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Pharmacology for Nurses > Exam 3 Material > Flashcards

Exam 3 Material Flashcards

1
Q

What is cancer?

A
  • Abnormal, uncontrolled cell division
  • Cells lose normal function and differentiation
  • Can travel to distant sites and create new tumors (metastasis)
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2
Q

Causes of Preventable Cancers

A
  • Smoking
  • Obesity
  • Alcohol
  • UV radiation
  • Physical activity
  • Poor diet
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3
Q

Goals of Chemotherapy

A
  • Cure
    • May not be possible
  • Control
    • Control the growth to help increase length or quality of life
  • Palliation
    • Relieve symptoms
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4
Q

Treatments used in Conjunction with Chemotherapy

A
  • Radiation
  • Surgery
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5
Q

ABVD Chemotherapy Combination

A
  • Adriamycin
  • Bleomycin
  • Vinblastine
  • Dacarbazine
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6
Q

BEACOPP Chemotherapy Combination

A
  • Bleomycin
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • Vincristine
  • Procarbazine
  • Prednisone
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7
Q

Standford V Chemotherapy Combination

A
  • Doxorubicin
  • Vinblastine
  • Mechlorethamine
  • Etoposide
  • Vincristine
  • Bleomycin
  • Prednisone
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8
Q

COPP/ABVD Chemotherapy combination

A
  • Cyclophosphamide
  • Vincristine
  • Procarbazine
  • Prednisone
  • Doxorubicin
  • Bleomycin
  • Vinblastine
  • Dacarbazine
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9
Q

MOPP Chemotherapy Combination

A
  • Mechlorethamine
  • Vincristine
  • Procarbazine
  • Prednisone
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10
Q

Why are combination drugs used in chemo?

A

Drugs are from multiple drug classes (different MOAs, affect cells in various stages of the growth cycle)

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11
Q

What type of cells is chemo most toxic too?

A

Tumors and tissues with rapidly dividing cells (hair follicles, bone marrow, GI epithelium)

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12
Q

Common Toxicities of Chemo

A
  • Alopecia
  • Mucositis: sloughing of mucous membranes
  • N/V: chemoreceptors in the brain
  • Bone marrow suppression (myelosuppression)
    • Anemia (decrease in hemoglobin and/or red blood cells)
    • Leukopenia/neutropenia (decreased white blood cells - increses susceptibility to infection)
    • Thrombocytopenia (low platelets)
  • Long term effects may include infertility, secondary malignancies
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13
Q

Cautions when administering Chemo

A
  • Be cautious when administering - gown/glove up to prevent YOU from getting cancer
  • Be aware that many chemotherapies are vesicants (serious tissue injury if they infiltrate/extravasate)
    • Specially trained to administer
    • Specific antidotes for infiltration/extravasation
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14
Q

Classes of Chemotherapy/Antineoplastics

A
  • Aklylting agents
  • Antimetabolites
  • Antitumor antibodies
  • Natrual products
  • Hormones/hormone antagonists
  • Biologi response modifiers/targeted therapies
  • Miscellaneous
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15
Q

Aklylating Agents for Cancer

A
  • Dates back to nitrogen mustarg used as chemical warfare agent in WWI
  • Most widely prescribed class
  • Examples: cyclophosphamide (Cytoxan), cisplatin (Platinol), busulfan
  • Cyclophosphamide is also used to include immunosuppression for autoimmune diseases such as rheumatoid arthritis and lupus
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16
Q

Antimetabolites for Cancer

A
  • Resemble nutrients used by the cell (folid acid, purine, pyrimidine analogs)
  • Examples: methotrexate, cytarabine, fluorouracil
  • Methotrexate rescue - leucovorin (form of folid acid) is given to rescue normal cells from the toxicity of the treatment
  • Methotrexate is also used in the treatment of rheumatoir arthritis, ulcerative colitis, lupus, and psoriasis
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17
Q

Antitumor Antibiotics for Cancer

A
  • Isolated from bacteria and have antitumor properties
  • Examples: doxurubicin (Adriamycin), idarubicin (Idamycin)
  • Cardiotoxicity is a dose limiting effect of many drugs in this class
    • May have a lifetime dose that can’t be exceeded due to its effects on the heart
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18
Q

Natural products for Cancer

A
  • Includes plant extracts
  • American Indians used May Apple to treat snakebites and warts
  • Examples: vincristine, etopside, paclitaxel
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19
Q

Hormones/Hormone Antagonists for Cancer

A
  • Used for hormone dependent tumors
  • Not cytotoxic, do not see toxicities associated with other chemo drugs
  • Examples: corticosteroids, progestins, estrogens, and androgens
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20
Q

Biologic Response Modifiers for Cancer

A
  • Enhance immune system to destroy cancer cells (immunostimulants)
  • Target specific antigens on surface of cancer cells
  • Includes interferons, interleukins, and other cytokines
  • Fewer adverse effects than cytotoxic chemo drugs
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21
Q

Targeted Therapies for Cancer

A
  • Specific to one type of tumor cells
  • Monoclonal antibodies (rituximab)
    • Also used to treat autoimmune diseases
    • Often require premedication for hypersensitivity reactions
  • Other targeted therapies: imatinib, bortezomib
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22
Q

Chemo Precautions

A
  • Use appropriate PPR
  • Signage outside of room
  • Dispose of IV bags, tubing, packaging, etc. in appropriate container
  • Be aware of how to handle spills
  • Patient body fluids are considered contaminated for at least 48 hours after last dose
    • Sexual realtions - wait 48 hours
  • Know your hospital’s policy for handling of body fluids
  • Some “non-chemo” medications may require “chemo-precautions”
  • Chemo certification is often required for administration
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23
Q

Endocrine System Function

A
  • The endocrine system is a collection of glands that secrete hormones to regulate the functions of cells, tissues, and rogans
  • Hormones are chemical messangers released in response to a change in the body’s internal environment to maintain body homeostass
  • Negative feedback system: one hormone controls secretion of another hormone, and the last hormone in the pathway provides feedback to turn off secretion of the first hormone
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24
Q

Hormones in Pharmacotherapy

A
  • Replacement therapy when insufficient quantities of endogenous hormones are produced
    • Examples: insulin in diabetes or levothyroxine (Synthroid) in hypothyroidism
  • Cancer treatment: to shrink the size of hormone-sensitive tumors
    • Examples: testosterone for breast cancer, estrogen for testicular cancer
  • Exaggerated response: of a normal action of a hormone
    • Example: hydrocortisone to suppress inflammation
  • Anti-hormones: block actions of endogenous hormones
    • Examples: propylthiouracil (PTU) in hyperthyroidism
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25
Q

Antidiuretic Hormone (ADH)

A
  • Component in fluid homeostasis
  • Desmopressin (DDAVP) and vasopressin are medications that mimic ADH
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26
Q

What happens to urine output when you have too much ADH (SIADH)?

A

A little urine that is very concentrated

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27
Q

What happens to urine output when you have too little ADH (Diabetes Insipidus)?

A

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

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28
Q

Therapeutic class of Desmopressin (DDAVP)

A

Hormone

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29
Q

Pharmacologic class of Desmopressin (DDAVP)

A

Antidiuretic hormone

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30
Q

Indications of Desmopressin (DDAVP)

A
  • Diabetes insipidus
  • von Willebrand’s disease (blood clotting disorder)
  • Bet wetting
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31
Q

MOA of Desmopressin (DDAVP)

A

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

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32
Q

Adverse effects of Desmopressin (DDAVP)

A
  • Drowsiness
  • Headache
  • Symptoms of water intoxication (edema, weight gain, HTN, hyponatremia/low serum sodium [diluting])
    • With low sodium - worry about seizures/comatose
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33
Q

Nursing implications of Desmopressin (DDAVP)

A
  • 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
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34
Q

Thyroid Hormones

A
  • 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
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35
Q

Symptoms of hypothyroidism

A
  • 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
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36
Q

Symptoms of Hyperthyroidism

A
  • 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
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37
Q

Therapeutic Class of Levothyroxine (Synthroid)

A

Thyroid hormone replacement

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38
Q

Pharmacologic class of Levothyroxine (Synthroid)

A

Thyroid hormone

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39
Q

Indications of Levothyroxine (Synthroid)

A

Hypothyroidism

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40
Q

MOA of Levothyroxine (Synthroid)

A

Synthetic T4; increases metabolic rate of body tissues

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41
Q

Adverse effects of Levothyroxine (Synthroid)

A

Symptoms of hyperthyroidism

  • Tachycardia
  • Anxiety
  • Insomnia
  • Weight loss
  • Heat intolerance
  • Diaphoresis
  • Menstrual irregularities
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42
Q

Nursing Implications of Levothyroxine (Synthroid)

A
  • 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
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43
Q

What changes in lab values would you expect to see with hypothyroidism?

A

Low T4

High TSH

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44
Q

Hyperthyroidism therapy

A
  • 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)
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45
Q

Adrenal hormones

A

Adrenal gland secretes three class of steroid hormones

  • Glucocorticoids (ex. cortisol) - sugar
  • Mineralocorticoids (ex. aldosterone) - salt
  • Androgens/gonadocorticoids (ex. testosterone) - sex
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46
Q

Glucocorticoids

A
  • 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
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47
Q

Diabetes

A
  • 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
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48
Q

Signs and Symptoms of Hyperglycemia (BG ~ 180)

A
  • 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
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49
Q

Signs and Symptoms of Hypoglycemia (BG < 70)

A
  • 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
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50
Q

Diabetes Type I

A
  • 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
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51
Q

Diabetes Type II

A
  • 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
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52
Q

Gestational Diabetes

A
  • 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
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53
Q

Insulin

A
  • 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
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54
Q

Insulin Aspart (Novolog)

A
  • 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
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55
Q

Insulin Lispor (Humalog)

A
  • 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
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56
Q

Insulin Glulisine (Apidra)

A

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

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57
Q

Insulin regular (Humulin R, Novolin R)

A

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

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58
Q

Isophane suspension (NPH, Humulin N, Novolin N)

A

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)

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59
Q

Insulin detemir (Levemir)

A

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

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60
Q

Insulin glargine (Lantus)

A

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

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61
Q

Rapid insulin

A
  • -og
  • 15 min onset
  • 1 hour peak
  • Can mix with NPH
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62
Q

Short insulin

A
  • -in
  • 30 min onset
  • 3 hour peak
  • Can mix with NPH
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63
Q

Intermediate insulin

A
  • NPH
  • Onset 30-60 min
  • Peak 1-2 hours
  • Can mix with short and rapid insulin
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64
Q

Therapeutic class of regular insulin (Humulin R, Novolin R)

A

Hormone, drug for diabetes

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65
Q

Pharmacologic class of regular insulin (Humulin R, Novolin R)

A

Hypoglycemic

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66
Q

Indications of regular insulin (Humulin R, Novolin R)

A

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

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67
Q

MOA of regular insulin (Humulin R, Novolin R)

A

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

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68
Q

Adverse effects of regular insulin (Humulin R, Novolin R)

A
  • Hypoglycemia
    • Tachycardia
    • Confusion
    • Sweating
    • Restlessness
    • Coma and death if severe hypoglycemia is untreated
  • Hypokalemia
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69
Q

Nursing implications of regular insulin (Humulin R, Novolin R)

A
  • Can be given IV or SQ
  • Only use insulin syringe
  • Administered 30 min before meal
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70
Q

Lipohypertrophy

A
  • 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
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71
Q

Nursing Considerations for Insulin

A
  • 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
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72
Q

Tye II Diabetes Risk Factors

A
  • Obesity
  • Fat distribution in abdomen
  • Dyslipidemia
  • Sedentary lifestyle
  • Family history
  • Race
  • Age
  • Pre-diabetes
  • Gestational diabetes
  • Polycystic ovarian syndrome
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73
Q

Oral Antidiabetic Medications

A
  • 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
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74
Q

Therapeutic class of metformin (Glucophage)

A

Antidiabetic

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75
Q

Pharmacologic class of metformin (Glucophage)

A

Biguanide

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76
Q

Indications of metformin (Glucophage)

A

Type II diabetes (first line drug)

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77
Q

MOA of metformin (Glucophage)

A

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)

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78
Q

Adverse effects of metformin (Glucophage)

A
  • N/V
  • Diarrhea
  • Abdominal bloating
  • Metallic taste
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79
Q

Black Box Warning of metformin (Glucophage)

A

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

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80
Q

Nursing implications of metformin (Glucophage)

A
  • 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
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81
Q

Sulfonylureas

A
  • 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
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82
Q

Neurodegenerative Diseases

A
  • 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
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83
Q

Parkinson’s Disease

A
  • 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
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84
Q

Pharmacotherapy for Parkinson’s

A
  • 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
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85
Q

Therapeutic class of carbidopa/levodopa (Sinemet)

A

Antiparkinson agent

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86
Q

Pharmacologic class of carbidopa/levodopa (Sinemet)

A

Dopamine agonist

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87
Q

Indications of carbidopa/levodopa (Sinemet)

A

Parkinson’s disease

88
Q

MOA of carbidopa/levodopa (Sinemet)

A

Levodopa is converted to dopamine in the CNS where it serves as a neurotransmitter

Carbidopa prevents peripheral destruction of levodopa

Relieves tremor and rigidity

89
Q

Adverse effects of carbidopa/levodopa (Sinemet)

A
  • Uncontrolled and purposeless movements
  • N/v
  • Orthostatic hypotension
  • Dark urine/sweat
  • Hepatotoxicity
  • Cardiac arrhythmias
  • Psychosis
90
Q

Nursing implications for carbidopa/levodopa (Sinemet)

A
  • 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
91
Q

Anticholinergics

A
  • 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
92
Q

Alzheimer’s Disease

A
  • 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
93
Q

Pharmacotherapy for Alzheimer Disease

A
  • 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
94
Q

Therapeutic class of donepezil (Aricept)

A

Anti-alzheimer’s agent

95
Q

Pharmacologic class of donepezil (Aricept)

A

Acetylcholinesterase inhibitor

96
Q

Indications of donepezil (Aricept)

A

Alzheimer’s disease

97
Q

MOA of donepezil (Aricept)

A

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

98
Q

Adverse effects of donepezil (Aricept)

A
  • N/V
  • Diarrhea
  • Poor appetite
  • GI bleeding
  • Abnormal dreams
  • Muscle cramps
99
Q

Nursing implications of donepezil (Aricept)

A

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

Administer at bedtime

100
Q

Causes of Muscle Spasms

A
  • Overuse of muscle
  • Injury
  • Dehydration
  • Electrolyte abnormalities
  • Adverse effect of antipsychotics
  • Neurological disorders (stroke, cerebral palsy)
101
Q

Treatment of Muscle Spasms

A
  • Nonpharmacologic
    • Heat/cold, exercise, massage, complementary therapy
  • Pharmacologic
    • Analgesics
    • Anti-inflammatory
    • Skeletal muscle relaxants
102
Q

Therapeutic class of baclofen (Lioresal)

A

Skeletal muscle relaxant

103
Q

Pharmacologic class of baclofen (Lioresal)

A

GABAB receptor agonist

104
Q

Indications of baclofen (Lioresal)

A

Muscle spasticity

105
Q

MOA of baclofen (Lioresal)

A

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

106
Q

Adverse effects of baclofen (Lioresal)

A
  • Hypotension
  • N/V
  • Constipation
  • Poor muscle tone
  • Dizziness
  • Sedation
107
Q

Nursing implications of baclofen (Lioresal)

A
  • Avoid activities requiring mental alertness until effects are known
  • Avoid alchol and other CNS depressants
  • Avoid stopping abruptly
  • May be administered via intrathecal pump
108
Q

Osteoporosis

A
  • 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)
109
Q

Incidence rate of osteoporosis

A

1 in 2 women

1 in 5 men

110
Q

Pharmacotherapy for Osteoporosis

A
  • 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)
111
Q

Bisphosphonates

A
  • 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)
112
Q

Selective estrogen receptor mondulates (SERMS)

A
  • 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)
113
Q

Arthritis

A

Inflammation and stiffness of joint (painful)

114
Q

Osteoarthritis

A

Erosion of cartilage at joint surface(s)

Most often affects weight bearing joints due to wear and tear (knees, spine, hips)

115
Q

Rheumatroid arthritis

A
  • Auto-immune disease
  • Leads to inflammation and disfigurement of multiple joints
  • Systemic effects
116
Q

Pharmacotherapy for Osteoarthritis

A
  • 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)
117
Q

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

A
  • 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
118
Q

Traditional DMARDs

A
  • Methotrexate
  • Lefunomide (Arava)
  • Sulfasalazine (SSZ, Azulfidine)
  • Hydroxychloroquine (HCQ, Plaquenil)
  • Azathiopine, cyclosporine
119
Q

Biologic DMARDS

A
  • TNF antagonists
    • Etanercept (Enbrel)
    • Adalimumab (Humira)
    • Infliximab (Remicade)
    • Certolizumab pegol (Cimzia)
    • Golimumab (Simponi)
  • Abatacept (Orencia)
  • Rituximab (Rituxan)
  • Tocilizumab (Actemra)
  • Tofacitinib (Xeljanz)
120
Q

Anxiety Disorders

A
  • 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
121
Q

Situational Anxiety

A

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

122
Q

Generalized anxiety disorder

A

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

123
Q

Panic disorder

A

Immediate feelings of apprehension, fearless, terror, impending doom

124
Q

Phobias

A

Fear associated with specific objects or situations

125
Q

Treatment of Anxiety Disorders

A
  • 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
126
Q

Use of Antidepressants

A
  • 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
127
Q

CNS Depressants

A
  • 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
128
Q

Benzodiazepines

A
  • 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)
129
Q

Barbiturates

A
  • 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)
130
Q

Miscellaneous Drugs for Anxiety

A
  • 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
131
Q

Seizures

A
  • 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
132
Q

Status epilepticus

A

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

133
Q

Causes of Seizures

A
  • 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
134
Q

Electrocephalogram (EEG)

A

Electric monitoring that measures and records electrical activity in the brain

135
Q

Pharmacotherapy for Seizures

A
  • 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)
136
Q

Pregnancy and Epilepsy

A
  • 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
137
Q

Valproate Syndrome

A
  • 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
138
Q

Pharmacotherapy for Seizures

A
  • 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
139
Q

Therapeutic class of phenobarbital (Luminal)

A

Anti-seizure drug, sedative

140
Q

Pharmacologic class of phenobarbital (Luminal)

A

Barbiturate, GABAA receptor drug

141
Q

Indications of phenobarbital (Luminal)

A

Seizure, sedation

142
Q

MOA of phenobarbital (Luminal)

A

Enhances GABA, suppressing abnormal neuronal discharges

143
Q

Adverse effects of phenobarbital (Luminal)

A
  • Drowsiness
  • Respiratory depression
  • Vitamin deficiencies (D, folate, B9, B12)
  • N/V
144
Q

Nursing considerations of phenobarbital (Luminal)

A
  • Schedule IV drug
  • Pregnancy category D
  • Avoid use with other CNS depressants
145
Q

Overdose of phenobarbital (Luminal)

A

CNS depression, coma, death

146
Q

Therapeutic class of diazepam (Valium)

A

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

147
Q

Pharmacologic class of diazepam (Valium)

A

Benzodiazepine, GABA receptor drug

148
Q

Indications of diazepam (Valium)

A
  • Seizure
  • Sedation
  • Anxiety
  • Muscle spasm
  • Alcohol, benzo withdrawal
149
Q

MOA of diazepam (Valium)

A
  • Enhances action of GABA, suppressing abnormal neuronal discharges
150
Q

Adverse effects of diazepam (Valium)

A
  • Hypotension
  • Muscle weakness
  • Drowsiness
  • Respiratory depression
  • More pronounced adverse effects when given IV
151
Q

Nursing considerations of diazepam (Valium)

A
  • 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
152
Q

Therapeutic class of phenytoin (Dilantin)

A

Anti-seizure drug, antidysrhythmic

153
Q

Pharmacologic class of phenytoin (Dilantin)

154
Q

Indications of phenytoin (Dilantin)

155
Q

MOA of phenytoin (Dilantin)

A

Desensitizes sodium channels in CNS, preventing abnormal neuronal discharges

156
Q

Adverse effects of phenytoin (Dilantin)

A
  • Drowsiness
  • Nausea
  • Gingival hypertrophy
  • Hirsutism
  • Suicidal thoughts
  • Ataxia (lack of muscle coordination)
  • Hematologic toxicities (RBC, WBC, platelets)
157
Q

Nursing considerations of phenytoin (Dilantin)

A
  • 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
158
Q

Purple Glove Syndrome

A
  • 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
159
Q

Situational depression

A

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

160
Q

Biologic depression

A

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

161
Q

Seasonal depression

A

Related to change in seasons and not receiving as much sun

162
Q

Treatment of Depression

A
  • 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
163
Q

Antidepressants

A
  • 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
164
Q

Neurotransmitters associated with depression

A
  • Norepinephrine
  • Serotonin
  • Dopamine
165
Q

Types of Antidepressants

A
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Selective Serotonin and Norepinephrine Inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)
  • Monoamine Oxidase Inhibitors (MAOIS)
166
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

A
  • 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)
167
Q

Therapeutic class of sertraline (Zoloft)

A

Antidepressant

168
Q

Pharmacologic class of sertraline (Zoloft)

169
Q

Indications of sertraline (Zoloft)

A
  • Depression
  • Anxiety
  • OCD
  • Panic disorder
  • Premenstrual dysphoric disorder
  • PTSD
  • Social anxiety disorder
170
Q

MOA of sertraline (Zoloft)

A

Inhibits the reuptake of serotonin

171
Q

Adverse effects of sertraline (Zoloft)

A
  • Insomnia
  • Headache
  • Dizziness
  • Fatigue
  • Dry mouth
  • Sexual dysfunction
  • Naursea
  • Diarrhea
  • Side effects taper over time
172
Q

Nursing considerations of sertraline (Zoloft)

A
  • 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
173
Q

Serotonin syndrome

A
  • Anticholinergic effect: too much fight or flight response
  • Care: stopping the treatment and supporting the patient through the episode
174
Q

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

A
  • 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
175
Q

Tricyclic Antidepressants (TCSa)

A
  • 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)
176
Q

MOA of MAOIs

A
  • 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
177
Q

MAOIs

A
  • 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)
178
Q

MAOIs food interactions

A
  • Aged food: cheese and wine
  • Alchol: beer
  • Soybeans
  • Bananas
  • Cured meats
  • Bovril
  • Marmite
179
Q

Drugs to aovid with MAOIs

A
  • Sympathomimetic agents:
    • Dopamine
    • Ephedrine
    • Levodopa
    • Pseudoephedrine
  • Opioid analagesics
  • Amphetamine
  • Dextromethorphan
  • CNS depressant (alchol, narcotics)
  • SSRIs
  • TCAs
180
Q

Bipolar disorder

A
  • 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
181
Q

Therapeutic class of lithium carbonate (Eskalith)

182
Q

MOA of lithium carbonate (Eskalith)

A

Exact mechanism unknown

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

183
Q

Adverse effects of lithium carbonate (Eskalith)

A
  • Metallic taste
  • Tremors
  • Polyuria
  • Polydipsia
  • diarrhea
  • Fatigue
  • Weight gain
184
Q

Nursing considerations for lithium carbonate (Eskalith)

A
  • 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)
185
Q

Signs of toxicity of lithium carbonate (Eskalith)

A
  • Unsteady gait (ataxia)
  • Vomiting
  • Diarrhea
  • Drowsiness
  • Tremor
  • muscle weakness
  • Blurred vision
  • Large volume diuresis
186
Q

Attention Deficit/Hyperactivity Disorder

A
  • 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)
187
Q

Therapeutic class of methylphenidate (Ritalin)

A

drug for ADHD

188
Q

Pharmacologic class of methylphenidate (Ritalin)

A

CNS stimulant

189
Q

Indications of methylphenidate (Ritalin)

A

ADHD, narcolepsy

190
Q

MOA of methylphenidate (Ritalin)

A

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

191
Q

Adverse effects of methylphenidate (Ritalin)

A
  • HTN
  • Tachycardia
  • Hepatoxocity
  • Decreased appetite
  • Anxiety
192
Q

Nursing implications of methylphenidate (Ritalin)

A
  • 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
193
Q

Psychoses

A
  • Severe mental disorders where there is a loss of contact with reality
    • Delusions
    • Hallucinations
    • Disorganized behavior
    • Paranoia
    • Difficulty relating to others
194
Q

Pharmacotherapy for Psychoses

A
  • 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%
195
Q

Conventional/typical Antipsychotics (first generation)

A
  • 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)
196
Q

Atypical Antipsychotics (Second Generation)

A
  • 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)
197
Q

Neuroleptic malignant syndrome (NMS) Clinical Manifestations

A
  • Hyperthermia: higher than 38C
  • Rigidity
  • Mental status changes: agistated delirium with confusion
  • Autonomic instability tachycardia, tachypnea, labile or high BP
  • Acute onset
198
Q

Dopamine-Serotonin System Stabilizers (Third Generation)

A
  • 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)
199
Q

Long Term Metabolic Effects Associated with Antipsychotics

A
  • Weight gain, obesity
  • Hyperlipidemia
  • Insilin resistance, diabetes
  • Antipsychotics should be used with caution in older adults - increased risk of sudden cardiac death and stroke
200
Q

Female Sex hormones

A

Estrogen and progesterone

201
Q

Indications of female sex hormones

A
  • Contraception
  • Hormone replacement therapy
  • Dysmenorrhea (painful menstruation)
  • Abnormal uterine bleeding
  • Hormone sensitive prostate cancer
  • Gender reassignment therapy
202
Q

Male sex hormone

A

Testosterone

203
Q

Indications for testosterone

A
  • Low testosterone levels
  • Delayed puberty in males
  • Gender reassignment therapy
204
Q

Oral contraceptives

A
  • 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
205
Q

Advantages of oral contraception

A
  • Regular/predictable menses
  • Protection from endometrial and ovarian cancer
206
Q

Disadvantages of oral contraception

A
  • 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
207
Q

Erectile Dysfunction Causes

A
  • Increased age
  • Disease processes (DM, CVA, HTN, atherosclerosis, renal disease)
  • Smoking, ETOH
  • Psychogenic causes (depression, fatigue)
  • Medications (beta blockers, SSRIs, TCAs, ACE inhibitors)
208
Q

Therapeutic class of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A

Erectile dysfunction agent, vasodilator

209
Q

Pharmacologic class of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A

Phsophodiesterase -5 inhibitor

210
Q

Indications of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A

Erectile dysfunction, pulmonary arterial hypertension

211
Q

MOA of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A

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)

212
Q

Dosing of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A

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

213
Q

Adverse effects of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A
  • Headache
  • Dizziness
  • Facial flushing
  • Nasal congestion
  • Hypotension
214
Q

Contraindication of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A

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

215
Q

Nursing implications of sildenafil (Viagra - erectile dysfunction; Revatio - pulmonary HTN)

A
  • 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

Pharmacology for Nurses (11 decks)

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