Exam 2 Study Guide Flashcards
1
Q
What are the general Principles of Virology?
A
a. A virus cannot replicate on its own. It must attach to and enter a host cell.
b. A virus then uses the host cell’s energy to synthesize protein, DNA and RNA.
c. Viruses are difficult to kill because they live inside cells. (Any drug that kills a virus also kills healthy cells)
2
Q
What is the purpose and use of antiviral drugs?
A
Kill or suppresses the virus by destroying virions or inhibiting the ability of viruses to replicate; controlled by current antiviral therapy.
3
Q
What drugs are used to treat influenza?
A
Amantadine and Rimantadine
Oseltamivir
4
Q
Amantadine and Rimantadine
A
Only active against influenza A viruses
5
Q
Oseltamivir
A
- Active against influenza A and B.
- Will reduce duration of illness.
- Treatment should begin within two days of influenza onset.
6
Q
Oseltamivir: Adverse Effects
A
Nausea and Vomiting
7
Q
Herpes Zoster (Shingles)
A
Painful (opioids for pain control)
Follow nerve tracts (dermatitis): usually unilateral
Postherpetic neuralgias
8
Q
What is used to treat Herpes Zoster (Shingles)?
A
Acyclovir
9
Q
Acyclovir
A
Drug that speeds the recovery of shingles.
Used to suppress replication of HSV-1, HSV-2, and HSV-3.
10
Q
Best results of acyclovir are seen when?
A
When the antiviral drug is started within 72 hours of symptom onset.
11
Q
What are the adverse effects of acyclovir?
A
Nausea
Diarrhea
Headache
Burning when topically applied
12
Q
HIV
A
Retrovirus (uses RNA as its genetic material)
Transmitted by sexual activity, intravenous drug use, perinatally from mother to child
13
Q
What drugs are used to treat HIV?
A
Zidovudine
Nevirapine
Both are well tolerated.
14
Q
What are the adverse effects of zidovudine?
A
BONE MARROW DEPRESSION
Nephrotoxicity
Hepatotoxicity
Decreased WBC
15
Q
What are the adverse effects of nevirapine?
A
Well tolerated. Rash Fever Nausea Headache Abnormal liver function test results
16
Q
What is the purpose and use of immunosuppressants?
A
a. Drugs that decrease or prevent immune response, thus suppressing the immune system.
b. Used to prevent or treat rejection of implanted organs or autoimmune disorders.
17
Q
What are the nursing implications for immunosuppressants?
A
- Patients taking immunosuppressants should be encouraged to take measures to reduce the risk of infection (i.e Avoid crowds and avoid people with colds or other infections)
- Inform patients to immediately report fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection.
- Interacts with grapefruit/grapefruit juice
18
Q
What is an organ transplant?
A
Transplanted organs have antigens that trigger an immune response -> rejection.
19
Q
What is azathioprine used for?
A
Prevents rejection of kidney transplants.
20
Q
What are the adverse effects of azathioprine?
A
a. BONE MARROW SUPPRESSION
b. Development of lymphoma and other malignancies
c. Hepatosplenic T-cell lymphoma
21
Q
What is SLE?
A
Multisystem autoimmune inflammatory disease.
22
Q
What is the Pathophysiology of SLE?
A
Antibodies react with circulating antigen (nucleic acids, erythrocytes, phospholipids, lymphocytes, platelets, etc.) Reaction forms circulating immune complexes.
23
Q
What are the clinical manifestations of SLE?
A
a. Photosensitivity, scaly erythmatous: Butterfly skin rash
b. Plaques with follicular plugging
c. Scarring
d. Nonerosive arthritis
e. Pancreatitis
f. Vasculitis
g. Anemia
h. GN
i. Pleural effusion
j. Endocarditis
k. Thrombosis of intracranial vessels
24
Q
What are the treatment options for SLE?
A
a. Hydroxychloroquine
b. Glucocorticoids
c. NSAIDs
d. Immunosuppressive Agents
e. Chronic Support – education, counseling, eat well, exercise
25
What is RA?
a. Autoimmune disorder that causes inflammation and tissue damage in joints.
b. Can also cause anemia, inflammation in lungs, eyes, pericardium, and SQ nodules under the skin.
26
What are the clinical manifestations of RA?
a. Pain and Stiffness in joints (particularly in the wrist, hands, elbows, shoulders, knees and ankles)
b. Reduced ROM
c. Affects both sides equally
27
What drugs are used to treat RA?
a. Methotrexate (DMARDs)
| b. Entaracept (DMARDs)
28
What are the adverse effects of methotrexate?
BONE MARROW SUPPRESSION
29
What are the adverse effects of etanercept?
Headache
Injection Site Reaction
URT Infection
Weakness and Dizziness.
30
What is MS?
Autoimmune response which causes:
i. Degeneration of CNS myelin
ii. Scarring in brain
iii. Loss of axons
31
What is the Pathophysiology of MS?
Autoreactive T and B cells cross the blood-brain barrier and recognize myelin and oligodendrocyte autoantigens
Triggers inflammation and loss of oligodendrocytes (myelin producing cells)
Activation of brain macrophages contribute to inflammation and injury with plaque formation and axonal degeneration
Loss of myelin disrupts nerve conduction and death of neurons and brain
32
What are the clinical manifestations of MS?
a. Paresthesia of the face, trunk or limbs
b. Weakness (all four limbs)
c. Impaired gait
d. Visual disturbances
e. Urinary incontinence
33
What are the treatment options for MS?
a. Corticosteroids
b. Immunosuppressants
c. Immune system modulators
d. Plasma exchange, Stem cell therapy
e. Regular Exercise, smoking cessation, decreased stress and extreme fatigue
f. Decrease heat exposure
34
What is hepatitis B?
Milder than Hep C, but can lead to hepatitis or liver failure and death.
35
How is one exposed to hepatitis B?
Transmitted through blood and body fluid exposure; maternal-baby exchange.
36
What are the clinical manifestations of hepatitis B?
..
37
What are the phases of hepatitis?
a. Prodromal
b. Icteric
c. Recovery Phase
38
What happens during the prodromal phase?
a. Lasts 1-21 days; Begins 2 weeks post exposure.
| b. Ends with appearance of jaundice; fatigue, anorexia, malaise, N/V, cough, HA, and low-grade fever.
39
What happens during the icteric phase?
a. 1-2 weeks after prodromal phase; lasts 2-6 weeks
b. The movement of jaundice occurs.
c. Hepatosplenomegaly, dark urine and clay colored stools.
40
What happens during the recovery phase?
a. 2-4 months
b. Begins with resolution of jaundice (average 6-8 weeks after exposure)
c. Symptoms diminish but hepatomegaly remains.
41
What drug is used to treat Hepatitis B?
Telbivudine
42
What is Telbivudine?
a. Nucleoside analogue reverse transcriptase inhibitor
| b. Treats Hep B
43
What are the adverse effects of telbivudine?
a. Fatigue
b. Headache
c. Diarrhea
d. Nausea
e. Pain in joints and muscles
44
What is hepatitis C?
a. Responsible for most cases of post-transfusion hepatitis.
b. Also implicated in infections related to IV drug use.
c. No vaccine yet.
45
How is one exposed to Hepatitis C?
a. 50-80% of hepatitis C cases result in chronic hepatitis.
46
What are the clinical manifestations of Hepatitis C?
..
47
What drugs are used to treat Hepatitis C?
a. Interferon
b. Ribavirin
c. Sofosbuvir
48
What are the adverse effects of interferon?
Fatigue, muscle aches, fever/chills, loss of appetite, SUPPRESSION OF BONE MARROW AND PRODUCTION OF RBCs
49
Interferon
Stimulates the body’s immune system to clear the virus. Good for acute
50
What are the adverse effects of ribavirin?
a. Rash
b. Conjunctivitis
c. Anemia
d. Mild Bronchospasm
51
What are the adverse effects of sofosbuvir?
a. Few side effects: fatigue, headache, nausea and difficulty sleeping.
52
When sofosbuvir is given with amiodarone, what can happen?
May cause slow HR which can lead to death.
53
What are the functions of the liver?
1. Stores large amounts of blood
2. Synthesis of all clotting factors
3. vitamin K storage
4. Kupffer cells
5. Fat synthesization
6. Synthesizes phospholipids and cholesterol
7. Synthesizes plasma proteins
8. Synthesizes serum enzymes
9. Gluconeogenesis
10. Detoxification
11. Storage of minerals and vitamins
12. Bile production
54
What are the clinical manifestations of liver disorders?
a. Portal Hypertension
b. Ascites
c. Hepatic Encephalopathy
d. Jaundice
e. Hepatorenal Syndrome
55
What are the causes of acute liver failure?
a. Acetaminophen OD
b. Viruses: Hepatitis A, B and C
c. Reaction to prescription/herbal medication
d. Ingestion of wild mushroom
56
What are the causes of chronic liver failure?
a. Viruses: Especial Hepatitis B and C
b. Hemochromatosis (too much iron storage)
c. Severe malnutrition
d. Long term alcohol consumption
e. Cirrhosis
57
What is cirrhosis?
a. Irreversible inflammatory disease that disrupts liver function and structure.
b. Normal liver cells are replaced with scar tissue -> fibrosis.
58
What is the Pathophysiology of cirrhosis?
1. Inflammation
2. Fibrosis and scarring -> portal HTN, splenomegaly, varices, decreased bilirubin matabloism -> increased unconsummated bilirubin (remains fat soluble) -> jaundice
3. Decreased bile in the GI -> light/clay colored stool
4. Decreased fat digestion -> decreased Vitamin K -> decreases clotting factors -> increases bleeding tendencies.
5. Increased urobilinogen -> concentrated dark urine.
6. Decreased protein hormones like angiotensinogen -> activates compensatory
7. Increased ammonia and presence of toxic substances -> encephalopathy
59
What are the treatment options for cirrhosis?
a. Beta Blockers
b. Nitrate
c. Diuretics
d. Lactulose
e. FFP
f. Neomycin/Metronidazole
60
What are adverse effects of diuretics?
Drop in Ca, take calcium supplements
61
What are the adverse effects of vitamin K?
a. Pain, swelling, soreness @ injection site
b. Flushing, taste changes, dizziness, rapid heart beat
c. Sweating and SOB
d. Treats and prevents unusual bleeding by increasing body’s production of clotting factors.
62
What are the adverse effects of lactulose?
a. Gas, bloating, burping, stomach pain, cramps and nausea.
b. Serious side effects: excessive diarrhea, vomiting and muscle cramps/weakness.
c. Is a laxative -> traps toxic compounds in the colon; loosens or increases frequency in stools
63
What causes a UTI?
Most common pathogen: E. Coli
64
What are kidney stones?
a. Masses of crystals, protein or other substances form within and may obstruct the urinary tract.
65
What are the risk factors for kidney stones?
a. Family history
b. Dehydration
c. Diet (high in protein, sodium and sugar)
d. Overweight and obesity
e. Digestive Diseases and surgery (IBS, Chronic diarrhea, gastric bypass surgery)
f. Other medical conditions (Polycystic kidney disease, hyperparathyroidism)
g. Medications (diuretics and calcium based antacids)
66
What are the types of kidney stones?
1. Calcium or Phosphate
2. Struvite
3. Uric Acid
67
Calcium or Phosphate Renal Calculi
caused by idiopathic calcium absorption (hypercalciuria, hyperparathyroidism, plus prolonged immobilization)
68
Struvite Renal Calculi
Includes Mg, Ammonium and Phosphate; Forms into alkaline urine during infection.
69
Uric Acid Renal Calculi
Excessive amount from endogenous purines and food; Consistent acidic urine increases risk.
70
What is a UTI?
Inflammation of the urinary epithelium caused by bacteria.
| Most common - bladder (cystitis)
71
What are the clinical manifestations of a UTI?
a. Often asymptomatic
b. Frequency, Urgency
c. Dysuria
d. Suprapubic/low back pain
e. Severe Symptoms: Hematuria, Cloudy Urine and Flank Pain
72
What is the Pathophysiology of a UTI?
..
73
What are drugs used to treat UTIs?
Bactrim (Sulfonamides)
| Macrobid (Nitrofurantoin)
74
What is sulfonamide?
Antibiotic
Bacteriostatic - Inhibits bacterial growth by inhibiting folic acid synthesis
Patient use drink lots of fluid to avoid crystallization which would add more problems (masses of protein in urine -> obstruction)
75
What are fluoroquinolones?
First line antibiotic
Bactericidal
Inhibits DNA gyrase
76
Levofloxacin
Fluoroquinolone
77
Ciprofloxacin
Fluoroquinolone
78
What are adverse effects of sulfonamide?
Rashes: **Stevens Johnson Syndrome, Severe reaction to medication
Component of crystallization: may cause calculi -> obstruction
79
What are adverse effects of fluorquinolones?
CNS: Headache, dizziness, insomnia, depression, restlessness, convulsions, neuropathy
GI: Nausea, constipation, increased AST and ALT levels, flatulence, heartburn, vomiting, diarrhea, oral candidiasis, dysphagia
Integumentary: Rash, pruritus, urticaria, flushing
Other: RUPTURE OF TENDONS AND TENDONITIS**, fever, chills, blurred vision, tinnitus
Prolonged QT interval
80
What is pyridium?
Is a urinary analgesic.
Local analgesic effect in bladder wall.
Relieves UT pain and symptoms.
81
What are adverse effects of pyridium?
Will cause tinted urine -> normal finding!
82
Define Acute Cystitis
Inflammation of the bladder.
83
What are the clinical manifestations of acute cystitis?
a. Frequency
b. Dysuria
c. Urgency
d. Lower abdominal and/or Suprapubic pain
84
What are the treatment options for acute cystitis?
a. Amoxicillin
b. Cephalosporins
c. Ciprofloxacin or Levofloxacin
d. Doxycycline
e. Nitrofurantoin (Macorbid)
f. Sulfonamides (Bactrim)
85
Define acute pyelonephritis
a. Infection of the renal pelvis and interstitium.
86
What are the clinical Manifestations of acute pyelonephritis?
a. Acute onset of symptoms
b. Fever/chills
c. Flank/groin pain
d. N/V
e. Symptoms of UTI
87
What is the Pathophysiology of acute pyelonephritis?
a. Check Exam 2: Urinary Tract Disorders on Brainscape for Pathophysiology
88
What drugs are used to treat acute pyelonephritis?
a. *Fluoroquinolones (Levofloxacin or Ciprofloxacin)
b. *Sulfonamides (Bactrim DS)
c. PCNs
d. Cephalosporins
e. Aminoglycosides (Gentamycin)
89
What are the contraindications of sulfonamides?
Sulfa allergy
| Pregnant women and infants younger than 2 months of age.
90
What are contraindications of fluorquinolones?
Allergy to quinolone
91
Urinalysis indicates
i. Specific Gravity
ii. Urinary pH
iii. Hematuria
iv. Proteinuria
v. Glycosuria
vi. Ketonuria
vii. Nitrates
viii. Leukocytes
92
What is specific gravity?
Patient’s hydration status.
93
Normal range for specific gravity.
1.003-1.030
94
Specific Gravity: Dehydration Range
> 1.020
95
Urinary pH is used to diagnose
Dx UTIs, calculi and renal tubular acidosis.
UTI with alkaline = struvite calculi
Acidic = uric acid calculi
Bacteria creates alkaline urine
96
What are the cause of hematuria?
Hematuria has various causes: glomerular, renal, and urologic (calculi, infections).
97
What causes proteinuria?
..
98
Renal Regulation
a. Kidneys regulate fluid volume, electrolytes and acid-base balance.
99
Kidneys secrete
renin, erythropoietin and calcitrol
100
Calcitrol
Is an active form of Vitamin D for homeostasis.
101
What is the purpose of nephrons?
a. Functional unit of the kidney that forms the final urine product.
102
Functions of the nephron include:
i. Filters plasma at glomerulus.
ii. Reabsorption and secretion of different substances along the tubular structures.
iii. Forms a filtrate of protein-free fluid.
iv. Regulates the filtrate to maintain body fluid volume, electrolyte composition and pH.
103
What is the purpose of the glomerulus?
Tuft of capillaries that loop into Bowman’s Capsule. Forms primary urine.
104
Glomerular filtration membrane
Filters blood.
105
What are the renal function tests?
a. Estimated Glomerular Filtration Rate
b. Plasma Creatine
c. Blood Urea Nitrogen
d. Potassium (serum)
106
What is eGFR?
Best estimate of functioning renal tissues.
107
As GFR decreases, what happens to plasma creatinine?
It increases.
108
When GFR decreases, what happens to BUN?
It increases.
109
Glomerular Disorders
a. Affects kidney function by attacking the glomeruli (where blood is cleaned).
110
Glomerular Disorders include
Glomerulonephritis and Glomerulosclerosis
111
What can cause glomerular disorders?
i. Acute post-streptococcal glomerulonephritis
ii. Bacterial endocarditis
iii. Diabetes: diabetic neuropathy
iv. SLE
112
What is glomerulonephritis?
a. A group of disease that injure the part of the kidney that filters blood (glomeruli).
113
What are the clinical manifestations of acute glomerulonephritis?
i. Infection in throat or on skin
ii. Puffiness of face in the morning
iii. Blood in urine (or brown urine)
iv. Urinating less than usual.
v. SOB and cough (d/t excess fluid in lungs)
114
What are the clinical Manifestations of chronic glomerulonephritis?
i. May develop without symptoms over several years. Often leads to complete kidney failure.
ii. Hematuria and proteinuria
iii. Decreased urine output accompanies decreased eGFR
iv. Fluid retention: High BP and Edema
v. Frequent urination at night (nocturia)
vi. Very bubbly or foamy urine
vii. Lack of appetite
viii. N/V
ix. Fatigue
x. Difficulty sleeping
xi. Dry/itchy skin
xii. Nighttime muscle cramps
115
What is the Pathophysiology of glomerulonephritis?
Injury to the body ->
Forms antibody against antigen ->
But instead of antibody breaking down the antigen ->
Formation of antigen-antibody complexes ->
Complexes deposit within glomerular membranes ->
Damage of glomerular network ->
Loss of function
116
Define Nephrotic Syndrome
a. AKA Nephrosis
b. Happens when the kidneys start losing large amounts of protein in urine.
c. Includes an excretion of > 3.5 g or more of protein in the urine per day
117
What are the clinical manifestations of nephrotic syndrome?
a. Hypoalbuminemia
b. Edema
c. Hyperlipidemia
d. Proteinuria
e. Vitamin D Deficiency
118
What is the Pathophysiology of nephrotic syndrome?
Disturbance in the glomerular basement membrane -> increases permeability of protein and loss of electrical negative charge -> hyperalbuminemia (d/t urinary loss of albumin and diminished synthesis of replacement albumin in the liver)
119
What is used to treat nephrotic syndrome?
a. Normal Protein Diet (1g/kg/day)
b. Low fat, Low salt diet
c. Treat HTN and Edema (Diuretics, CCB, ACEI, ARBs, corticosteroids)
120
Define Acute Renal Failure/Acute Kidney Injury
a. Sudden decline in kidney function.
b. Decrease in GFR.
c. Accumulation of waste products in the blood.
121
What is prerenal AKI?
a. Most common cause of AKI.
b. Decreased renal function with increased BUN and creatinine. (Caused by impaired renal blood flow)
c. GFR declines (d/t decrease in filtration pressure)
122
What are the causes of prerenal AKI?
i. Hypovolemia
ii. Hypotension
iii. Shock
iv. Hemorrhage
v. MI with poor cardiac output
vi. Left ventricular failure
123
What is intrarenal AKI?
a. Caused by impaired blood flow within the kidney.
| b. Is a result of direct damage to the kidney including ischemia or inflammatory damage.
124
What is the most common cause of intrarenal AKI?
Acute tubular necrosis
125
Other causes of intrarenal AKI include:
i. Glomerulonephritis
ii. Malignant HTN
iii. Disseminated Intravascular Coagulation (DIC)
iv. Renal Vasculitis
126
What is the postrenal AKI?
a. Caused by impaired outflow from the kidney.
b. Urine is unable to pass d/t obstruction (urine backs up into the renal pelvis and changing pressures within the kidney)
127
What are causes of postrenal AKI?
i. Kidney stones
ii. Bladder outlet obstruction
iii. Enlarged prostate
128
What are examples of nephrotoxic?
```
Aminoglycosides
Amphotericin B
ACE Inhibitors*
NSAIDs*
Cyclosporine/Tacrolimus
Foscarnet
Pentamidine
Radiographic contrast agents*
Cisplatin/carboplatin
```
129
Define Chronic Renal Failure/Chronic Kidney Disease
a. The irreversible loss of renal function that affects nearly all organ systems.
b. Includes conditions that damage the kidneys and decrease their ability to keep you healthy.
130
What is the pathophysiology of chronic kidney failure?
- Injury -> irreversible d/t already lost nephrons
- Loss of nephrons -> Ang 2 and renin release
- High Ang 2 levels lead to -> vasoconstriction
- HTN in kidneys -> increased permeability
- Injury to kidney -> scarring -> fibrosis
131
What are the clinical Manifestations of chronic kidney failure?
a. Fatigue
b. Trouble concentration
c. Poor appetite
d. Trouble sleeping
e. Muscle cramps at night
f. Swollen feet/ankles
g. Puffiness around eyes especially in the morning
h. Dry/itchy skin
i. Needs to urinate more often especially at night
132
What are Complications of renal failure?
- Fatigue, weakness
- Fractures (d/t decrease in Vitamin D not bein able to absorb calcium)
- HTN, edema
- Decrease EPO -> anemia
- Weak immunity
- Ammonia, urea and nitrogenous substances have affinity to CNS
- Irritation -> neuropathy -> if severe -> confusion and decreased LOC
- N/V, Not eating well
- Crystal formation on skin
133
What is the pathophysiology of complications of renal failure?
..
134
What is the treatment used to manage complications of renal failure?
- Attempt to cure causes of dysfunction (can cure acute but NOT chronic)
- Diuretics to increase urine output
- Cardiovascular drugs to treat HTN and HF
- Dietary Management: Restriction of protein, salt and water; Reduction of Na, K, phosphorus and Mg
135
What are diuretic classes used to treat renal failure?
a. Potassium Sparing Diuretics: Spironolactone and Aldactone
b. Loop Diuretics: Furosemide
c. Thiazide Diuretics: Hydrochlorothiazide
136
Define loop diuretic - furosemide.
Increases rate of urine flow. Excretion of excess fluid.
137
Define potassium-sparing diuretics.
a. Diuresis without affecting blood potassium levels.
| b. Used to significantly reduce mortality in heart failure.
138
Define thiazide diuretics
Used to treat mild to moderate HTN. Also indicated to reduce edema associated with HF, severe renal and hepatic failure.
139
Define mannitol
Osmotic diuretic
| Given for pt. With head trauma and cerebral edema. (Decreases ICP)
140
What is the MOA of loop diuretics?
Acts in the loop of Henle and prevents reabsorption of Na and water in the kidneys.
141
What is the MOA of potassium-sparing diuretics?
Either by blocking sodium or by blocking aldosterone.
142
What is the MOA of thiazide diuretics?
Blocks sodium absorption in distal convoluted tubule of nephron.
143
What are the adverse effects of loop diuretics?
a. Orthostatic Hypotension
b. Hypokalemia - dysrhythmias
c. Hyponatremia
d. Polyuria
e. Rash or pruritus
f. Ototoxicity
144
What are the adverse effects of potassium-sparing diuretics?
Hyperkalemia
145
What are the adverse effects of thiazide diuretics?
a. Dehydration
b. Orthostatic Hypotension
c. Hypokalemia
146
What are the nursing implications for loop diuretics?
a. Take medications in the morning
b. Change positions slowly
c. Monitor weight
d. Take potassium supplements and consume potassium rich foods.
147
What are the nursing implications for potassium-sparing diuretics?
a. Spironolactone may decrease effectiveness of anticoagulants
b. Clients taking lithium or digoxin may be at increased risk for toxicity.
c. Report S&S of hyperkalemia.
148
What are the nursing implications of thiazide diuretics?
a. Use sunscreen to decrease photosensitivity.
b. Take K+ supplements as ordered; consume K+ rich foods
c. Report any tenderness or pain in joints (may cause hyperuricemia.. gout like conditions)
149
Methotrexate
Inhibits lymphocyte multiplication.
| Can be used to treat psoriasis and RA.
150
Entanercept
b. Treats psoriasis and RA.
| c. PATIENTS MUST BE SCREEN FOR LATEX ALLERGY. SOME DOSAGE FORMS MAY CONTAIN LATEX.
151
Side effects of Mannitol
```
Electrolyte Disturbances
Fatigue, N/V
Dizziness
Hyponatremia
Edema
Convulsions
Tachycardia
```
152
Triamterine is contraindicated in
Lactating women
153
Adverse effects of Amantadine
```
Insomnia
Nervousness
Lightheaded ness
Anorexia, Nausea
Anticholinergic Effects
Orthostatic Hypotension
Blurred vision
```
