ATI CH 16

Question 1

For a pt. Suffering from acute toxicity from a benzodiazepine what is a nursing intervention?

Answer 1

For oral toxicity, gastric lavage can be used, followed by the administration of activated charcoal or saline cathartics.

For IV toxicity, administer flumazenol (Romazicon) to counteract sedation and reverse side effects

Monitor vital signs, maintain patent airway provide fluids to maintain blood pressure

Have resuscitation equip avail.

Question 2

Name some non benzodiazepines.

Answer 2

zaleplon ( Sonata)
eszopiclone (Lunesta)
trazadone ( Oleptro)

Question 3

What is the action of non benzodiazepines?

Answer 3

Enhances the action of GABA in the CNS. This results in prolonged Sleep duration and decreased wakenings

Management of insomnia

Question 4

What is a nursing consideration of those taking non benzodiazepines.

Answer 4

Advise clients to take med just before bed

Administer all agents by oral or sublingual route

Question 5

Melatonin agonists

Answer 5

Management of insomnia by activation of melatonin receptors.

Question 6

What are adverse effects of melatonin agonists?

Answer 6

Sleepiness, dizziness, fatigue
Hormonal effects (amenorrhea, decreased libido, infertility, galactorrhea)

Question 7

What is the prototype drug of melatonin agonists

Answer 7

ramelteon ( Rozerem)

Question 8

What are contraindications and precautions of melatonin agonists

Answer 8

Contraindicated in pregnancy and lactation
In severe forms of liver disease
Depression
Apnea and COPD

Question 9

What are medication and food interactions of melatonin agonists (ramelteon)

Answer 9

1. )High fat meals and grapefruit juice increase absotion- take med on an empty stomach
2. ) concurrent use of fluvoxamine (Luvox) can increase levels of ramelteon.
3. ) CNS depressants such as opiods, alcohol can cause additive CNS depression.

Question 10

What are nursing considerations for administration of melatonin agonists ( ramelteon)

Answer 10

Administer by oral route
Instruct clients to take 30 min before bedtime
Instruct clients to take on an empty stomach

Question 11

Intravenous anesthetics

Answer 11

Intravenous non opioid agents

Barbituates: pentobarbital sodium ( Nembutal)
Benzodiazepines: midazolam, diazepam ( Valium)
Other medications: propofol ( Diprivan) ketamine( Ketalar)

Question 12

Intravenous anesthetics

Intravenous opiod agents

Answer 12

Fentanyl ( Sublimaze)

alfentanil ( Alfenta) sufentanil ( Sufenta)

Question 13

What is the expected pharmacological action of intravenous anesthetics

Answer 13

These medications produce loss of consciousness and elimination of response to painful stimuli

Therapeutic uses:
Induction and maintenance of anesthesia
Moderate ( conscious) sedation ( usually an IV non opiod agent combined with an opioid agent.
Intubation and mechanical ventilation.

Question 14

What are adverse effects of lorazepam?

Answer 14

Incoordination-
Euphoria-
Retrograde amnesia-

Question 15

What drug is used to reverse the effects of benzodiazepines

Answer 15

Flumazenil

Is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzodiazepines

Question 16

What foods should a client avoid while taking ramelteon (Rozerem)

Answer 16

Grapefruit juice and high fat foods increase absorption of ramelteon.

Question 17

A client is admitted to undergo a surgical procedure. The nurse should be aware that which of the following preexisting conditions may be a contraindication for the use of ketamine ( Ketalar) as an intravenous anesthetic for this client.

Answer 17

Schizophrenia
Ketamine can produce psychological effects such as hallucinations. Therefore, schizophrenia can be a contraindication for the use of ketamine.

Question 18

A nurse is providing instructions to a client who,has a new prescription for zolpidem ( Ambien), what instruction should be provided.

Answer 18

Notify provider if you plan to become pregnant.

Pregnancy category C

Question 19

What are contraindications and precautions regarding benzodiazepines?

Answer 19

Theses medications are pregnancy category D; estazolam,quaxepam,triazolam & temazepam are pregnancy category X
These MEDS are contraindicated in those who have sleep apnea, respiratory depression, organic brain disease or who are breastfeeding
Use cautiously in clients who have a history of substance use disorder, liver dysfunction and kidney failure. Older adults need decreased dosages.