exam 2 Flashcards
Cognitive changes –delirium, agitation, confusion, euphoria, insomnia,
Autonomic changes- fever, tachycardia, arrhythmias, elevated resp. rate, Increased BP,
Neuromuscular changes- tremor, hyperreflexes,
Serotonin Syndrome
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)
SSRIs
Depression:Second-Generation Antidepressants
CNS Depressants: Sedative-Hypnotic Types
Long-acting
diazepam (Valium), clonazepam (Klonopin)
Adverse Effects:
Uncommon and mild
Dysrhythmia, orthostatic hypotension, bradycardia, headache, dizziness, fatigue, nausea, vomiting, abdominal cramps, diarrhea, others
Antifibrinolytic Drugs
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.
The SSRI may take several weeks to have a beneficial effect\
It may take several weeks to see the therapeutic effects of SSRIs.
CNS depression Respiratory stimulation or depression Vasodilation, producing warm, flushed skin Increased sweating Diuretic effects More accurately known as ethanol (ETOH)
Alcohol (Ethanol)
amphetamine (Dexedrine, Adderall)
methylphenidate (Concerta, Ritalin, Metadate CD)
atomoxetine (Strattera)
Drugs for ADHD and Narcolepsy
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
ketorolac (Toradol)
Stimulate areas of the brain associated with mental alertness
Mood elevation or euphoria
Increased mental alertness and capacity for work
Drugs for ADHD and Narcolepsy
During pregnancy to prevent neural tube defects
Should not be used until actual cause of anemia is determined
Folic Acid
Used to treat the pain of osteoarthritis
Adverse effects:
GI discomfort
Drowsiness, headache, skin reactions (glucosamine)
Glucosamine and Chondroitin
Follow instructions for diet and exercise
Take in the morning
Avoid caffeine
Fat-soluble vitamin supplementation may be needed
Anorexiants
Drugs that break down, or lyse, preformed clots
Reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction
Thrombolytic Drugs
Adverse Effects
Headache, drowsiness, dizziness, cognitive impairment, vertigo, lethargy
fall hazard for elderly persons
“Hangover” effect/daytime sleepiness
Benzodiazepines (Zepam or Zolam)
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
Lithium carbonate and lithium citrate
Interactions:
Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics, grapefruit juice
CNS depressants (alcohol, opioids)
Others: olanzapine, rifampin
Benzodiazepines (Zepam or Zolam)
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.”
“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.
Cause sleep, much more potent effect on CNS than sedatives
Hypnotics
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
Anticholinergics
Contraindications: acute or chronic cardiac problem or history of seizure
Commom Adverse Effects:anticholinergic adverse effect, orthostatic hypotension
Tricyclic Antidepressants
alprazolam (Xanax) , lorazepam (Ativan), diazepam (Valium)
Benzodiazepines
is used for smoking cessation treatment
Adverse effects: dizziness, confusion, tachycardia, agitation, tremor and dry mouth
*bupropion [Zyban]
may be manifested by respiratory rate of less than 10 breaths/min, dyspnea, diminished breath sounds, or shallow breathing
Respiratory depression
Indications:
Mild to moderate pain
Fever
Alternative for those who cannot take aspirin products
Acetaminophen (Tylenol)
Act to relieve pain associated with skeletal muscle spasms
Majority are centrally acting
Similar in structure and action to other CNS depressant
Muscle Relaxants
Normally used to:
Relieve pain, reduce cough, relieve diarrhea, and induce anesthesia
Also known as narcotics
Produce analgesia, drowsiness, euphoria, tranquility, other mood alterations
Opioids
Brief episode of abnormal electrical activity in nerve cells of the brain
Seizure
Physiologic adaptation of the body to the presence of an opioid
Physical Dependence
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
Depressants Withdrawal
Peak period: 1 to 3 days, duration: 5 to 7 days
Opioid Drug Withdrawal
Inhibit reuptake of both serotonin and norepinephrine
Examples:
venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)
SNRIs
Depression:Second-Generation Antidepressants
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
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.
(Zepam or Zolam)
Benzodiazepines
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
carbamazepine (Tegretol)
First-Line Antiepileptic Drugs
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
Benzodiazepines (Zepam or Zolam)
CNS Depressants: Sedative-Hypnotic Types
Short-acting
midazolam (Versed)
analgesic and antipyretic effects
Black box warning: GI risk and cardiovascular risk
ibuprofen (Motrin, Advil)
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)
Serotonin Syndrome
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
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.
Inhibit the action or formation of clotting factors
Prevent clot formation
Anticoagulants
Black box warning: severe neutropenia, orthostatic hypotension, bradycardia, syncope, seizure
clozapine (Clozaril),
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.
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.
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
Stimulants
Anxiolytic drugs (for anxiety) Mood-stabilizing drugs (Affective disorders) Antidepressant drugs (depression) Antipsychotic drugs (psychoses)
Types of psychotherapeutic drugs
Cardiovascular risk : cardiovascular thrombotic events, etc
Gastrointestinal risk : ulcer and GI bleeding*
FDA Warning on All NSAIDs
Adverse Effects:
Possible elevated blood pressure and heart palpitations
Anxiety, agitation, dizziness, headache
Anorexiants
Overdose
Death results from: convulsions, coma, cerebral hemorrhage
Stimulants
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
Respirations
Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations.
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
Stimulant Withdrawal
Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms
Reduce the production of inflammatory neuropeptides
Triptans
Antimigraine Drugs
Monoamine oxidase inhibitors (MAOIs)
Second-generation antidepressants:
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Miscellaneous
Tricyclic antidepressants
Reverse the effects of these drugs on pain receptors
Bind to a pain receptor and exert no response
Antagonists
Interactions:
1+1=2
Alcohol, antihistamines, barbiturates, benzodiazepines, monoamine oxidase inhibitors
Opioid Analgesics
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.
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.
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
Drugs for ADHD and Narcolepsy
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)
Increased chance for gastrointestinal bleeding
NSAIDs taken with alcohol may result in increased risk of gastrointestinal bleeding.
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.
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.
Chronic, progressive, degenerative disorder
Affects dopamine-producing neurons in the brain
Caused by an imbalance of two neurotransmitters
Dopamine
Acetylcholine (ACh)
Parkinson’s Disease (PD)
condition that results from inappropriate uric acid metabolism
Gout
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
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.
: Reduce anxiety by reducing overactivity in CNS
Anxiolytic Drugs
Signs and symptoms
Elevated blood pressure, pulse rate, and temperature, insomnia, tremors, agitation
Alcohol (Ethanol)
Indications:
Muscle spasms
Management of spasticity of severe chronic disorders (multiple sclerosis, cerebral palsy)
Work best when used along with physical therapy
Muscle Relaxants
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)
Anticoagulants
Assist primary drugs in relieving pain NSAIDs Antidepressants Anticonvulsants Corticosteroids
Adjuvant Drugs
Alter platelet function
Hemorheologic drugs
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
Anticoagulants
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.
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.
Promote blood coagulation
Antifibrinolytic or hemostatic
Drugs used to treat serious mental illness
Behavioral problems or psychotic disorders
Have been known as tranquilizers or neuroleptics
Antipsychotics
Adverse Effects:
Bleeding
May also cause: Heparin-induced thrombocytopenia (HIT)
Anticoagulants
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
Feverfew
Overdose:
Dangerous when taken with other sedatives or alcohol
Flumazenil may be used to reverse benzodiazepine effects
Treatment is generally symptomatic and supportive
Benzodiazepines
Anxiolytic Drugs
Essential mineral in the body
Stored in the liver, spleen, and bone marrow
deficiency results in anemia
Iron
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
Iron dextran (INFeD, Dexferrum)
Contraindication:
Children with flulike syndrome
Reye’s syndrome: life threatening, progressive neurologic deficit
NSAIDs
Major therapeutic uses (attention deficit hyperactivity disorder [ADHD], narcolepsy, obesity, migraine, and respiratory depression syndromes)
Classified according to: Chemical structural similarities
CNS Stimulants
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
Suicidal thoughts
: Some studies have indicated a higher risk for suicide during the first few weeks of antidepressant therapy.
A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity?
Bradycardia
Hypoventilation
Constipation
Hyperglycemia
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.
Benzodiazepines are the treatment of choice
diazepam (Valium), lorazepam (Ativan), or chlordiazepoxide (Korsakoff’s psychosis)
Dosage and frequency depend on severity
Alcohol (Ethanol)
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
Herbal Products: Ginseng
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
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