycardia c. Syncope d. Depression e. Urinary retention f. Impotence g. Headache h. Visual changes

b, c, d

The nurse has received an order to administer an initial dose of IV phenytoin to a patient with new-onset seizures. What will the nurse check before administering this medication? (Select all that apply) a. Hourly urine output b. Blood glucose levels c. Cardiac rhythm d. Blood pressure

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? a. Naloxone [Narcan] b. Flumazenil [Romazicon] c. Acetylcysteine [Mucomyst] d. Vitamin K

The nurse is assessing a female patient who came in complaining of calf swelling and pain. The nurse notes that the affected extremity is also red in color and warm to the touch. When reviewing the patient's medication history, the nurse suspects which of the following medications for this serious adverse effect? a. Acetaminophen b. Ethinyl estradiol (Yaz) c. Levothyroxine (Synthroid) d. Vitamin C supplement

The nurse is giving instructions to a client receiving phenytoin (Dilantin). The nurse concludes that the client has a sufficient knowledge if the client states that: A. "Wearing a medical alert tag is not required". B. "Alcohol is permitted while taking this medication". C. "I can take the medicine with milk". D. "Have the serum phenytoin level taken before giving the medication".

b, d, f

The nurse is preparing to give medications. Which is an appropriate nursing action for IV phenytoin (Dilantin)? Select all that apply. a. Give IV doses via rapid IV push. b. Administer in normal saline solutions. c. Administer in dextrose solutions. d. Use a filter for IV infusions. e. Ensure continuous infusion of the drug. f. Administer the medication into a large vein using an 18-gauge venous catheter.

The nurse is providing education to a patient and the patient's caregiver, who is pregnant, on the medication finasteride for treatment of benign prostatic hyperplasia (BPH). What important teaching would the nurse provide to the patient and the patient's caregiver about this medication? a. Instruct to put the drug into a container with other medications. b. Notify your health care provider for an erection that lasts 2 hours. c. Take the medication with dairy containing products such as milk or yogurt. d. Emphasize it must not be touched or handled by pregnant women because of teratogenic effects.

The nurse is providing instructions to the daughter of a patient who has been diagnosed with Alzheimer's and is prescribed donezepil. The nurse will include all of the following information EXCEPT: a. The effects of this drug may not be felt for up to 6 weeks. b. This medication will help cure your father of Alzheimer's. c. You can take this medication with food to decrease any GI upset. d. Keep a journal that details the progression of the disease and the drug's adverse effects. e. Do not discontinue this medication abruptly.

b, d, e

The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate. Select all that apply. a. AED therapy can be stopped when seizures are stopped. b. Consistent dosing is the key to controlling seizures. c. A dose may be skipped if the patient is experiencing adverse effects. d. AED therapy is usually lifelong. e. Abruptly stopping AEDs may cause rebound seizure activity.

b, c, d, f

The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? Select all that apply. a. The patient should be told which foods contain tyramine and be instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any OTC medications.

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? a. "When it is time to discontinue this drug, you will need to taper it off slowly." b. "Protect your skin from the sun to prevent rash and exaggerated sunburn." c. "Increase your intake of fluid and high-fiber foods to prevent constipation." d. "Take this medication on an empty stomach at least 2 hours after meals."

The nurse is working on a neurosurgery unit. The patient calls the desk to complain that his arm is really burning and feels hot. The patient is receiving IV phenytoin for his grand mal seizures. What is the nurse's best action? a. Call the health care provider immediately to change the medication to oral b. Continue the infusion and reassure the patient c. Flush the line with 10 mL of normal saline and continue the infusion d. Discontinue the IV and restart the IV infusion in a different site

The nurse suspects that a client is experiencing extrapyramidal symptoms (EPS) from long-term treatment with antipsychotic medications when which of the following behaviors are observed? a. The client hoards food in the bedside stand. b. The client refuses to participate in group activities. c. The client frequently paces in the room. d. The client walks with a shuffling gait and stooped posture. e. The client has frequent angry outbursts

The nurse will include which of the following information for a patient prescribed lithium? a. "You should make sure to get enough fluids with this medication." b. "You should be on a low-sodium diet with this medication to avoid adverse effects." c. "You do not have to discontinue your ibuprofen for your pain relief." d. "This medication has been prescribed for your anxiety."

The nurse will include which of the following information when educating a patient about finasteride? a. "You should schedule regular prostate screenings with your provider." b. "Storing your medication in the cabinet above your stove should be fine." c. "Your wife can continue to help you with administering this medication as it won't affect her pregnancy." d. "Therapy is normally temporary and should not be prolonged."

b, c, e, f

The nurse will monitor a patient taking lithium for which of the following signs of toxicity? Select all that apply a. Tinnitus b. Muscle weakness c. Vomiting d. Lethargy e. Seizures f. Confusion

The nurse will provide all of the following instructions for a patient prescribed with a benzodiazepine EXCEPT: a. "You must avoid alcohol with this medication." b. "You should make sure to change your positions slowly." c. "You should get an eye exam before beginning this medication." d. "You should avoid operating heavy machinery and driving until the effects of this drug are resolved." e. "You may stop this medication if you feel any adverse effects coming on."

The nurse would immediately report which of the following levels for lithium? a. 0.6 mEq/L b. 1.6 mEq/L c. 1 mEq/L d. 0.9 mEq/L

a, c

The nurse would include which of the following information when educating a patient about sildenafil (Viagra)? Select all that apply. a. You should immediately report an erection that lasts longer than 4 hours b. You may continue to use your nitroglycerin patch. c. You should take this medication an hour before you intend to have sex. d. High fat foods may promote better absorption of this drug. e. An expected side effect of this medication is temporary hearing loss.

The nurse would question a prescription for estrogen replacement therapy in a patient with a history of which condition? a. Weight loss b. Dysmenorrhea c. Vaginal bleeding d. Deep vein thrombosis

The patient has just been diagnosed with epilepsy and will be starting phenytoin. The patient's spouse asks how this medication works in the body. What is the nurse's best response? a. "It inhibits the enzyme that destroys one of the neurotransmitters." b. "It helps stop the entry of sodium into the cell." c. "It has not been determined exactly how it prevents seizures." d. "It increases the amount of calcium that enters the cell."

What is the main purpose of menopausal hormone therapy? a. To manage the vasomotor symptoms associated with menopause. b. To prevent pregnancy. c. To treat hypertension. d. To treat osteoporosis.

What possible common adverse effect would the nurse include in the discharge teaching for a patient prescribed finasteride (Proscar)? a. Hair loss b. Increased libido c. Muscle weakness d. Ejaculatory dysfunction

What would the nurse expect to see if the patient is experiencing a common side effect of phenytoin? a. Gingival hyperplasia b. Excessive thirst c. Weight gain d. Muscle tremors

b, c, e, f, g

When administering diazepam, a benzodiazepine, the nurse will monitor the patient for which of the following manifestations? Select all that apply. a. Hyperactivity b. Loss of coordination c. Sedation d. Diarrhea e. Headaches f. Dizziness g. Drowsiness

a, b, d, e

When administering serotoninergic drugs, the nurse will monitor for which manifestations associated with serotonin syndrome? a. Agitation b. Tachycardia c. Hepatitis d. Diaphoresis e. Myoclonus

When educating a patient about the use of levodopa/carbidopa (Sinemet), the nurse will include all of the following EXCEPT: a. "You should take this drug 30 minutes before or 1 hour after eating a protein-rich food." b. "This medication is best taken on an empty stomach, however, you can take it with food if you are experiencing GI discomfort." c. "This medication will help stop the progression of Parkinson's." d. "You should aim to drink about 3 L of water a day." e. "You may experience dry mouth with this medication and can use hard candy or gum to help alleviate this symptom."

b, d, e

When teaching a patient who is taking an oral contraceptive for the first time, the nurse relates that adverse effects may include which of the following? Select all that apply. a. Dizziness b. Nausea c. Tingling in the extremities d. Breast tenderness e. Fluid retention

Which food should be avoided by the patient taking selegiline (Eldepryl)?1 a. Popcorn b. Oranges c. Cheese d. Bananas

Which information is correct to provide when educating a patient about when to take selegiline (Eldepryl)? a. Every 6 hours to ensure maintenance of therapeutic blood levels b. At breakfast and lunch to decrease the potential for insomnia c. One hour before or 2 hours after meals to increase absorption d. At bedtime to increase therapeutic effects

a, b, e, f, h

Which of following are adverse effects associated with gabapentin? Select all that apply. a. Dizziness b. Speech changes c. Nystagmus d. Agranulocytosis e. Edema f. Nausea h. Drowsiness

a, b, c, d, e

Which of the following are adverse effects associated with St. John's wort? Select all that apply. a. GI upset b. Photosensitivity c. Dry mouth d. Dizziness e. Confusion

a, c, e, f

Which of the following are adverse effects associated with carbamazepine? Select all that apply. a. Nystagmus b. Weight gain c. Behavioral changes d. Cognitive impairment e. Skin rash f. Abnormal gait

a, c, e

Which of the following are adverse effects associated with donezepil use? Select all that apply. a. Syncope b. Constipation c. Hypotension d. Urinary retention e. Nausea

a, b, d, f

Which of the following are adverse effects associated with selegiline? Select all that apply. a. Dizziness b. Dyskinesia c. Anxiety d. Hypotension e. Ataxia f. Nausea

a, b, c, d

Which of the following are adverse effects associated with the use of conventional antipsychotics like haloperidol and chlorpromazine? Select all that apply. a. Agranulocytosis b. Hemolytic anemia c. Akathisia d. Uncontrollable facial spasms

a, b, d, e

Which of the following are common adverse effects associated with SSRI use? Select all that apply. a. Insomnia b. Inability to orgasm c. Hypertension d. Weight gain e. Dyskinesias

a, c

Which of the following are considered extrapyramidal symptoms? Select all that apply. a. Akathisia b. Choreoathetosis c. Dystonia d. Involuntary facial muscle contractions

c, d

Which of the following are indications for finasteride? Select all that apply. a. Prostate cancer b. Hormone replacement therapy c. BPH d. Male pattern baldness

a, c, d, e, f

Which of the following are manifestations of phenytoin toxicity? Select all that apply. a. Nystagmus b. Urinary frequency c. Encephalopathy d. Agranulocytosis e. Ataxia f. Rash

a, b, d, e

Which of the following can interact with St. John's wort? Select all that apply. a. Selegiline b. Phenytoin c. Propranolol d. Warfarin e. Oral contraceptives

a, b, c, d, e

Which of the following drugs interact with SSRIs? Select all that apply. a. Warfarin b. Phenytoin c. MAOIs d. Lithium e. Benzodiazepines

a, b, c, d

Which of the following foods will the nurse advise the patient to avoid when taking selegiline? Select all that apply. a. Fava beans b. Cheddar cheese c. Brewer's yeast d. Lox e. Vodka

a, b, c, f

Which of the following have a potential interaction with phenytoin? Select all that apply. a. Warfarin b. Meperidine c. Diazepam d. Grapefruit juice e. Acetaminophen f. Carbamazepine

a, b, c, d, e, f

Which of the following have potential interactions with oral contraceptives? Select all that apply. a. Penicillin b. Rifampin c. Propranolol d. Warfarin e. Theophylline f. Pioglitazone

Which of the following is NOT an adverse side effect associated with phenytoin use? a. Acne b. Hirsutism c. Dyskinesia d. Osteoporosis e. Hypertrophy of subcutaneous facial tissue

Which response would the nurse expect to find in a patient with a phenytoin (Dilantin) level of 25 mcg/mL? a. Ataxia b. Hypertension c. Seizures d. No unusual response; this level is therapeutic.

Which vitamin should be avoided by a patient taking levodopa (Larodopa)? a. Vitamin C b. Vitamin B6 (pyridoxine) c. Vitamin D d. Vitamin B1 (thiamine)

While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by which finding? a. Limp extremities with weak muscle tone. b. Rigid, tend muscles. c. Confusion and altered mental status. d. Difficulty performing voluntary movements.

tardive dyskinesia

a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors Symptoms -Choreoathetosis (wavelike movements of extremities) -Involuntary contractions of oral and facial muscles

extrapyramidal symptoms

side effects of antipsychotic medications that affect a person's gait, movement, or posture Symptoms: -akathisia (distressing muscle restlessness) -acute dystonia (painful muscle spasms -Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)

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