Exam 3 Material Flashcards

Question

Antidiuretic Hormone (ADH)

Answer 1

* Component in fluid homeostasis * Desmopressin (DDAVP) and vasopressin are medications that mimic ADH

Answer 2

A little urine that is very concentrated

Answer 3

A lot of urine; can become very dehydrated; will give lots of fluids

Answer 4

Antidiuretic hormone

Answer 5

* Diabetes insipidus * von Willebrand's disease (blood clotting disorder) * Bet wetting

Answer 6

Acts on the kidneys to reabsorb water; controls bleeding in certain clotting disorders; contraction of smooth muscle in vascular system

Answer 7

* Drowsiness * Headache * Symptoms of water intoxication (edema, weight gain, HTN, hyponatremia/low serum sodium [diluting]) * With low sodium - worry about seizures/comatose

Answer 8

* Closely monitor intake and output, fluid volume status, urine specific gravity * Use with caution in clients with renal disease, hyponatremia, HTN * Available PO, intranasal spray, SC, IV

Answer 9

* The thyroid gland affects basal metabolic rate; growth and development in children * Thyroid hormones affect almost every cell in the body * The thyroid hormones consist of triiodothyronine (T3) and tetraiodothyronine (T4) * Iodine is required for synthesis of thyroid hormones * Disorder results from either hyper- or hypo-function of thyroid gland; arising from thyroid disease, or abnormalities of piututary gland or hypothalamus * TSH is a common lab value we look at * T3 is the more effective/active hormone * T4 is typically given and it needs to be converted into T3 * T3 has a shorter half life than T4

Answer 10

* Intolerance to cold * Receding hairline * Facial and eyelid edema * Dull-blank expression * Extreme fatigue * Thick tongue - slow speech * Anorexia * Brittle nails and hair * Menstural disturbances * Hair loss * Apathy * Lethargy * Dry skin (coarse and scaly) * Muscle aches and weakness * Constipation * Late clinical manifestations * Subnormal temp * Bradycardia * Weight gain * Decreased loss of consciousness * Thickened skin * Cardiac complications

Answer 11

* Intolerance to heat * Fine, straight hair * Bulging eyes * Facial flushing * Enlarged thyroid * Tachycardia * Increased systolid BP * Breast enlargement * Weight loss * Muscle wasting * Localized edema * Menstrual changes (amenorrhea) * Increased diarrhea * Tremors * Finger clubbing

Answer 12

Thyroid hormone replacement

Answer 13

Thyroid hormone

Answer 14

Hypothyroidism

Answer 15

Synthetic T4; increases metabolic rate of body tissues

Answer 16

Symptoms of hyperthyroidism * Tachycardia * Anxiety * Insomnia * Weight loss * Heat intolerance * Diaphoresis * Menstrual irregularities

Answer 17

* Administer 30-60 min before breakfast (empty stomach; prevent insomnia) * Narrow therapeutic range, blood levels monitored * Long half-life, given once a day * Steady state is achieved in 6-8 weeks * Many drug interactions * Use with caution in elderly with heart disease (start low and slow) * Educate clients that this is a life-long therapy (does not cure hyperthryoidism) * Monitor TSH levels * There is an IV formulation

Answer 18

Low T4 High TSH

Answer 19

* Methimazole (Tapazole) is used for hyperthyroidism; often prior to thyroidectomy or radioactive iodine therapy (I-I#I) * Interferes with synthesis of T3 and T4 * Adverse effects: * Symptoms of hypothyroidism * Hetpatotoxicity * Bone marrow suppression (decreased white blood cells, red blood cells, platelets) * Seond line drug therapy for hyperthyroidism is propylthiouracil (PTU)

Answer 20

Adrenal gland secretes three class of steroid hormones * Glucocorticoids (ex. cortisol) - sugar * Mineralocorticoids (ex. aldosterone) - salt * Androgens/gonadocorticoids (ex. testosterone) - sex

Answer 21

* Examples: hydrocortisone (Solu-Cortef), methylprednisone (Solu-Medrol), cortisone, prednisone, dexamethasone (Decadron) * Can be used to manage adrenal insufficiency (due to Addison's disease, sudden withdrawal of corticosteroids, or insufficient amounts in the critically ill * Too much can cause Cushing's disease or Syndrome Symptoms * Too little can cause Addison's disease

Answer 22

* Deficiency in insulin secretion, or a decreased sensitivity of insulin receptors, leading to elevated blood glucose levels (hyperglycemia) * Normal blood glucose is 70-110 * Insulin allows glucose to enter cells in order to be used for energy (major energy source) * If insulin is not avilable to facilitate the entry of glucose into the cells, the body then metabolizes lipids as a source of energy, leading to a state of acidosis

Answer 23

* Three Ps * Polydipsia - thirst * Polyphagia - hunger * Polyuria - frequent urination * Headache * Difficulty concentrating * Blurred vision * Decreased vision * Weight loss * Vaginal or skin infections * Delayed wound healing * Erectile dysfunction * Painful or insensitive feet * Cold feet * Chronic constipation or diarrhea * Fatigue

Answer 24

* Usually sudden onset * Pale, cool, moist skin * Hunger * Dizziness * Decreased LOC * Confusion, slurred speech * Loss of consciousness * Coma * Double or blurred vision * Seizures * Palpitations * Tachycardia * Anxiety

Answer 25

* Goal: prevent long term consequences * Disease of childhood (juvenile-onset); insulin dependent diabetes mellitus * 1/4 are adults * Autoimmune destruction of pancreatic cells * Pancreas can't secrete insulin (insulin must be administered) * Etiology - genetic, immunologic, and environmental factors * Fasting blood sugar \> 126 on 2 separate occassions * Symptoms: * Polyuria * Polyphagia * Polydipsia * Glucosuria * Weight loss * Fatigue * Diabetic ketoacidosis * Long term: * Heart disease * Stroke * Kidney failure * Blindness * Neuropathy of extremities * Impaired wound healing * Amputations

Answer 26

* Previously called adult-onset * Increasing larger number of children are getting it * Pancreas secretes insulin, but usually in small amounts; insulin receptors in target tissues are unresponsive (insulin resistance) * Can regain sensitivity through diet and exercise * Treated with antidiabetic first, insulin if necessary * Overweight, low HDL cholesterol, high triglycerides, hyperosmolar hyperglycemic state (HHS) * May be asymptomatic * Long term: as cells become more resistant, blood glucose levels rise and pancrease hypersectreiton of insulin leads to beta cell death * Same physical effects as with Type I * More common than Type I

Answer 27

* Around the 24th week of pregnancy, women who have never had diabetes develop hyperglycemia * Incidence as high as 9.2% * Unknown cuase, but believed to be due to increased hormones from the placenta that block the mother's insulin leading to insulin resistance; mother may need as much as 3 times normal insulin * High blood glucose in mother effects unborn chlid by crossing the placenta and stimulating the baby's pancreas to secrete large amounts of insulin leading to macrosoma (fat baby) * Long term: mother usually ok after birth; baby can have hypoglycemia and respiratory complications at birth * Increases child's risk of obesity and adult type II diabetes mellitus

Answer 28

* Produced from human recombinant DNA rechnology; effective, few allergic reactions, little resistance * Insulins are mofied for rapid, short, intermediate, or long onset of action * Must individualize doses of insulin for maximum control * Those with latex allergies - one punctire before vial needs to get tossed * Don't hold basal level of insulin even in NPO unless levels are really low * Insulin is destroyed by the acids in the GI tract, so it must be injected SQ or given IV * HA1C - blood test that gives a percentage that shows how well glucose has been managed over the last 3 months * Insulin pump is programmed to release insulin at predetermined intervals throughout the day, may also be used to deliver bolus dose

Answer 29

* Action: rapid * Onset: 15 min * Peak: 1-3 hours * Duration: 3-5 hours * Administration: SQ 5-10 min before meals * Compatibility: Can give with NPH - draw up first and give immediately

Answer 30

* Action: rapid * Onset: 5-15 min * Peak: 0.5-1 hour * Duration: 3-4 hours * Administration: SQ 5-10 min before meals * Compatilibility: Can give with NPH, draw up lispro first and give immediately

Answer 31

Action: rapid Onset: 15-30 min Peak: 1 hour Duration: 3-4 hours Administration: SQ 15 min before min or within 20 min of starting Compatilibility: Can give with NPH, draw up glulisine first and give immediately

Answer 32

Action: short Onset: 30-60 min Peak: 2-4 hours Duration: 5-7 hours Administration: SQ 30-60 min beofre meals; IV in emergency Compatilibility: Can give with NPH

Answer 33

Action: intermediate Onset: 1-2 hours Peak: 4-12 hours Duration: 18-24 hours Administration: SQ 30 min before meals Compatilibility: Can mix with aspart, lispro, or regular; mix clear (regular) to cloudy (NPH)

Answer 34

Action: long Onset: gradual over 24 hours Peak: 6-8 hours Duration: up to 24 hours Administration: SQ 1 time a day; evening meal or before bedtime Compatilibility: do not mix with any other insulin

Answer 35

Action: long Onset: gradual over 24 hours Peak: no peak Duration: up to 24 hours Administration: SQ 1 time a day, same time each day Compatilibility: do not mix with any other insulin

Answer 36

* -og * 15 min onset * 1 hour peak * Can mix with NPH

Answer 37

* -in * 30 min onset * 3 hour peak * Can mix with NPH

Answer 38

* NPH * Onset 30-60 min * Peak 1-2 hours * Can mix with short and rapid insulin

Answer 39

Hormone, drug for diabetes

Answer 40

Hypoglycemic

Answer 41

Treatment of hyperglycemia, treatment of acute ketoacidosis, treatment of hyperkalemia (off-label use)

Answer 42

Short acting insulin; promotes entry of glucose into cells for use as energy

Answer 43

* Hypoglycemia * Tachycardia * Confusion * Sweating * Restlessness * Coma and death if severe hypoglycemia is untreated * Hypokalemia

Answer 44

* Can be given IV or SQ * Only use insulin syringe * Administered 30 min before meal

Answer 45

* Lumps (lipohypertrophy) below the surface of the skin from repeated insulin injections into the same area * May be mildly painful and can change the timing or completeness of insulin action

Answer 46

* Only use approvd calibrated syringes * Opened insulin vials can be stored at room temperature, out of sunlight and excessive heat for up to 1 month * Mark date opened and expiration day 28 days after on the bottle * Don't use if precipitate forms in vial * Draw up "clear to cloudy" when mixing insulins * Check blood sugar levels before administering * Give before meals if rapid, short, or intermediate acting * Rotate injection site - do not inject in raised, swollen, itchy areas * Increase frequency of glucose monitoring with fever, N/V, diarrhea * Hba1c is a lab value that indicates average glucose levels over the past 3 months * Pregnancy category B

Answer 47

* Obesity * Fat distribution in abdomen * Dyslipidemia * Sedentary lifestyle * Family history * Race * Age * Pre-diabetes * Gestational diabetes * Polycystic ovarian syndrome

Answer 48

* Lower blood glucose, some may cause hypoglycermia * Not effective for Type I diabetes * Multiple class, start with one and add on as necessary * Failure to achieve results with 2 drugs may require a 3rd oral med or insulin

Answer 49

Antidiabetic

Answer 50

Type II diabetes (first line drug)

Answer 51

Decrease hepativ production of glucose and reduces insulin resistance Benefits is that it does not cuase hypoglycemia; also lowers triglyceride and LDL and promotes weight loss)

Answer 52

* N/V * Diarrhea * Abdominal bloating * Metallic taste

Answer 53

Increased risk of lactic acidosis (may be fatal) with liver/renal disease, excess alcohol intake, or serious infection

Answer 54

* Contraindicated with impaired renal function, heart failure, liver failure, serious infection * Must be held 2 days before and after receiving IV contrast * In emergency, will do the contrast and then hold metformin and will monitor

Answer 55

* 1st and 2nd generations equally effective in lowering glucose levels * 2nd generation as fewer drug-drug interactions * Stimulate release of insulin and increase sensitivity of insulin receptors on target cells * Adverse effects: * Hypoglycemia * Weight gain * GI distress * Hypersensitivity reactions (caution if hypersensitivity to sulfonamide drugs) * Hepatotoxicity * Taken with alcohol: flushing, palpations, nausea

Answer 56

* Neurodegenerative diseases cause degeneration and/or death of neurons; results in problems with movement and/or cognitive functioing * Chronic * Progesive * Debilitating * Examples: Parkinsons, Alzheimer's Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Huntington's * Goals of pharmacotherapy: slow progression of disease, provide symptom relief

Answer 57

* Low levels of dopamine due to loss of dopamine producing neurons * Acetylcholine works in conjunction with dopamine to produce smooth muscle movement * Results in decreased smooth muscle movement * Symptoms often include tremors, muscle rigidity, bradykinesia (slow movement), impaired balance/coordination, shuffling gait, pill-rolling

Answer 58

* Dopaminergic medications * Dopamine replacement therapy * Helps with motor symptoms * Levodopa (L-dopa) is first line therapy Given in gombination with carbidopa (peripheral decarboxylase inhibitor) * Prevents it from converting to dopaine systemically - helps reduce adverse effects of having increased dopamine in the peripherals) * Levodopa is a precursor to dopamine * Levodopa crosses the blood-brain barrier (dopamine does not) * Other drug classes that increases dopamine levels: * MOA-B: inhibits the breakdown of dopamine * COMT inhibitors: inhibits the breakdown of dopamine

Answer 59

Antiparkinson agent

Answer 60

Dopamine agonist

Answer 61

Parkinson's disease

Answer 62

Levodopa is converted to dopamine in the CNS where it serves as a neurotransmitter Carbidopa prevents peripheral destruction of levodopa Relieves tremor and rigidity

Answer 63

* Uncontrolled and purposeless movements * N/v * Orthostatic hypotension * Dark urine/sweat * Hepatotoxicity * Cardiac arrhythmias * Psychosis

Answer 64

* Monitor liver function * Instruct clients to rise slowly when standing * Taking with high protein foods may decrease absorption of the medication * Vitamin B6 promotes breakdown of levodopa * Avoid abrupt withdrawal of medication

Answer 65

* Block acetylcholine, inhibiting over-activity * Help in controlling tremors * Adverse effects include dry mouth, blurred vision, urinary retention, constipation, tachycardia * Example: benztropine (Cogentin) * This medication is also used to relieve extrapyramidal symptoms associated with antipsychotic medications

Answer 66

* Form of dementia (progressive memory loss, confusion, and inability to think or communicate effectively) due to loss of functioning neurons * Characterized by: * Neurofibrillary tangles * Beta-amyloid plaques

Answer 67

* Therapy started as soon as client is diagnosed * May discontinue in later stages of disease due to number of damaged neurons (risk outweights benefits) * Medications may provide symptom relief and slow disease progression * Cholinesterase inhibitors * Acetylcholine deficiency is thought to be partly responsible for cognitive decline and behavioral changes * Examples: donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne) * Glutamatergic inhibitors * Thought to slow intracellular calcium accumulation and thereby help prevent further nerve damage * Example: memantine (Namenda) * Adjunct therapies for secondary symptoms, such as depression, agitation, aggression, hallucinations, delusions, and sleep disorders

Answer 68

Anti-alzheimer's agent

Answer 69

Acetylcholinesterase inhibitor

Answer 70

Alzheimer's disease

Answer 71

Inhibits acetylcholinesterase, making more acetylcholine available; enhances effects of acetylcholine in neurons that have not yet been damaged, improving memory and cognition in mild to moderate dementia

Answer 72

* N/V * Diarrhea * Poor appetite * GI bleeding * Abnormal dreams * Muscle cramps

Answer 73

Can take weeks to notice any effect, maximum benefit may take up to 6 months Administer at bedtime

Answer 74

* Overuse of muscle * Injury * Dehydration * Electrolyte abnormalities * Adverse effect of antipsychotics * Neurological disorders (stroke, cerebral palsy)

Answer 75

* Nonpharmacologic * Heat/cold, exercise, massage, complementary therapy * Pharmacologic * Analgesics * Anti-inflammatory * Skeletal muscle relaxants

Answer 76

Skeletal muscle relaxant

Answer 77

GABA_B receptor agonist

Answer 78

Muscle spasticity

Answer 79

GABA_B receptor agaonist; general CNS depression; exact MOA is unkown (thought to inhibit transmission or mono/polysynaptic reflexes)

Answer 80

* Hypotension * N/V * Constipation * Poor muscle tone * Dizziness * Sedation

Answer 81

* Avoid activities requiring mental alertness until effects are known * Avoid alchol and other CNS depressants * Avoid stopping abruptly * May be administered via intrathecal pump

Answer 82

* Asymptomatic until fracture occurs * Secondary to: * Lack of vitamin D and calcium * Bone resorption \> bone deposition * Most common risk factor is menopause * Decreased estrogen levels leads to increased bone demineralization (resorption) * Corticosteroids * Birth control (certain types)

Answer 83

1 in 2 women 1 in 5 men

Answer 84

* Early intervention may prevent osteoporosis * Treatment of already established osteoporosis may halt progression * Calcium, vitamin D * Calcitonin * Given SQ or nasall * Can be used for people with too much calcium in the bloodstream * Bisphosphates * SERMS (selective estrogen receptor modulators)

Answer 85

* Most common class of drug used for osteoporosis prevention and treatment * Inhibits bone resorption by suppressing osteoclast activity (increasing bone density) * Adverse effects: * Bone pain * Abdominal pain * Esophageal irritation * Nursing impplications: take on an empty stomach with a full glass of water, remain upright for 30 minutes, long duration of action (may be given daily, once a week, or once a month) * Examples: alendronate (Fosamax), ibandronate (Bonvia)

Answer 86

* Prevention and treatment of osteoporosis in postmenopausal women * Decreases bone resorption through estrogen receptors, increasing bone density * Also used for breast cancer prevention * Lowers cholesterol * Black box warning: increased risk of DVT, pulmonary embolism, increased risk of stroke in those with heart disease * Example: raloxifene (Evista)

Answer 87

Inflammation and stiffness of joint (painful)

Answer 88

Erosion of cartilage at joint surface(s) Most often affects weight bearing joints due to wear and tear (knees, spine, hips)

Answer 89

* Auto-immune disease * Leads to inflammation and disfigurement of multiple joints * Systemic effects

Answer 90

* Goal of therapy is to decrease pain and inflammation * Topicals (capsaicin, NSAIDS) * Acetaminophen - first line * NSAIDS (oral) - anti-inflammatory * Tramadol * Corticosteroid injections for flare ups * DMARDs (biologic and nonbiologic)

Answer 91

* Most important class of medication for successful treatment * Clients may be "bridged" with analgesic, anti-inflammatory, or corticosteroid medications until DMARDs take effects * Can take several months before maximum benefit is achieved

Answer 92

* Methotrexate * Lefunomide (Arava) * Sulfasalazine (SSZ, Azulfidine) * Hydroxychloroquine (HCQ, Plaquenil) * Azathiopine, cyclosporine

Answer 93

* TNF antagonists * Etanercept (Enbrel) * Adalimumab (Humira) * Infliximab (Remicade) * Certolizumab pegol (Cimzia) * Golimumab (Simponi) * Abatacept (Orencia) * Rituximab (Rituxan) * Tocilizumab (Actemra) * Tofacitinib (Xeljanz)

Answer 94

* Anxiety is a state of "apprehension, tension, or uneasiness that stems from the anticipation of danger, the source of which is largely unknown or unrecognized" * Most common psychiatric diagnosis * Common cormorbidities include depression, alcohol abuse, and drug abuse * Imbalances in norepinephrine, serotonin, dopamine, and GABA are thought to contribute to symptoms of anxiety

Answer 95

Stressful environment or situation; can be motivational (take action)

Answer 96

Excessive anxiety lasting longer than 6 months; interferes with daily activities

Answer 97

Immediate feelings of apprehension, fearless, terror, impending doom

Answer 98

Fear associated with specific objects or situations

Answer 99

* Combination of: * Psychotherapy (cognitive behavior therapy, biofeedback, counseling, meditation) * Pharmacotherapy (anxiolytics) - when anxiety interferes with activities of daily life * Antidepressants (Selective Serotonin Reuptake Inhibitprs -SSRI) * CNS depressants (sedatives/hypnotics) * Benzodiazepines * Barbiturates * Miscellaneous medications

Answer 100

* Overlapping features between depressive disorders and anxiety disorders * May have initial worsening of anxiety, agitation, and irritability when treatment is started * Can take 4-6 weeks for full effects * Adverse effects noticed with initiation of therapy or dose changes typically resolve within days to weeks

Answer 101

* Used as an adjunct to antidepressants * Helpful for acute attacks, short term use * Can lead to physical and psycholigical dependence (withdrawal symptoms when stopped abruptly) * Benzodiazepines * Barbiturates * Miscellaneous medications

Answer 102

* Indications: anxiety, insomnia, seizures, muscle relaxation, sedation, induction of anesthesia, alcohol withdrawal * Intended for short term use * Useful in actue anxiety situations aor as a bridge until SSRI takes effect * Drugs in this class are similar in effect, but differ in their onset and duration of action * Intensify effects of GABA (inhibitory neurotransmitter) * Avoid use with other CNS depressants * Schedule IV * Reversal agent - flumazanil (Romazicon) * Examples: lorazepam (Ativan), diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax), midazolam (Versed)

Answer 103

* Indications: anxiety, insomnia, seizures * Replaced mostly by benzodiaepines due to safety profile * Serious adverse effects - respiratory depression, hypotension, shock * Intensify action of GABA * Schedule II * Withdrawal symptoms can be severe, even fatal * Examples: phenobarbital (Luminol), pentobarbital (Nembutal)

Answer 104

* Valproic acid (Depakene): indications include panic disorder, bipolar disorder, seizures, migraine prevention * Atenolol (Tenormin): indications include performance anxiety, social anxiety, HTN, myocardial infarction, angina * Buspirone (BuSpar): indications include generalized anxiety disorder, OCD, depression

Answer 105

* Seizure is a disturbance of electrical activity in the brain that may alter consciousness, motor activity, or sensation * Caused by abnormal neuronal discharges * May remain focal or move to other areas of the brain * Symptom of an underlying disorder

Answer 106

Seizure lasts too long or seizure recurs without recovery in btween (life threatening)

Answer 107

* Medications * Drug abuse/withdrawal (ETOH, sedatives) * Infection * Trauma * Hypoxia/altered perfusion * Tumor * Severe HTN in pregnancy (eclampsia) * Strobe/flickering lights * Electrolyte imbalances * High fever in children

Answer 108

Electric monitoring that measures and records electrical activity in the brain

Answer 109

* Depends on type of seizure and associated pathology * Started on one medication; dose is increased until seizure is controlled or adverse effects limit the dose * If a second drug is needed, the first drug is tapered off while the second drug is increased * Abrupt withdrawal of a medciation may precipitate seizures * Serum drug levels are often monitored * Other conditions may be treated with anti-seizure meducations: various psychiatric diagnoses, migraines, neuropathic pain, ADHD, PTSD (calms the nerves)

Answer 110

* Severl antiseixure drugs decrase effectiveness or oral contraceptives * Most anti-seizure drugs are associated with high fetal risk in pregnancy (Category D) * May require high doses of folic acid due to deficiency caused by medication * Encourage registration with antiepileptic drug pregnancy registry

Answer 111

* Prenatal exposure to valproid acid (depakene, depakote) durinf the first trimester * Distinctive facial features * Neural tube defects * Congenital heart disease * Cleft lip and/or palate * Genitourinary malformations * Tracheomalacia * Arm/hand defects * ARachnodactyly/overlapping digits * Abdominal wall defects * Intellectual impairment

Answer 112

* Goal is to suppress neuronal activity just enough to prevent abnormal firing * Influx of sodium or calcium increases neuronal activity * Influx of chlorine suppresses neuronal activity * Mechanism of action (one or more of the following): * Delay influx of sodium ions * Delay influx of calcium ions * Stimulate influc of chlorine ions (associated with the increasing action of GABA) * Classes of anti-seizure medications * Barbiturates * Benzodiazepines * Hydantoins * Succinimies * Many others

Answer 113

Anti-seizure drug, sedative

Answer 114

Barbiturate, GABA_A receptor drug

Answer 115

Seizure, sedation

Answer 116

Enhances GABA, suppressing abnormal neuronal discharges

Answer 117

* Drowsiness * Respiratory depression * Vitamin deficiencies (D, folate, B9, B12) * N/V

Answer 118

* Schedule IV drug * Pregnancy category D * Avoid use with other CNS depressants

Answer 119

CNS depression, coma, death

Answer 120

Anti-seizure drug, sedative, anxiolytic, skeletal muscle relaxant

Answer 121

Benzodiazepine, GABA receptor drug

Answer 122

* Seizure * Sedation * Anxiety * Muscle spasm * Alcohol, benzo withdrawal

Answer 123

* Enhances action of GABA, suppressing abnormal neuronal discharges

Answer 124

* Hypotension * Muscle weakness * Drowsiness * Respiratory depression * More pronounced adverse effects when given IV

Answer 125

* Schedule IV drug * Pregnancy category D * May take 1-2 weeks to reach max concentration when taken orally * Avoid use with other CNS depressants * Quick onset and lasts about 20 minutes awhen given IV * For short term use, can be given rectally

Answer 126

Anti-seizure drug, antidysrhythmic

Answer 127

Desensitizes sodium channels in CNS, preventing abnormal neuronal discharges

Answer 128

* Drowsiness * Nausea * Gingival hypertrophy * Hirsutism * Suicidal thoughts * Ataxia (lack of muscle coordination) * Hematologic toxicities (RBC, WBC, platelets)

Answer 129

* Many drug-drug interactions * Never administer IV in the same line as another drug or with dextrose solution (NS only) * Monitor drug levels * Can cause tissue necrosis if there is IV infiltration * IV administration requires a filter * Hold tube feeding for 2 hours before and after administration

Answer 130

* Typically, within 2 to 12 hours after infusion, erythema and blue-purple discoloration occur around the intravenous site, and there may be petechiae on the fingers and palms * 12 to 24 hours after infusion, spreading discoloration, edema, skin blistering, sloughing, and ulcerations may occur, with possible extension thereafter * Resolution may take weeks to months, with discoloration receding toward the original intravenous site

Answer 131

Related to circumstances, such as illness, divorce, loss of job, death of loved one, substance abuse, medication

Answer 132

Imbalance of neurotransmitters; genetic, hormonal, secondary to another condition such as traumatic brain injury or stroke

Answer 133

Related to change in seasons and not receiving as much sun

Answer 134

* Assess for causative factors, or other disease processes that mimic deprssion * psychotherapy * Pharmacotherapy * When depression is unresponsive to other therapies and become life threatening: * Electroconvulsive therapy (ECT) * Repeitive treancranial stimulation (rTMS) * Vagus nerve stimulation (surgical implant) * Very aggressive treatment - involves implanting in the brain

Answer 135

* Reduce depressive symptoms by correcting chemical imbalances (norepinephrine, dopamine, and serotonin in particular) * Antidepressants also used to treat anxiety, phobias, OCD, and neuropathic pain * Improvement in symptoms usually occurs within the first 2 weeks; may take 6-8 weeks for full effect * May feel worse while chemical changes are occurring * Black box warning: increased risk of suicidal thinking and behavior in children and young adults * Do not take with St. John's wort * Can cause serotonin syndrome

Answer 136

* Norepinephrine * Serotonin * Dopamine

Answer 137

* Selective Serotonin Reuptake Inhibitors (SSRIs) * Selective Serotonin and Norepinephrine Inhibitors (SNRIs) * Tricyclic antidepressants (TCAs) * Monoamine Oxidase Inhibitors (MAOIS)

Answer 138

* First line treatment of depression * Slows reuptake of serotonin into presynaptic nerve terminals * Increased levels of serotonin enhance mood * Safer than other classes of antidepressants * Less sedation, fewer sympathomimetic and anticholinergic effects * Low toxicity with overdose * Monitor for serotonin syndrome * Examples: citalopram (Clexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft)

Answer 139

Antidepressant

Answer 140

* Depression * Anxiety * OCD * Panic disorder * Premenstrual dysphoric disorder * PTSD * Social anxiety disorder

Answer 141

Inhibits the reuptake of serotonin

Answer 142

* Insomnia * Headache * Dizziness * Fatigue * Dry mouth * Sexual dysfunction * Naursea * Diarrhea * Side effects taper over time

Answer 143

* Many drug-drug interactions (digoxin, warfarin, diazepam, aspirin, NSAIDS) * Avoid use with alcohol * Monitor for suicidal ideation * Avoid abrupt discontinuation * Do not give concurrently with MAOI

Answer 144

* Anticholinergic effect: too much fight or flight response * Care: stopping the treatment and supporting the patient through the episode

Answer 145

* Inhibit reabsorption of serotonin and norepinephrine; may also affect levels of dopamine * Safety and side ffect profile same as for SSRIs with addition of HTN * Examples: venlafaxine (Effexor), duloxetine (Cymbalta) * Used to help women in menopause with hot flashes

Answer 146

* Inhibit reuptake of serotonin and norepinephrine * Less commonly used than SSRIS and SNRIs due to adverse effects and toxicity with overdise * Adverse effects include: orthostatic hypotension, sedation (develop tolerance), anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision, tachycardia) * Avoid use with alcohol * Take at bedtime due to sedative effects, use caution iwth activities that require alertness * Examples: amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor)

Answer 147

* MAO is a mitochondiral enzume found in nerve and other tissues * MAO breaks down norepinephrine, serotonin, and dopamine * When MAO is inhibited, norepinephrine, serotonin, and dopamine are not broken down, increasing the concentration of all three neurotransmitters in the brain

Answer 148

* Oldest class of medications used to treat depression * Adverse effects include: orthostaic hypotension, insomnia, headache, diarrhea, sexual dysfunction * As effective as other classes, but have significant drug-drug and drug-food interactions and risk of hepatoxicity * Tyramine is degraded by MAO, so inhibiting the MAO enzyme leads to high levels of tyramine in the blood * Similar to norepinephrine and displaces it from receptor sites, leading to high levels of norepinephrine in the blood - can result in hypertensive crisis (headahce, flushing, palitations, sweating, and nausea)

Answer 149

* Aged food: cheese and wine * Alchol: beer * Soybeans * Bananas * Cured meats * Bovril * Marmite

Answer 150

* Sympathomimetic agents: * Dopamine * Ephedrine * Levodopa * Pseudoephedrine * Opioid analagesics * Amphetamine * Dextromethorphan * CNS depressant (alchol, narcotics) * SSRIs * TCAs

Answer 151

* Alternate between periods of depression and overexcitement * Excess of excitatory neurotransmitters (norepinephrine, glutamate) or deficiency of inhibitory neurotransmitters (GABA) * Treatment: depends on current symptoms * Lithium cabonate (mood stabilizer) * Antipsychotics * Anti-seizure medications * Benzodiazepines

Answer 152

Exact mechanism unknown Affects synthesis, release, and reuptake of acetylcholine, dopamine, GBA, norepinephrine; alters Na+ transport in nerve cells

Answer 153

* Metallic taste * Tremors * Polyuria * Polydipsia * diarrhea * Fatigue * Weight gain

Answer 154

* Monitor serum drug levels (narrow therapeutic indix, patients vary widely in absorption and excretion) * Take with food to decrease N/V * Consistent salt intake * Therapeutic effects may take 7-10 days * Contraindicated in pregnancy * Black box warning: monitor serum levels (high toxicity)

Answer 155

* Unsteady gait (ataxia) * Vomiting * Diarrhea * Drowsiness * Tremor * muscle weakness * Blurred vision * Large volume diuresis

Answer 156

* Inattention and distractibility, with or without hyperactivity * Thought to be related to deficit or dysfunction of dopamine and norepinephrine * Pharmacotherapy * CNS stimulants * Heighten alertness, increase focus * Schedule II * May cause paradoxical hyperactivity * Examples: dextroamphetamine/amphetamine (Adderall), methylphenidate (Ritalin) * Non-CNS stimulants * Norepinephrine reuptake inhibitors * Newer alternative to CNS stimulants * No abuse potential * Examples: atomoxetine (Strattera) * Make sure there is not an underlying biopolar disorder ( can exacerbate manic episodes)

Answer 157

drug for ADHD

Answer 158

CNS stimulant

Answer 159

ADHD, narcolepsy

Answer 160

Activates reticular activating system (increasing alertness); blocks uptake of norepinephrine and dopamine

Answer 161

* HTN * Tachycardia * Hepatoxocity * Decreased appetite * Anxiety

Answer 162

* Symptoms typically improve within a few weeks * Schedule II * Period drug-free holiday recommended to reduce dependence and asses patient for underlying disorders * Taken early in tay to prevent disruption of sleep pattern * Black box warning: cardiovascular effects

Answer 163

* Severe mental disorders where there is a loss of contact with reality * Delusions * Hallucinations * Disorganized behavior * Paranoia * Difficulty relating to others

Answer 164

* Offer symptom relief, not cure * Goal is for client to maintain social relationships, cre for self, hold a job * Long-term or life-ling therapy is required * Compliance can be an issue * Adverse effects * Feel well; denial of problem * Relapse rates 60-80%

Answer 165

* Thought to block dopamine receptor sites, reducing positive symptoms * Positive symptoms: hallucinations, delusions, dysfunction, sedation, neuroleptic malignant syndrome, extrapyramidal symptoms * Adverse effects: anticholinergic effects, sexual dysfunction, sedation, neuroleptic malignant syndrome, extrapyramidal symptoms * Black box warning: older adults with dementia - related psychosis are at increased risk of death * Examples: * Phenothiazines: chlorpromazine (Thorazine), prochlorperazine (Compazine), thioridazine (Mellarill) * Haloperidol (Haldol)

Answer 166

* Thought to block dopamine, serotonin, and alpha 1 adrenergic receptor sites * Broader spectrum of action than first generation * Less incidence of extrapyramidal symptoms, less sedating * May cause neutropenia, weight gain diabetes, seizure, neuroelptic malignant syndrome (life-threatening) * Examples: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (seroquel), risperidone (Risperdal), ziprasidone (Geodon)

Answer 167

* Hyperthermia: higher than 38C * Rigidity * Mental status changes: agistated delirium with confusion * Autonomic instability tachycardia, tachypnea, labile or high BP * Acute onset

Answer 168

* Dopamine partial agonists * Lower incidence of EPS, less weight gain, no anticholinergic effects * Common adverse effects include: N/V, headache, fever, constipation, anxiety * Example: aripiprazole (abilify)

Answer 169

* Weight gain, obesity * Hyperlipidemia * Insilin resistance, diabetes * Antipsychotics should be used with caution in older adults - increased risk of sudden cardiac death and stroke

Answer 170

Estrogen and progesterone

Answer 171

* Contraception * Hormone replacement therapy * Dysmenorrhea (painful menstruation) * Abnormal uterine bleeding * Hormone sensitive prostate cancer * Gender reassignment therapy

Answer 172

Testosterone

Answer 173

* Low testosterone levels * Delayed puberty in males * Gender reassignment therapy

Answer 174

* Estrogen/prgestin * Prevents ovulation * Various combinations of dose and type * Progestin only "mini-pill" * Suppresses ovulation, creates thick mucous layer at the cervix preventing sperm from entering the uterus * Less effective than estrogen/progestin * Increased menstrual irregularities * Used when estrogen is contraindicated * Women with personal or family history of breast cancer shoud seek non-hormonal methods of birthcontrol

Answer 175

* Regular/predictable menses * Protection from endometrial and ovarian cancer

Answer 176

* Success depends upon daily administration * Adverse effects: N/V, breast tenderness, weight gain, break-through bleeding, headache * Additional risks: HTN, DVT (increases with smoking), stroke, breast cancer/cervical

Answer 177

* Increased age * Disease processes (DM, CVA, HTN, atherosclerosis, renal disease) * Smoking, ETOH * Psychogenic causes (depression, fatigue) * Medications (beta blockers, SSRIs, TCAs, ACE inhibitors)

Answer 178

Erectile dysfunction agent, vasodilator

Answer 179

Phsophodiesterase -5 inhibitor

Answer 180

Erectile dysfunction, pulmonary arterial hypertension

Answer 181

Inhibiting PDE-5 increases levels of cGMAP, which produces smooth muscle relaxation and icnreases blood flow to the corpus cavernosum (Viagra) or vasodilation of the pulmonary vascular bed (REvatio)

Answer 182

Viagra is generally higher dose (50mg) and is taken 30 min to 1 hour before sexual activity and only once a day. Revatio dose is generally lower (5-20 mh) and taken 3 times a day

Answer 183

* Headache * Dizziness * Facial flushing * Nasal congestion * Hypotension

Answer 184

Concurrent use of nitrates may cause refractory, life-threatening hypotension

Answer 185

* Viagra; there is no effect in the absence of sexual stimulation, seek medicatl attention if erection lasts more than 4 hours (priapism), counsel on STI/HIV prevention * REvatio: monitor vital signs, cardiac fucntion, excercise tolerance prior to and during therapy