exam 2 Flashcards

1
Q

Cognitive changes –delirium, agitation, confusion, euphoria, insomnia,

Autonomic changes- fever, tachycardia, arrhythmias, elevated resp. rate, Increased BP,

Neuromuscular changes- tremor, hyperreflexes,

A

Serotonin Syndrome

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2
Q

Selectively inhibit serotonin reuptake

Little or no effect on norepinephrine or dopamine reuptake

Result in increased serotonin concentrations at nerve endings

Examples:
fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa)

A

SSRIs

Depression:Second-Generation Antidepressants

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3
Q

CNS Depressants: Sedative-Hypnotic Types

Long-acting

A

diazepam (Valium), clonazepam (Klonopin)

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4
Q

Adverse Effects:
Uncommon and mild

Dysrhythmia, orthostatic hypotension, bradycardia, headache, dizziness, fatigue, nausea, vomiting, abdominal cramps, diarrhea, others

A

Antifibrinolytic Drugs

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5
Q

When providing teaching for a patient who is prescribed a selective serotonin reuptake inhibitor (SSRI), which statement will the nurse include?

The SSRI will work faster than the older tricyclic antidepressants.

The SSRI will have an immediate beneficial effect on the patient’s depression symptoms.

The SSRI will not work well for severe cases of depression.

The SSRI may take several weeks to have a beneficial effect.

A

The SSRI may take several weeks to have a beneficial effect\

It may take several weeks to see the therapeutic effects of SSRIs.

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6
Q
CNS depression
Respiratory stimulation or depression 
Vasodilation, producing warm, flushed skin
Increased sweating
Diuretic effects
More accurately known as ethanol (ETOH)
A

Alcohol (Ethanol)

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7
Q

amphetamine (Dexedrine, Adderall)
methylphenidate (Concerta, Ritalin, Metadate CD)
atomoxetine (Strattera)

A

Drugs for ADHD and Narcolepsy

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8
Q

powerful analgesic effects, for moderate and severe pain

Black box warning: GI risk, renal risk, cardiovascular thrombotic event, bleeding risk

FDA warning: less than five days use only

A

ketorolac (Toradol)

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9
Q

Stimulate areas of the brain associated with mental alertness
Mood elevation or euphoria
Increased mental alertness and capacity for work

A

Drugs for ADHD and Narcolepsy

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10
Q

During pregnancy to prevent neural tube defects

Should not be used until actual cause of anemia is determined

A

Folic Acid

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11
Q

Used to treat the pain of osteoarthritis

Adverse effects:
GI discomfort
Drowsiness, headache, skin reactions (glucosamine)

A

Glucosamine and Chondroitin

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12
Q

Follow instructions for diet and exercise
Take in the morning
Avoid caffeine
Fat-soluble vitamin supplementation may be needed

A

Anorexiants

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13
Q

Drugs that break down, or lyse, preformed clots

Reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction

A

Thrombolytic Drugs

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14
Q

Adverse Effects

Headache, drowsiness, dizziness, cognitive impairment, vertigo, lethargy

fall hazard for elderly persons

“Hangover” effect/daytime sleepiness

A

Benzodiazepines (Zepam or Zolam)

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15
Q

Serum level: 0.6 and 1.2 mEq/L
Contraindication (risk of toxicity): dehydration, sodium imbalance, major renal and cardiovascular disease

Adverse effects:
toxicity: GI discomfort, tremor, confusion, somnolence, seizure, cardiac dysrhythmia and possible death

Others: drowsiness, slurred speech, choreoathetotic movement

A

Lithium carbonate and lithium citrate

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16
Q

Interactions:

Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics, grapefruit juice

CNS depressants (alcohol, opioids)

Others: olanzapine, rifampin

A

Benzodiazepines (Zepam or Zolam)

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17
Q

A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching?

“Take the medication with your evening meal.”
“You will need to take this drug for at least 2 years.”
“If you develop a dry mouth, stop taking the drug immediately.”
“Avoid intake of caffeine.”

A

“Avoid intake of caffeine.”

Caffeine in any form must be avoided by patients taking anorexiants. These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times. These drugs should not be abruptly stopped as a rebound increase of appetite may develop.

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18
Q

Cause sleep, much more potent effect on CNS than sedatives

A

Hypnotics

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19
Q

block the effects of ACh

Used to treat muscle tremors and muscle rigidity associated with PD

Adverse effects: Tachycardia, heat stroke, confusion, constipation, urinary retention

Contraindication: angle closure glaucoma

A

Anticholinergics

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20
Q

Contraindications: acute or chronic cardiac problem or history of seizure

Commom Adverse Effects:anticholinergic adverse effect, orthostatic hypotension

A

Tricyclic Antidepressants

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21
Q

alprazolam (Xanax) , lorazepam (Ativan), diazepam (Valium)

A

Benzodiazepines

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22
Q

is used for smoking cessation treatment

Adverse effects: dizziness, confusion, tachycardia, agitation, tremor and dry mouth

A

*bupropion [Zyban]

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23
Q

may be manifested by respiratory rate of less than 10 breaths/min, dyspnea, diminished breath sounds, or shallow breathing

A

Respiratory depression

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24
Q

Indications:

Mild to moderate pain
Fever
Alternative for those who cannot take aspirin products

A

Acetaminophen (Tylenol)

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25
Q

Act to relieve pain associated with skeletal muscle spasms

Majority are centrally acting

Similar in structure and action to other CNS depressant

A

Muscle Relaxants

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26
Q

Normally used to:
Relieve pain, reduce cough, relieve diarrhea, and induce anesthesia

Also known as narcotics

Produce analgesia, drowsiness, euphoria, tranquility, other mood alterations

A

Opioids

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27
Q

Brief episode of abnormal electrical activity in nerve cells of the brain

A

Seizure

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28
Q

Physiologic adaptation of the body to the presence of an opioid

A

Physical Dependence

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29
Q

Signs/Symtoms
Increased psychomotor activity; agitation; hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature;

Treatment involves tapering of the drug over a course of a 7 to 10 or 10 to 14 days

A

Depressants Withdrawal

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30
Q

Peak period: 1 to 3 days, duration: 5 to 7 days

A

Opioid Drug Withdrawal

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31
Q

Inhibit reuptake of both serotonin and norepinephrine
Examples:

venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)

A

SNRIs

Depression:Second-Generation Antidepressants

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32
Q

The nurse has administered iron intravenously to a patient. To prevent orthostatic hypotension, it is recommended that the nurse have the patient remain in the recumbent position for how long?

10 minutes
30 minutes
60 minutes
90 minutes

A

30 minutes

It is recommended that the patient remain recumbent for 30 minutes after an intravenous injection of iron to prevent drug-induced orthostatic hypotension.

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33
Q

(Zepam or Zolam)

A

Benzodiazepines

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34
Q

drug stimulate the production of enzymes that enhance its own metabolism, which lead to lower than expected drug concentrations.

Black box warning: bone marrow suppression and skin hypersensitivity reaction

A

carbamazepine (Tegretol)

First-Line Antiepileptic Drugs

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35
Q

Adverse Effects: Toxicity and Overdose

Somnolence, confusion, coma , diminished reflexes

Do not cause hypotension and respiratory depression unless taken with other CNS depressants

Treatment symptomatic and supportive
Flumazenil as an antidote

A

Benzodiazepines (Zepam or Zolam)

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36
Q

CNS Depressants: Sedative-Hypnotic Types

Short-acting

A

midazolam (Versed)

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37
Q

analgesic and antipyretic effects

Black box warning: GI risk and cardiovascular risk

A

ibuprofen (Motrin, Advil)

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38
Q

Symptoms
Delirium, tachycardia, hyperreflexia, shivering, agitation, sweating, muscle spasms, coarse tremors

Symptoms of severe cases
Hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, disseminated intravascular coagulation (DIC)

A

Serotonin Syndrome

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39
Q

An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy?

Blood sugar
Liver function studies
Assessment of hearing
Renal function studies

A

Renal function studies

: NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and elderly patients are at greater risk for this adverse drug reaction.

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40
Q

Inhibit the action or formation of clotting factors

Prevent clot formation

A

Anticoagulants

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41
Q

Black box warning: severe neutropenia, orthostatic hypotension, bradycardia, syncope, seizure

A

clozapine (Clozaril),

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42
Q

A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this?

The patient’s pain should subside by that time.
There are concerns about addiction to the drug.
The drug can cause severe renal and gastrointestinal effects.
The drug loses its effectiveness over time.

A

The drug can cause severe renal and gastrointestinal effects.

The main adverse effects of ketorolac include renal impairment, edema, gastrointestinal pain, dyspepsia, and nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects on the kidney and gastrointestinal tract.

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43
Q

Adverse Effects
CNS: Restlessness, syncope (fainting), tremor, hyperactive reflexes, talkativeness, irritability, insomnia, euphoria

Cardiovascular: Palpitations, tachycardia, cardiac dysrhythmias, anginal pain, hypertension or hypotension, circulatory collapse,

Gastronintestinal: Dry mouth, metallic taste, anorexia, nausea, vomiting, diarrhea, abdominal cramps
Fatal hyperthermia

A

Stimulants

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44
Q
Anxiolytic drugs (for anxiety)
 Mood-stabilizing drugs (Affective disorders)
 Antidepressant drugs (depression)
 Antipsychotic drugs (psychoses)
A

Types of psychotherapeutic drugs

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45
Q

Cardiovascular risk : cardiovascular thrombotic events, etc

Gastrointestinal risk : ulcer and GI bleeding*

A

FDA Warning on All NSAIDs

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46
Q

Adverse Effects:

Possible elevated blood pressure and heart palpitations
Anxiety, agitation, dizziness, headache

A

Anorexiants

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47
Q

Overdose

Death results from: convulsions, coma, cerebral hemorrhage

A

Stimulants

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48
Q

A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern?

Pulse
Blood pressure
Temperature
Respirations

A

Respirations

Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations.

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49
Q

Signs and Symtoms

Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia, depression, suicidal thoughts and behavior, paranoid delusions

Peak period: 1 to 3 days
Duration: 5 to 7 days

A

Stimulant Withdrawal

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50
Q

Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms

Reduce the production of inflammatory neuropeptides

A

Triptans

Antimigraine Drugs

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51
Q

Monoamine oxidase inhibitors (MAOIs)

Second-generation antidepressants:

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Miscellaneous

A

Tricyclic antidepressants

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52
Q

Reverse the effects of these drugs on pain receptors

Bind to a pain receptor and exert no response

A

Antagonists

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53
Q

Interactions:

1+1=2

Alcohol, antihistamines, barbiturates, benzodiazepines, monoamine oxidase inhibitors

A

Opioid Analgesics

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54
Q

Which statement regarding muscle relaxants does the nurse identify as being accurate?

Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.

Cyclobenzaprine (Flexeril) produces little sedation.

Patients taking muscle relaxants are at high risk to develop hypertension.

Patients taking muscle relaxants should be told to stop taking the medication if they feel sleepy.

A

Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.

: Baclofen (Lioresal) is sometimes used in an injectable form. Cyclobenzaprine (Flexeril) often results in deep sedation and sleepiness. Patients taking muscle relaxants are at risk to develop hypotension; therefore, they should be taught safety measures to prevent falls. Sedation and sleepiness are common side effects of muscle relaxants; however, a patient should not abruptly discontinue use of the medication. Safety procedures should be followed to prevent accidents and falls.

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55
Q

Adverse Effects, dose-related:

Tend to “speed up” body systems

Common adverse effects include:
Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others

A

Drugs for ADHD and Narcolepsy

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56
Q

A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for osteoarthritis. While taking a health history, the nurse finds out that the patient has few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?

Increased bleeding tendencies

Increased chance for gastrointestinal bleeding

Increased nephrotoxic effects

Reduced antiinflammatory effects of the nonsteroidal antiinflammatory drug (NSAID)

A

Increased chance for gastrointestinal bleeding

NSAIDs taken with alcohol may result in increased risk of gastrointestinal bleeding.

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57
Q

A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be

1000 mg.
2000 mg.
3000 mg.
4000 mg.

A

2000 mg.

: Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use. For this reason, a maximum daily dose of 2000 mg is generally recommended for these persons.

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58
Q

Chronic, progressive, degenerative disorder

Affects dopamine-producing neurons in the brain

Caused by an imbalance of two neurotransmitters
Dopamine
Acetylcholine (ACh)

A

Parkinson’s Disease (PD)

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59
Q

condition that results from inappropriate uric acid metabolism

A

Gout

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60
Q

Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy?

If you feel sleepy when taking the drug, decrease the dose by one half

Take the drug on an empty stomach

Call your health care provider if you experience a sore throat or fever

Patients with epilepsy are not able to hold a job and work, so you should apply for benefits

A

Call your health care provider if you experience a sore throat or fever

To prevent complications, patients should be taught to call the health care provider if they experience fever, sore throat, excessive bleeding or bruising, and new onset of nosebleeds. Drowsiness is a common side effect of these drugs; the dose should never be altered without consulting the prescriber. These medications should be taken with food to decrease GI upset. Most patients with seizure disorders are able to work and are protected by the Americans with Disabilities Act.

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61
Q

: Reduce anxiety by reducing overactivity in CNS

A

Anxiolytic Drugs

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62
Q

Signs and symptoms

Elevated blood pressure, pulse rate, and temperature, insomnia, tremors, agitation

A

Alcohol (Ethanol)

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63
Q

Indications:

Muscle spasms

Management of spasticity of severe chronic disorders (multiple sclerosis, cerebral palsy)

Work best when used along with physical therapy

A

Muscle Relaxants

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64
Q

Also known as antithrombotic drugs

Have no direct effect on a blood clot that is already formed

Used prophylactically to prevent:
Clot formation (thrombus)
An embolus (dislodged clot)
warfarin sodium (Coumadin)
enoxaparin (Lovenox) 
heparin
dabigatran (Pradaxa) 
fondaparinux (Arixtra)
argatroban (Argatroban)
A

Anticoagulants

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65
Q
Assist primary drugs in relieving pain
NSAIDs
Antidepressants
Anticonvulsants
Corticosteroids
A

Adjuvant Drugs

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66
Q

Alter platelet function

A

Hemorheologic drugs

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67
Q

Used to prevent clot formation in certain settings where clot formation is likely

Myocardial infarction, Atrial fibrillation, Indwelling devices, such as mechanical heart valves, Major orthopedic surgery

A

Anticoagulants

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68
Q

A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks (TIAs). The concern with taking these two drugs together is:

increased risk of gastric ulcer.

decreased action of the aspirin because of the interaction with the ginkgo.

increased risk of bleeding because of the ginkgo.

antagonism of the action of the aspirin because of the multivitamins.

A

increased risk of bleeding because of the ginkgo.

Ginkgo may cause some increased bleeding times, so taking aspirin with ginkgo may put the patient at a higher risk for bleeding episodes.

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69
Q

Promote blood coagulation

A

Antifibrinolytic or hemostatic

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70
Q

Drugs used to treat serious mental illness
Behavioral problems or psychotic disorders
Have been known as tranquilizers or neuroleptics

A

Antipsychotics

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71
Q

Adverse Effects:

Bleeding
May also cause: Heparin-induced thrombocytopenia (HIT)

A

Anticoagulants

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72
Q

Antiinflammatory properties

Used to treat migraine headaches, menstrual cramps, inflammation, and fever

May cause GI distress, altered taste, muscle stiffness

May interact with aspirin and other NSAIDs, and anticoagulants

A

Feverfew

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73
Q

Overdose:

Dangerous when taken with other sedatives or alcohol
Flumazenil may be used to reverse benzodiazepine effects
Treatment is generally symptomatic and supportive

A

Benzodiazepines

Anxiolytic Drugs

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74
Q

Essential mineral in the body
Stored in the liver, spleen, and bone marrow
deficiency results in anemia

A

Iron

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75
Q

Serious: fatal anaphylactic reactions, major orthostatic hypotension

Test dose of 25 mg of iron dextran is administered before injection of the full dose, and then remainder of dose is given after 1 hour

Used less frequently now; replaced by newer products ferric gluconate and iron sucrose

A

Iron dextran (INFeD, Dexferrum)

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76
Q

Contraindication:

Children with flulike syndrome
Reye’s syndrome: life threatening, progressive neurologic deficit

A

NSAIDs

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77
Q

Major therapeutic uses (attention deficit hyperactivity disorder [ADHD], narcolepsy, obesity, migraine, and respiratory depression syndromes)

Classified according to: Chemical structural similarities

A

CNS Stimulants

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78
Q

When patients are taking selective serotonin reuptake inhibitors (SSRIs) for the first time for depression, which is most important to monitor for during the first few weeks of therapy?

Hypertensive crisis
Suicidal thoughts
Convulsions
Orthostatic hypotension

A

Suicidal thoughts

: Some studies have indicated a higher risk for suicide during the first few weeks of antidepressant therapy.

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79
Q

A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity?

Bradycardia
Hypoventilation
Constipation
Hyperglycemia

A

Hyperglycemia

Manifestations of salicylate toxicity include increased heart rate, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness, nausea, vomiting, diarrhea, sweating, thirst, hyperventilation, and hypoglycemia or hyperglycemia.

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80
Q

Benzodiazepines are the treatment of choice

diazepam (Valium), lorazepam (Ativan), or chlordiazepoxide (Korsakoff’s psychosis)

Dosage and frequency depend on severity

A

Alcohol (Ethanol)

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81
Q

Uses: stress reduction, improvement of physical endurance and concentration

May cause elevated BP, chest pain, palpitations, anxiety, insomnia, headache, GI symptoms

Interactions with anticoagulants, immunosuppressants, anticonvulsants, antidiabetic drugs

A

Herbal Products: Ginseng

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82
Q

A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use?

Administer the drug by rapid IV push
Infuse slowly, not exceeding 50 mg/min
Mix the medication with dextrose solution
Administer via continuous infusion

A

Infuse slowly, not exceeding 50 mg/min

Phenytoin should be mixed only with normal saline, and it should be given by slow IV infusion (but not as a continuous infusion

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83
Q

Used to treat obesity
Suppress appetite control centers in the brain
Increase the body’s basal metabolic rate

A

Anorexiants

84
Q

The use of folic acid to prevent fetal neural tube defects should be started:

during a woman’s adolescence.
at least 1 month before pregnancy.
when a pregnancy is first discovered.
at the beginning of the last trimester of pregnancy.

A

at least 1 month before pregnancy.

: It is recommended that administration of folic acid begin at least 1 month before pregnancy and continue throughout early pregnancy to reduce the risk for fetal neural tube defects.

85
Q

Indications:

Long-term maintenance therapy for chronic, recurring seizures
Acute treatment of convulsions and status epilepticus

A

Antiepileptic Drugs:

86
Q

does not cross the blood-brain barrier and prevents levodopa breakdown in the periphery

A

Carbidopa

87
Q

Considered second line, replaced by SSRI as first line

Adjunctive analgesics for chronic pain conditions, such as trigeminal neuralgia

A

Tricyclic Antidepressants

88
Q

is able to cross the blood-brain barrier

A

Levodopa

89
Q

medication for Affective Disorders (Mood Disorders)

A

Lithium carbonate and lithium citrate

90
Q

Result: larger dose is required to maintain the same level of analgesia

A

Opioid Tolerance

91
Q

Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function

A

Conventional drugs

92
Q

A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse monitors for autoinduction, which will result in

toxic levels of carbamazepine (Tegretol).
lower than expected drug levels.
gingival hyperplasia.
cessation of seizure activity.

A

lower than expected drug levels.

Carbamazepine (Tegretol) is associated with autoinduction of hepatic enzymes. Autoinduction is a process in which, over time, a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations.

93
Q

Monitored by activated partial thromboplastin times (aPTTs)
Parenteral
Short half-life (1 to 2 hours)
Effects reversed by protamine sulfate

A

Heparin

94
Q

Which drug will the nurse anticipate administering to a patient experiencing benzodiazepine overdose?

flumazenil
naltrexone
Vivitrol
flunitrazepam

A

flumazenil

Flumazenil is a benzodiazepine reversal agent. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the benzodiazepine receptor in the CNS and thus reversing sedation. For opioid abuse or dependence, naltrexone, an opioid antagonist, is administered. Naltrexone, which is also available as an injection called Vivitrol, works by blocking the opioid receptors so that use of opioid drugs does not produce euphoria. Flunitrazepam is a benzodiazepine.

95
Q

Block specific dopamine receptors: dopamine-2 (D2) receptors

Also block specific serotonin receptors: serotonin 2 (5-HT2) receptors

A

Atypical Antipsychotics:

96
Q

First and only remaining COX-2 inhibitor

Indicated for osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea

A

COX-2 Inhibitor: (Celebrex)

97
Q

Potentially life threatening

High fever, unstable BP, myoglobinemia

A

Neuroleptic malignant syndrome (NMS)

98
Q

Adverse Effects:
Central nervous system
Diuresis, miosis, convulsions ,nausea, vomiting, respiratory depression

Non–central nervous system
Hypotension
Constipation
Urinary retention 
Flushing of the face, neck, and upper thorax
Sweating, urticaria, and pruritus
A

Opioids

99
Q

Contraindications: sulfa allergy
FDA black Box Warning:
Cardiac (fetal vardipvascular thrombotic events)
GI risk

A

COX-2 Inhibitor: (Celebrex)

100
Q

Adverse Effects:

often necessitate a change in medication
Black box warning as of 2008
Suicidal thoughts and behavior

A

Antiepileptic Drugs

101
Q

Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living

A

Psychosis

102
Q

Calming effect on the CNS
Reduce excessive sensory stimulation, inducing sleep
Induce skeletal muscle relaxation

A

Benzodiazepines (Zepam or Zolam)

103
Q

Elevation of mood
Reduction of fatigue
Increased alertness
Invigorated aggressiveness

A

Stimulants

104
Q

Involuntary contractions of oral and facial muscles
Choreoathetosis (wavelike movements of extremities)
Occurs with continuous long-term antipsychotic therapy

A

Tardive dyskinesia (TD)

105
Q

Drugs that stimulate a specific area of the brain or spinal cord

Sympathomimetic drugs

A

CNS Stimulants

106
Q

Approved for alcohol –dependence patients to reduce cravings for alcohol

A

Naltrexone

107
Q

Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia

Take on an empty stomach, 30 to 45 minutes before meals

A

Drugs for ADHD

108
Q

Drug therapeutic levels are 10-20 mcg/ml

Highly Protein –bound

Black box warning: Cardiovascular risk with rapid infusion
IV infusion should not exceed 50 mg/min

Slow IV infusion, only can be diluted in normal saline

Long-term therapy with phenytoin (Dilantin) may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies

Other serious adverse effects : V fib, hypotension, cardiovascular collapse, thrombocytopenia, anemia

A

First-Line Antiepileptic Drugs

phenytoin (Dilantin)

109
Q

Adverse Effects:

Bleeding
Other effects
Nausea, vomiting, hypotension, anaphylactoid reactions
Cardiac dysrhythmias; can be dangerous

A

Thrombolytic Drugs:

110
Q

Adverse Effects:

extension of effects on CNS and skeletal muscles
Euphoria, Lightheadedness, dizziness, drowsiness, fatigue, muscle weakness

A

Muscle Relaxants

111
Q

Adverse Effects:

CNS: Drowsiness, sedation, loss of coordination, dizziness, blurred vision, headaches, and paradoxical reactions

Gastronintestinal: Nausea, vomiting, constipation, dry mouth, and abdominal cramping

Pruritus and skin rash
“Amotivational” syndrome

A

Depressants

112
Q

Nonsedating and non–habit forming

May have drug interaction with SSRIs (serotonin syndrome)

Do not administer with MAOIs

A

Anxiolytic drug: buspirone (BuSpar)

113
Q

Adverse Effects

Sedation
Orthostatic hypotension
Photosensitivity
Dry mouth
Urinary hesitancy or retention
Leukopenia and agranulocytosis
A

Antipsychotics

114
Q

Give 30 to 60 minutes before bedtime for maximum effectiveness in inducing sleep (depends on drug’s onset)

A

hypnotics

115
Q

CNS Depressants: Sedative-Hypnotic Types

Intermediate-acting

A

alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril)

116
Q

Three main emotional and mental disorders:

A

Anxiety
Affective disorders
Psychoses

117
Q

Adverse effects:

Paradoxical anxiety
Blurred vision
Headache
Nausea

A

Anxiolytic drug: buspirone (BuSpar)

118
Q

Contraindications:

Allergy, risk of bleeding, Category C-first two trimesters, and D-last trimester

A

NSAIDs

119
Q

A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which finding does the nurse expect upon assessment of the patient?

Hyperthermia
Hypotension
Bradycardia
Somnulence

A

Hyperthermia

Delirium tremens are characterized by hypertensive crisis, tachycardia, agitation, and hyperthermia and may be life threatening.

120
Q

Synthetic drugs that bind to the opiate receptors to relieve pain

Very strong pain relievers

A

Opioid Drugs

121
Q

A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time?

Pressure should be applied to the lump for 3 to 5 minutes.

He will need to take two doses of warfarin tonight to prevent blood clotting.

He needs to be examined for possible internal bleeding from the fall.

As long as there is no bleeding, there is no concern.

A

He needs to be examined for possible internal bleeding from the fall.

Careful examination will be needed to ensure that there is no hematoma or other internal bleeding as a result of the fall, even if superficial bleeding is not noted.

122
Q

Manifested as: Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, confusion

A

Opioid withdrawal/opioid abstinence syndrome

123
Q

Inhibit the MAO enzyme system in the CNS, Amines (dopamine, serotonin, norepinephrine) are not broken down,

A

Monoamine Oxidase Inhibitors (MAOIs)

124
Q

Sign and symptoms

Irritability, restlessness, decreased heart rate and BP

Cardiac symptoms resolve in 3 to 4 weeks, but cigarette craving may persist for months or years

A

Nicotine Withdrawal

125
Q

Adverse Effects:

Serious: Most common cause of pediatric poisoning deaths

Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain

Causes black, tarry stools

Liquid oral preparations may stain teeth

Injectable forms cause pain upon injection

A

Iron:

126
Q

Indications:

Acute MI
Arterial thrombolysis
DVT
Occlusion of shunts or catheters
Pulmonary embolus
Acute ischemic stroke
A

Thrombolytic Drugs:

127
Q

A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate?

Strattera is highly addictive.

Psychotherapy is rarely helpful in cases of ADHD.

The patient should be monitored for possible suicidal thoughts and behavior.

Strattera is used to treat narcolepsy as well as ADHD

A

The patient should be monitored for possible suicidal thoughts and behavior.

: Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient’s family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.

128
Q

Lyse (break down) existing clots

A

Thrombolytic drugs

129
Q

oxycodone 5mg and acetaminophen 325 mg

A

Norco

130
Q

Large and chemically diverse group of drugs with the following properties:

Analgesic
Antiinflammatory
Antipyretic
Aspirin-platelet inhibition

A

NSAIDs

131
Q

When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information?

These medications have little effect on the normal sleep cycle.
Using this medication may cause drowsiness the next day.
It is safe to drive while taking this medication.
These drugs are safe to use with alcohol.

A

Using this medication may cause drowsiness the next day.

Benzodiazepines interfere with REM sleep and may cause a “hangover” effect or next-day drowsiness. They should not be used with alcohol, and persons taking these drugs should not drive.

132
Q

Reduces inflammatory response to the deposits of urate crystals in joint tissue

Used for short-term management or prevention of gout

Adverse effects serious: myelosuppression
leukopenia and bleeding into the gastrointestinal or urinary tracts

A

colchicine

133
Q

Adverse Effects:

CNS depression: Most serious adverse effect
Nausea and vomiting
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation 
Itching
A

Opioid Analgesics

134
Q

Bind to an opioid pain receptor in the brain

Cause an analgesic response (reduction of pain sensation)

A

Agonists

135
Q

To control or prevent seizures while maintaining a reasonable quality of life

To minimize adverse effects and drug-induced toxicity

A

Antiepileptic Drugs (AEDs)

anticonvulsants

136
Q

Several months later the patient returns to the health care provider’s office for follow-up regarding use of the SSRI. The patient tells the nurse that he is feeling better and stopped taking the SSRI yesterday. He doesn’t plan on taking the medication again. When talking with the patient, which knowledge should guide the nurse’s response?

Drug dependency will develop, so it is appropriate to stop therapy after a few months.

Drug therapy must be stopped as soon as the patient feels better to avoid serotonin syndrome.

The patient is the best person to determine when the drug therapy should end.

A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation.

A

A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation

: A taper period of 1 to 2 months is needed to prevent the development of adverse effects of withdrawal from the medication, which include dizziness, diarrhea, and a worsening of the depressive mood disorder. Serotonin syndrome is a result of taking too much of the medication. The patient and the provider should determine together when is the optimal time for drug discontinuation. There is no evidence of drug dependency associated with use of SSRIs.

137
Q

Lethal when overdosed

Overdose: hepatotoxicity

Long-term ingestion of large doses also causes nephropathy

Recommended antidote: acetylcysteine regimen

A

Acetaminophen

138
Q

Drugs that relieve anxiety, irritability, and tension

Used to treat seizure disorders and induce anesthesia

A

Depressants

139
Q

Maximum daily dose for healthy adults: 3000 mg/day

Elderly or those with liver disease: 2000 mg

A

Acetaminophen

140
Q

A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming “unbearable.” The nurse is reluctant to give him the ordered pain medication because the nurse does not want the patient to get addicted to the medication. The nurse’s actions reflect

appropriate concern for the patient’s best welfare.

appropriate caution for a patient who is already on a long-term opioid.

an uncaring attitude toward the patient.

a failure to manage the patient’s pain properly.

A

a failure to manage the patient’s pain properly.

: Patients with severe pain, including metastatic pain or bone pain, may need higher and higher doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain relief.

141
Q

Indications:

Agitation relief
Sedation, sleep induction
Skeletal muscle relaxation
Anxiety relief, anxiety-related depression
Treatment of alcohol withdrawal
Treatment of acute seizure disorders
Balanced anesthesia, Moderate/conscious sedation

A

Benzodiazepines (Zepam or Zolam)

142
Q
Seizures
Alcoholic hepatitis, progressing to cirrhosis
Cardiomyopathy
Fetal alcohol syndrome (FAS)
Nutritional and vitamin deficiencies (especially B vitamins)
Wernicke’s encephalopathy
Korsakoff’s psychosis
Polyneuritis
Nicotinic acid deficiency encephalopathy
A

Alcohol (Ethanol)

143
Q

Which food will the nurse teach the patient to avoid when ingesting an iron supplement?

Eggs
Veal
Orange juice
Fish

A

Eggs

: Although eggs are a common dietary source of iron, they should be avoided when ingesting oral iron preparations. The other foods enhance iron absorption.

144
Q

A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

A

Psychologic Dependence (addiction)

145
Q

A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct?

The patient is receiving a double dose of anticoagulants.

The heparin therapy was ineffective, so the warfarin was started.

The heparin provides anticoagulation until therapeutic levels of warfarin are reached.

The heparin and warfarin work together synergistically to provide anticoagulation.

A

The heparin provides anticoagulation until therapeutic levels of warfarin are reached.

Heparin has a faster onset and therefore is used to provide anticoagulation until therapeutic levels of warfarin are reached.

146
Q

Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

A

Convulsion

147
Q

Used to treat insomnia

Examples: zaleplon (Sonata), zolpidem (Ambien), eszoplicone (Lunesta), and ramelteon (Rozerem)

Eszoplicone and extended-release zolpidem (Ambien CR) approved for long-term therapy

A

Nonbenzodiazepine Hypnotics

148
Q

Contraindications/Interactions:

Should not be taken in the presence of 
Drug allergy
Liver dysfunction
Possible liver failure
G6PD deficiency
Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic
A

Acetaminophen

149
Q

Strong sedative effect

Indication for depression, anxiety and insomnia

A

Trazodone (Desyrel)

150
Q

promoting clot formation
prevention and treatment of excessive bleeding
Treatment of hemophilia or von Willebrand’s dx

A

Antifibrinolytic Drugs

151
Q

Interactions:

Serious interactions can occur when given with:
Anticoagulants, Aspirin
Ulcerogenic drugs: Corticosteroids
Protein bound drugs

A

NSAIDs

152
Q

Used to prevent uric acid production.

Adverse effects: serious
agranulocytosis, aplastic anemia;
Skin reaction: Stevens-Johnson

A

allopurinol (Zyloprim)

153
Q

Inhibit the reabsorption of uric acid in the kidney

Adverse effects serious
blood dyscrasias
Contraindication: Allergic to sulfa

A

probenecid (Benemid), sulfinpyrazone (Anturane)

154
Q

Cardiovascular: Increased heart rate

Central nervous: Tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness

Gastrointestinal: Nausea, vomiting, diarrhea

Metabolic: Sweating, thirst, hyperventilation, hypoglycemia, or hyperglycemia

A

Salicylate Toxicity

155
Q

Does not cause CNS depression
No potential for abuse
No withdrawal signs and symptoms

A

Ramelteon (Rozerem) melatonin

156
Q

Indications

Main use: to alleviate moderate to severe pain

also used for:
Cough center suppression; treatment of diarrhea; balanced anesthesia

A

Opioid Analgesics

157
Q

Which action does the nurse perform when administering iron intravenously?

Premedicate the patient with an antihistamine to prevent anaphylaxis

Administer the iron with a running dextrose solution

Flush the intravenous line with 10 mL of normal saline

Have available Regitine to reverse vasoconstriction at the site should infiltration occur

A

Flush the intravenous line with 10 mL of normal saline

The appropriate nursing action when administering iron intravenously is to flush the intravenous line with 10 mL of normal saline prior to administering the iron.

158
Q

The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patient

is unaware of his own disease history.
has been taking his wife’s medication by mistake.
may be taking this drug for neuropathic pain.
is reluctant to admit to having a seizure disorder.

A

may be taking this drug for neuropathic pain.

Gabapentin is commonly used to treat neuropathic pain.

159
Q

The patient was admitted to the hospital for observation and has now recovered. Which information will the nurse include in patient teaching about SSRIs?

It usually takes 4 to 6 weeks until you will experience benefits from the medication.

The patient must avoid foods that contain tyramine.

If the patient develops an upset stomach when taking this medication, he should discontinue use.

The patient should take the medication at bedtime to enhance sleep.

A

It usually takes 4 to 6 weeks until you will experience benefits from the medication.

: Patients should be taught that the time period for SSRIs to take effect is 4 to 6 weeks. These medications can cause GI upset and taking them with food is recommended. SSRIs should be taken in the morning to prevent any sleep disturbances.

160
Q

CNS depressant reduce: nervousness, excitability and irritability

A

Sedatives

161
Q

Sedative-hypnotics—dose dependent

At__ doses, calm the CNS without inducing sleep
At _ doses, calm the CNS to the point of causing sleep

A

low

high

162
Q

Inhibition of the leukotriene or prostaglandin or both pathway

Blocking the chemical activity of the enzyme called Cox

A

NSAIDs

163
Q

Adverse Effects: orthostatic hypotension most common

Interactions:
sympathomimetic drugs: hypertensive crisis
SSRIs: serotonin syndrome

A

Monoamine Oxidase Inhibitors (MAOIs)

164
Q

Before administering epoetin alfa to a patient in renal failure, it is most important for the nurse to assess which laboratory result?

BUN
White blood cell count
Hemoglobin level
Urine specific gravity

A

Hemoglobin level

: Use of epoetin and darbepoetin is contraindicated in cases of uncontrolled hypertension and when hemoglobin levels are above 10 g/dL for cancer patients and 12 g/dL for renal patients. Use in patients with head or neck cancers or patients at risk for thrombosis is controversial as these medications increase tumor growth and risk for thrombosis.

165
Q

Highly protein-bound

Serious adverse effects: hepatotoxicity, pancreatitis and bone marrow suppression

A

Valproic acid

First-Line Antiepileptic Drugs

166
Q

Medications that relieve pain without causing loss of consciousness

A

Analgesics

167
Q

Contraindications:

Known drug allergy and severe asthma

Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity and/or sleep apnea
Paralytic ileus
Pregnancy
A

Opioid Analgesics

168
Q

Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern?

High white blood cell count
Low serum albumin levels
Low platelet levels
High hemoglobin levels

A

Low serum albumin levels

Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur.

169
Q

A patient wants to take orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects?

Restrict dietary intake of fat
Restrict dietary intake of fiber
Increase intake of dairy products
Avoid intake of carbonated beverages

A

Restrict dietary intake of fat

: Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients.

170
Q

Which statement does the nurse include when teaching a patient about disulfiram (Antabuse) therapy?

“Disulfiram (Antabuse) will cure your alcoholism if you take it as directed.”

“If you drink alcohol after taking disulfiram (Antabuse), your blood pressure will get very high.”

“You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).”

“If you miss a dose of disulfiram (Antabuse), double the dose the next time it is due.”

A

You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).”

The rationale for the use of disulfiram (Antabuse) is that patients know that if they are to avoid the devastating experience of acetaldehyde syndrome, they cannot drink for at least 3 or 4 days after taking disulfiram. Disulfiram (Antabuse) does not cure aolcoholism; blood pressure gets very low if alcohol is consumed with disulfiram (Antabuse); and patients should follow the prescribed dosing schedule and not double a dose.

171
Q

Treatment for Opioid Withdraw

A

Clonidine and Methadone substitution

172
Q

Chemical analogue of GABA, a neurotransmitter inhibits brain activity

Commonly used to treat neuropathic pain

A

Gabapentin (Neutontin)

First-Line Antiepileptic Drugs

173
Q

Oral iron preparations are available as _______

A

ferrous salts

174
Q

Used to treat pernicious anemia and other megaloblastic anemias

Administered orally or intranasally to treat vitamin B12 deficiency

Usually administered by deep intramuscular injection

A

Cyanocobalamin (Vitamin B12)

175
Q

Drug interactions:

Enhances effects of warfarin
May increase insulin resistance (glucosamine)

A

Glucosamine and Chondroitin

176
Q

Stimulates nicotine receptors

Neuropsychiatric symptoms and suicidality

A

varenicline (Chantix)

177
Q

Adverse effects: Vasoconstriction

A

Triptans

Antimigraine Drugs

178
Q

Used to treat rheumatoid arthritis, osteoarthritis, acute bursitis or tendonitis, ankylosing spondylitis, etc

A

indomethacin (Indocin)

179
Q

Releases epinephrine, which creates physiologic stress rather than relaxation

Tolerance develops

Physical and psychologic dependency

Withdrawal symptoms occur if stopped

A

Nicotine

180
Q

Used in the treatment of emotional and mental disorders

A

Psychotherapeutic Drugs

181
Q

Chronic, recurrent pattern of seizures

A

Epilepsy

182
Q

Adverse effects:
Decreased CNS activity, sedation, hypotension, drowsiness, loss of coordination, dizziness, headaches
Others: nausea, vomiting, dry mouth, constipation

A

Benzodiazepines

Anxiolytic Drugs

183
Q

When providing teaching to a patient receiving an anticholinergic for the treatment of Parkinson’s disease, the nurse will include which information?

Take the medication first thing in the morning.

Limit fluid intake when taking this drug.

The tremors you experience will be reduced within 24 hours of taking this drug.

Do not take this medication at the same time as other medications.

A

Do not take this medication at the same time as other medications.

When anticholinergics are used for the treatment of Parkinson’s disease, these medications should not be taken at the same time as other mediations. The medications should be administered at bedtime. Fluid intake should not be restricted as they cause dry mouth, and it may take several days to weeks for the beneficial effects of the medication to become evident.

184
Q

The “off-on phenomenon” that some patients with Parkinson’s disease (PD) experience is best explained as the

need to take a drug holiday to improve response to medications.

variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms.

alternating schedule of medications needed to control PD.

fluctuation of emotions that often occurs with PD.

A

variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms.

Some patients who take levodopa on a long-term basis experience times when their PD symptoms are under control and other times when symptoms are not well controlled.

185
Q

Blocks pain impulses peripherally by inhibiting prostaglandin synthesis

Analgesic and antipyretic effects

Little to no antiinflammatory effects

Nonopioid Analgesics

A

Acetaminophen (Tylenol)

186
Q

Given orally only

Monitored by prothrombin time and INR (PT-INR)

Antidote is vitamin K

Full therapeutic effect takes several days

May be started while the patient is still on heparin until PT-INR levels indicate adequate anticoagulation

Monitor PT-INR regularly—keep follow-up appointments

Many herbal products have potential interactions—increased bleeding may occur

Capsicum pepper,Garlic,Ginger, Ginkgo, St. John’s wort, Feverfew

A

warfarin sodium (Coumadin)

187
Q

Irreversible inhibitor of COX-1 receptors

Inhibits platelet aggregation (81 mg or 325 mg daily)

Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders

A

Salicylic acid (aspirin)

188
Q

Toxicity and Management of Overdose

Regardless of withdrawal symptoms, when a patient experiences severe respiratory depression, an opioid antagonist should be given.

two drugs are

A

naloxone (Narcan)

naltrexone (ReVia)

189
Q

Inhibit platelet aggregation

Prevent platelet plugs

A

Antiplatelet drugs

190
Q

For Anxiety (primary treatment) (CNS depressant)

A

Benzodiazepines

191
Q

Two main pharmacologic classes:

Benzodiazepines (flunitrazepam)
Barbiturates

A

Depressants

192
Q

Used for depression, anxiety, sleep disorders, nervousness
May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity

Severe interactions if taken with MAOIs and SSRIs; many other drug interactions

Food-drug interaction with tyramine-containing foods

A

Herbal Products: St. John’s Wort

193
Q

Overdose
Tachycardia, circulatory collapse, seizures, coma
Treatment: protect brain and heart, eliminate toxin

Avoid foods that contain tyramine! (Hypertensive Crisis)
Aged, mature cheeses, smoked/pickled or aged meats, fish, poultry, yeast extracts, Red wines, Italian broad beans

A

Monoamine Oxidase Inhibitors (MAOIs)

194
Q

Prior to administering a serotonin agonist, it is most important for the nurse to assess the patient for a history of

hypertension.
allergy to penicillin.
chronic bronchitis.
cataracts.

A

hypertension.

: The nurse should complete a thorough cardiac history as well as measurement of blood pressure and pulse rate and rhythm. If a patient has a history of hypertension, there is risk of further increases in blood pressure to dangerous levels with use of these drugs, and thus the need for careful assessment and documentation. In fact, generally these drugs are not prescribed for patients with migraines who also have coronary artery disease unless a thorough cardiac evaluation has been performed.

195
Q
enoxaparin (Lovenox) and dalteparin (Fragmin)
More predictable anticoagulant response
Do not require laboratory monitoring
Given subcutaneously
Do NOT rub after administration
A

Low–molecular-weight heparins

196
Q

The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is

pain management.
fever reduction.
treatment of osteoarthritis.
thromboprevention.
A

thromboprevention.

“Low-dose” aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher usually.

197
Q

Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value?

Blood sugar
Sodium
Urine osmolality
Hematocrit

A

Sodium

: Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity.

198
Q

Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated BP and pulse, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise

A

Opioid Drug Withdrawal

199
Q

Used for treatment of anemia associated with end-stage renal disease, chemotherapy-induced anemia, and for anemia associated with zidovudine therapy

Contraindications: drug allergy, uncontrolled hypertension, head and neck cancers, risk of thrombosis

A

epoetin alfa (Epogen)

darbepoetin (Aranesp)

200
Q

Used to relieve anxiety, stress and restlessness and to promote sleep

May cause CNS depression, hepatotoxicity

Interactions: CNS depressants, alcohol, MAOIs, phenytoin, warfarin,

Contraindicated in cardiac and liver disease

Patient should not operate heavy machinery during use

A

Kava and Valerian

201
Q

The nurse is explaining the differences between transdermal nicotine and nicotine gum programs. Which statement by the nurse is correct?

“The nicotine patch will give you quick relief from cravings.”

“Chewing the gum rapidly will release an immediate dose of nicotine.”

“It seems that patients have better treatment compliance with the gum than the patch.”

“The dose of nicotine in the gum is approximately twice the dose the average smoker receives in one cigarette.”

A

“Chewing the gum rapidly will release an immediate dose of nicotine.”

: The patch system uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, and patient treatment compliance seems higher than with the gum. Acute relief from withdrawal symptoms is most easily achieved with the use of the gum, because rapid chewing releases an immediate dose of nicotine. The dose is approximately half the dose the average smoker receives in one cigarette, however.

202
Q

Indicated for repletion of total body iron content in patients with iron-deficiency anemia who are undergoing hemodialysis

Doses higher than 125 mg are associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching

A

Ferric gluconate (Ferrlecit)

203
Q

CNS Depressants Classified into three main groups:

A

Barbiturates
Benzodiazepines
Miscellaneous drugs

204
Q

First nicotine-free prescription medicine to treat nicotine dependence

A

bupropion (Zyban)

205
Q

Peak period
2 to 4 days for short-acting drugs,4 to 7 days for long-acting drugs

Duration
4 to 7 days for short-acting drugs, 7 to 12 days for long-acting drugs

A

Depressants Withdrawal

206
Q

Involuntary muscle symptoms/ Pseudo parkinsonism
Akathisia (distressing muscle restlessness)
Acute dystonia (painful muscle spasms)
Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)

A

Extrapyramidal symptoms (EPS)