exam 3

Question 1

Lithium-indications

Answer 1

-manic episodes of bipolar disorder

Question 2

Lithium- MOA

Answer 2

• alters cation transport in nerve and muscle

- may also influence re uptake of neuron transmitters

Question 3

Lithium contraindications

Answer 3

• Hypersensitivity;
• Severe cardiovascular or renal disease;
• Dehydrated or debilitated patients;
• Sodium depletion;
• Brugada syndrome;
• Should be used only where therapy, including blood levels, may be closely monitored;
• Some products contain alcohol or tartrazine and should be avoided in patients with known hypersensitivity or intolerance;
• Lactation.

Question 4

Lithium- Adverse reactions

Answer 4

• Seizures,
• fatigue,
• headache,
• impaired memory,
• ECG changes,
• abdominal pain,
• anorexia,
• bloating,
• diarrhea,
• nausea,
• polyuria,
• acneiform eruption, *hypothyroism,
• lukocytoisis,
• muscle weakness,
• tremors

Question 5

Lithium- drug interactions

Answer 5

• Diuretics
• NSAIDS
• Ace inhibitors
• ARBs
• May prolong the action of neuromuscular blocking agents
• Hypothyroid effect

Question 6

Lithium Toxicity

Answer 6

Toxicity

Therapeutic range: 1-1.5 mEq/L, > 1.5-2.5 mEq/L toxicity starts to occur

Question 7

Lithium Toxicity Signs and Symptoms

Answer 7

Vomiting
diarrhea
slurred speech
decreased coordination
drowsiness
muscle weakness 
twitching

Question 8

Lithium implimentatin

Answer 8

do not crush or chew

administer with milk or food to minimize GI irritation

Question 9

Lithium Pt teaching

Answer 9

-take as directed
-may cause dizzies or drowsiness
-drink 2000-3000 ml of fluid
avoid coffee and caffeine
-notify provider of fever -vomiting or diarrhea
-weight gain may occur
-notify provider of fainting, difficulty breathing or irregular pule
-regular lipid panels

Question 10

Phenytoin MOA

Answer 10

• limits seizure propagationin by altering ion transport
• may also decrease synaptic transmission
• arrhythmic properties

Question 11

phenytoin- indications

Answer 11

treatment of tonic-clonic seizuers and complex partial seizures

Question 12

Phenytoin- contraindicated

Answer 12

hystory of hepatoxicity
-bradycardia, 2nd degree 3rd degree heart block
pregnancy

Question 13

Phenytoin-Adverse reactions

Answer 13

Suicidal thoughts
ataxia
diplopia
nystagmus
hypotention
acute hepatic failre
gingival hyperplasia
nausea
steven-johnss syndrom
toxic epidermal necrolysis 
agranulocitosis
aplastic anema
drug reaction with eosinophila and systemic symptoms

Question 14

phenytoin drug interactions

Answer 14

amiodarone, benzoazepines, capeciitabine, chlodiazepoxide, cimetiding

Question 15

phenytoin- assessment

Answer 15

• changes in behavior
• suicidal thoughts
• hypersensitivyt syndrome (fever, skin rash, lymphadnopahty
• development of rash
• toxic epidermis necrolysis

*monitor CBC, serum calcium, albumin, and hepatic functions

Question 16

Phenytoin-pt teaching

Answer 16

• take medication as directed
• may cause drowsiness
• good dental hygiene
• ****Instruct patients that behavioral changes, skin rash, fever, sore throat, mouth ulcers, easy bruising, petechiae, unusual bleeding, abdominal pain, chills, pale stools, dark urine, jaundice, severe nausea or vomiting, drowsiness, slurred speech, unsteady gait, swollen glands, or persistent headache should be reported to health care professional immediately. Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.

Question 17

CarBAMazepine-Indications

Answer 17

Treatment of tonic-clonic, mixed and complex partial seizers
mgmtn of trigeminal neuralgia
acute manic or mixed episodes assoiciated with bipolar disorder

Question 18

CarBamazepine- MOA

Answer 18

Decreases synaptic transmission in the CNS by affecting sodium channels in neurons.

Question 19

CarBamazepine-contra indication

Answer 19

bone marrow suppression

within 14 days of MAO inhibitors