Exam 2 Flashcards
What are the CNS stimulant drugs?
- amphetamines
- analeptics, caffeine
- anorexiants
What is the mechanism of action for amphetamines?
- stimulate the release of the neurotransmitters norepinephrine and dopamine
What are the uses of amphetamines?
- they increase wakefulness in narcolepsy
- they increase attention span, cognition
- they decrease hyperactivity, impulsiveness, restlessness of ADHD
- they cause euphoria (leading to misuse)
Amphetamine drugs are …
- amphetamine (Adderall)
- dextroamphetamine (Dexedrine)
What are the side effects of amphetamines?
- increased P, BP and palpitations
- Tachycardia
- palpations
- dysrhythmias
- hypotension
- anorexia
- dry mouth
- weight loss
- diarrhea
- constipation
- impotence
When should amphetamines be given?
- At least 6-8 hours before bed
- Typically given before morning and noon meals
What is the use of modafinil (Provigil)?
It is used for narcolepsy
What is the therapeutic effect of modafinil (Provigil)?
It increases the time the patient feels awake. (daytime wakefullness)
What is the use of methylphenidate (Ritalin)?
- Used for ADHD, fatigue, and narcolepsy
- Increases the effects of dopamine and norepinephrine
What are the interactions of methylphenidate (Ritalin)?
- Caffeine may increase effects
- Decreased effects of decongestants, antihypertensives, and barbituates
- may alter insulin effects
What are the adverse reactions of methylphenidate (Ritalin)
- Tachycardia
- palpitations
- hypertension
- weight loss
- growth suppression
- thrombocytopenia
- hepatotoxicity
What are the side effects of modafinil (Provigil)?
- headache
- nausea
- diarrhea
- nervousness
What is are the uses of lidocaine?
- general anesthesia - in conjunction with other anesthesia (propofol) in order to decrease pain associated with injection.
- local anesthesia - to block pain at the administration site
What is the therapeutic effect of lidocaine?
blockage of pain at the site of administration.
What is the therapeutic range of phenytoin (Dilantin)?
What is the level where it becomes toxic?
What are some important nursing interventions?
- 10-20mcg/mL
- 30-50mcg/mL
- Monitor CBC’s for early detection of blood dyscrasias
- May cause anorexia, NV
- use seizure precautions
- monitor drug serum levels
What are the side effects of phenytoin?
- HA
- diplopia
- dizziness
- slurred speech
- decreased coordination
- alopecia
What are the adverse effects of phenytoin?
- Gingivitis
- gingival hyperplasia
- nystagmus
- Thrombocytopenia
- Stevens-Johnson syndrome
- Long-term: hyperglycemia
What should be covered during patient teaching for phenytoin?
- Urine may have a pink or reddish-brown color
- primrose and borage lower the seizure threshold
- gingko may decrease phenytoin effectiveness
- shake solution well
- may have teratogenic effects - consult before/with pregnancy
- avoid alcohol and other CNS depressants
- monitor blood glucose if diabetic
- DONT STOP ABRUPTLY
For what is phenytoin used?
anticonvulsant
prevention of grand mal and partial seizures
What are the uses of Benzodiazepines?
- anxiety
- insomnia (short-term use)
- seizures
- sedation
What is the therapeutic effect of benzodiazepines related to insomnia?
- It is a minor tranquilizer and anxiolytic.
- Therefore, it induces sleep and reduces anxiety
Which benzodiazepine(s) are used to treat status epilepticus?
- Diazepam**
- midazolam
- lorazepam
What are the side effects of benzodiazepines?
- drowsiness
- loss of muscle coordination
- behavioral changes
What are the signs of an overdose of benzodiazepines
and what is the antidote?
- Dizziness
- confusion
- drowsiness
- blurred vision
- unresponsiveness
- anxiety
- agitation
- Antidote is flumazenil (romazicon)
What is the use of valproic acid?
- petit mal
- grand mal
- mixed types of seizures
- bipolar
What are the adverse effects of valproic acid?
- hepatotoxicity
- Stevens-Johnson syndrome
- pancreatitis
- birth defects
What are the side effects of valproic acid?
- NV
- sedation
What is the therapeutic range for valproic acid?
50-100mcg/mL
What labs must be monitored with valproic acid?
- AST
- ALT
- Billirubin
For what is carbamazepine (Tegretol) used?
- Grand mal
- parital seizures
- trigeminal neuralgia
- bipolar disorder
What dietary alerts must be communicated to the patient for carbamazepine (Tegretol)?
- Do not take with grapefruit juice
- it increases drug blood levels by inhibiting enzymes responsible for its breakdown
What are the side effects of carbamazepine (Tegretol)?
- dizziness
- drowsiness
- unsteadiness
- nausea
- vomiting
What are the adverse reactions with carbamazepine (Tegretol)?
- agranulocytosis
- aplastic anemia
- thrombocytopenia
- SJS
What is the therapeutic range for carbamazepine (Tegretol)?
5-12mcg/mL
For what are barbiturates used?
- general anesthesia
- partial mal
- grand mal
- acute episodes of status epilepticus
- meningitis
- toxic reactions
- eclampsia
For what is phenobarbital used?
- to prevent grand mal and complex partial seizures
What are the side effects of phenobarbital?
- drowsiness
- dizzyness
- HA
- nausea
- loss of appetite
- Hangover effect
- Respiratory depression
What are some things to cover during pt teaching for phenobarbital?
- Phenobarbital should be gradually reduced
- There are risks of sedation so the pt should not drive or operate heavy equipment
- There is a risk of tolerance and dependency
- high doses for adults may lead to coma or respiratory depression
- high doses for older adults and children may cause confusion, depression, irritability.
- Adverse effects include suicidal ideation.. seek Dr. help!
For what is auranofin (Ridaura) used?
- gold therapy for rheumatoid arthritis.
- slows disease progression and prevents deformities
What are the adverse effects of auranofin (Ridaura)?
- diarrhea
- urticaria
- dermatitis
What are the contraindications for auranofin (Ridaura)?
- hemorrhagic conditions
- eczema
- urticaria
- colitis
- SLE
What are some teaching goals for auranofin (Ridaura)?
- good oral care
- schedule and monitor lab tests (CBC) for thrombocytopenia
- report bleeding gums/ blood in stool
- avoid direct sunlight
For what is methadone used?
- Used for weaning program for meth
- also can be used to decrease severity of pain
What is the therapeutic effect of methadone?
It suppresses withdrawal symptoms
What is drug tolerance?
a diminished response to a drug as a result of repeated use and the bodies adaptation to continued presence of the drug.
What is dependence?
an adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of drug use.
What is the hangover effect?
it is residual drowsiness caused by some CNS depressants (barbiturates, benzodiazepates)
What are extrapyramidal symptoms?
Tremors, masklike facies, rigidity, shuffling gait may develop.
What is serotonin syndrome?
hallucinations, inc HR, inc. temp., loss of coordination, muscle spasms, NVD, and rapid changes in blood pressure
What is agranulocytosis?
What are the signs of the condition?
failure of bone marrow to make enough WBCs
- sudden fever
- chills
- sore throat
- weakness in your limbs
- sore mouth and gums
- mouth ulcers
- bleeding gums
What is thrombocytopenia?
What are the signs of the condition?
is a deficiency of platelets in the blood. This causes bleeding into tissues, bruising, and slow blood clotting after injury.
- Easy or excessive bruising
- (petechiae), usually on the lower legs.
- Prolonged bleeding from cuts.
- Bleeding from your gums or nose.
- Blood in urine or stools.
What is neutropenia?
a count of 1,700 or fewer neutrophils per microliter of blood (adult)
- asymptomatic beyond increased susceptibility to infection
What are the uses for NSAIDS?
- Reduce inflammation and pain
- rheumatoid and osteoarthritis
- Not recommended for fever or headaches
- except aspirin, ibuprofen
What are the types of NSAIDs
- First generation
- Salicylates
- propionic acid derivatives
- phenylacetic acid derivatives
- second generation
- cox-2 inhibitors
What are the side effects of salicylates?
- Tinnitus, hearing loss
- Dizziness, confusion, drowsiness
- GI distress, peptic ulcer
- thirst
- diarrhea
- vomiting
What are the adverse reactions to salicylates
- Reye’s syndrome (children)
- Thrombocytopenia
- leukopenia
- agranulocytosis
- hepatotoxicity
- convulsions
- cardiovascular collapse
- coma
- gastric bleeding
- bronchospasm
What are some nursing interventions for salicylates?
- Check for signs of bleeding or toxicity (tinnitus, visual changes, HA, GI)
- Don’t take with anticoagulants (coumadin)
- Discontinue 3-7 days prior to surgery
- Inform dentist if taking before procedure
- Do not give to children
- Take with food
What are the side effects of propionic acid derivatives?
- Gastric distress
- tinnitus
- ness, confusion
- edema
- blood dyscrasias
- dysrhythmias
- nephrotoxicity (monitor creatinine clearance)
What are the Cox-2 inhibitors and how are they different from non-selective cox inhibitors?
- Celebrex
- Only affect Cox-2 which decreases inflammation and pain
- lacks the regulation of blood platelets and GI disturbance from Cox-1
What are the therapeutic effects of opioids?
pain relief and antitussive (cough suppressant)
What are the side effects of opioids?
- Hypotension
- Sedation
- Constipation
- Urinary retention
- Respiratory depression
- tolerance and withdrawal symptoms
Which opioids are used for moderate vs. severe pain?
- Codeine is for mild to moderate pain
- Dilaudid and Demerol are used for moderate to severe pain
- Morphine is for severe pain
How long do they take to elicit a therapeutic response (IV vs PO)
- Exact time ??
- IV almost immediately, PO slower
What is the antidote for opioid overdose?
naloxone (Narcan)
What is the maximum 24 hour dose of acetaminophen?
4 grams
What are the adverse reactions of clozapine?
- agranulocytosis
- extrapyramidal symptoms
- pseudoparkinsonism (seizures, tremors, uncontrolled movements)
Which antidepressants do not cause sedation and can be taken before bed?
SSRIs and SNRIs
Patients taking MAOIs must avoid what foods?
- Those containing tyramine such as
- cheese
- cream
- yogurt
- coffee
- chocolate
- bananas
- raisins
- Italian green beans
- liver
- pickled foods
- sausage
- soy sauce
- yeast
- beer
- red wines
The therapeutic range for lithium is
0.5-1.5mEq/L
Levels greater than 1.5-2mE/L
The normal range for Na in the body is
135-145mEq/L
What are the side effects of lithium?
- dry mouth
- thirst
- increased urination
- weight gain
- bloated feeling
- metallic taste
- edema of the hands and ankles
What lab values must be monitored for a patient taking lithium?
- creatinine
- AST
- ALT
- BUN
- drug serum levels
- urine output must be greater than 600ml/day
For what is allopurinol used?
it is an anti-gout medication
What is the mechanism of allopurinol?
It inhibits the final steps of uric acid biosynthesis and therefore lowers the serum uric acid levels.
What are some teaching goals r/t allopurinol?
- have regular lab tests for renal, liver and CBC fx
- Increase fluid intake
- report side effects of anorexia, NV, diarrhea, stomatitis, dizziness, rash, pruritis and metallic taste
- Have a yearly eye exam
- avoid alcohol and caffeine
- Do not take large doses of Vitamin C
- avoid foods high in purine
- Report gastric distress
What herbal contraindications should be avoided with antidepressants
- St. Johns Wart
- feverfew
- MAOIs
- ginseng
- ephedra
- ma-huang
- anise
- brewer’s yeast
What are the side effects of TCAs (antidepressants)?
- orthostatic hypertension
- sedation
- anticholinergic effects (tachycardia, urinary rtn, constipation, dry mouth, blurred vision)
- cardiotoxicity
- seizures
- Amitriptyline - EPS
- Clomipramine - neuroleptic malignant syndrome
What are the side effects of SSRIs
- dry mouth
- blurred vision
- insomnia
- HA
- nervousness
- anorexia
- N
- Diarrhea
- suicidal ideation
- sexual dysfunction
What are the side effects of MAOIs
- CNS stimulation
- orthostatic hypotension
- anticholinergic effects
