Final 6/7 Flashcards
mechanism of action & classification of lorazepam
- benzodiazepine: combines c GABA receptors = calms CNS down =
decrease CNS functioning = calms people down & helps them sleep - anti-anxiety, sedation, anesthesia induction & maintenance,
Seizures (status epilepticus), sedation for mechanical ventilation, alcohol
withdrawal symptoms
how do benzodiazepines work
combines c GABA receptors = calms CNS down =
decrease CNS functioning = calms people down & helps them sleep
contraindications of Lorazepam
- pregnancy
interactions of Lorazepam
- CNS depressants (alcohol): increased effect
- OCs: increase or decrease effectiveness
- some herbs: excessive sedation
side effects of Lorazepam
- drowsiness
- excessive sedation
- impaired motor coordination
- confusion
- orthostatic hypotension
nursing considerations for Lorazepam
- aspirate prior to IV injection (because gangrene if not in vein)
- if IV: give slowly
- if pt. smokes: they require larger dose
- monitor ambulation
- don’t take with other CNS depressants
mechanism of action & classification of Diazepam
- benzodiazepine: combines c GABA receptors = calms CNS down =
decrease CNS functioning = calms people down & helps them sleep - control anxiety, preoperative sedation, skeletal relaxant, treat status epilepticus
- GAD, seizures, alcohol withdrawel
contraindications of Diazepam
- . narrow-angle glaucoma
- pregnancy
- depressed vitals
side effects of Diazepam
drowsiness
nursing considerations of Diazepam
- can take with food
- ween off
mechanism of action for flumazenil
- antidote to benzodiazepines
- short half-life
nursing consideration for flumezanil
- does not reverse or affect opioid overdose
mechanism of action of Zolpidem
treatment of insomni
nursing considerations for Zolpidem
- give right before going to sleep (watch out for sleep walking/eating - non-pharm measurea for sleep)
- avoid giving c food (prolongs absorption)
- pt’s will always be at fall risk
- NEVER take c alcohol/CNS depressants
mechanism of action of phenobarbitol
- improved memory, function and behavior through elevating acetylcholine concentration in the CNS
- short-term treatment of insomnia
- seizures
- not given commonly for sleep
side effects of Phenobarbitol
- A, N, V, D
- gi cramping
- HA
- insomnia
nursing considerations for Phenobarbitol
- it’s a barbiturate = suicide
- develops tolerance easily to CNS effects = takes more to help fall asleep (respiratory system doesn’t develop this tolerance = unsafe)
mechanism of action and classification for Donepezil
- indirect acting cholinergic (anticholinesterases)
- improved memory, function & behavior through elevating acetylcholine
concentration in the CNS
Side effects of Donepezil
- A, N, V, D (because we’re stimulating PNS & ANS)…most will go away with continued use
- GI cramping
- HA
- insomnia
Nursing Conderations for Donepezl
- monitor cognitive function (can pt. be responsible enough to take their
own meds) - monitor for GI bleeding, especially if on NSAIDS
- monitor for respiratory function, especially for asthma or COPD pts
- cholinergic = decrease in bronchoconstriction
- monitor for safety issues/depression
*- does not cure/prevent disease, just slows it down - encourage to take with food/milk to decrease GI upset
mechanism of action of amphetamine & dextroamphetamine
- stimulant
- drug of choice for ADHD
- narcolepsy, weight loss
- stimulates the CNS to improve alertness, awakeness, mood, & attention
- causes paradoxical sedation effect in ADHD
interactions for amphetamine & dextroamphetamine
- alkaline drugs = decrease elimination
- acidic drugs = increase excretion
- caffeine = increase CNS stimulation = avoid
side effects of amphetamine & dextroamphetamine
- irritability
- insomnia
- anorexia
Nursing considerations for amphetamine & dextroamphetamine
- assess for therapeutic effects (non toxic), side effects (BP, HR)
- monitor for med abuse = out of reach
- diabetic = monitor BS
- monitor adverse effects of insomnia
- can decrease growth in children = monitor growth
- chew gum, drink water for dry mouth
- paradoxical effect
mechanism of action of atomoxatine
- non-stimulant
- ADHD
- improves attentiveness & decreases distraction & forgetfulness
contraindications of atomoxatine
- highly protein bound drugs
- MAOIs
side effects of atomoxatine
- HA
- N, V, A
- insomnia
nursing considerations for atomoxatine
- BLACK BOX: increase suicidal thoughts
- take 2-4 wks to show therapeutic effect of ADHD
- monitor LFTs
- teach what happens when liver gets sick: chronic N, V, jaundice, dark brown urine, light gray stools
- make position changes slowly
mechanism of action & classify Levodopa
- dopamine agonist
- Sinemet (Carbidopa)
- drug of choice for Parkinsons
- treat parkinsonism = relieve tremors & rigidity
- crosses BBB
side effects of Levodopa
- anticholinergics (dry mouth, blurred vision, urinary retention)
- involuntary choreiform: spazzy dance movements
- A, V, N
- psychosis: because of increase dopamine
if client is experiencing quick jerking movements while on Levodopa, what maybe should the nurse ask for
a lowered dosage
nursing considerations for Levodopa
- monitor liver & kidney function (metabolism & excretion probs)
- assist c ambulation
- assess for narrow-angle glaucoma
- ween off
- don’t crush/chew
- report s/s toxicity: twitching, winking, mood changes
- make position changes slowly
- increase fluid & fiber in diet: avoid high in protein
- affects may take several months
- may have darkening of urine/sweat
- can take c other meds to help c N, V
mechanism of action & classification of Pramipexole
- dopamine agonist
- treat early stages of Parkinsonism
interactions of Pramipexole
- dopamine antagonists: phenothiazines & metaclopramide
nursing considerations for Pramipexole
- monitor VS (BP because of orthostatic hypotension)
- avoid alcohol & CNS depressants = drowsiness
- can cause sleep attacks
- full effects take several months
- report hallucinations & uncontrolled movement
- monitor for tarted dyskinesia (repetative purposeless movements)
- monitor for potential mental status/mood changes
mechanism of action and classification of Benztropine
- anticholinergic
- treat tremor & rigidity of Parkinson’s
side effects of Benztropine
- dry mouth
- constipation
- sedation
nursing considerations for Benztropine
- assess mood changes
- assess response to tremor/rigidity
- make position changes slowly
- monitor eyes & nose, urinary retention, bowel status
- avoid alcohol & CNS depressants = drowsiness
- be careful when overheating because of inability to sweat from anticholinergic properties
- chew gum/candy
- can take with food
- increase fluid & fiber due to constipation
mechanism of action & classification of Cyclobenzaprine
- central acting (CNS)
- short term use for muscle spasm
contraindications of Cyclobenzaprine
- with other sedative hypnotics = can cause excessive CNS depression
- geriatrics = more risk for hallucinations & cardiac effects
- similar to TCS = infinity to heart muscle = adversely affect heart muscle
- breast feeding
side effects of Cyclobenzaprine
- drowsiness
- dry mouth
- dizziness
nursing consideration for Cyclobenzaprine
- fall risk due to drowsiness
- hold if hypersensitivity occurs: rashes, itching, hives
- discourage alcohol
- can give with food or milke
- report CV adverse effects & excessive sedation
- report if not showing s/s after 1-2 wks
- encourage nonpharm: positioning, strength exercise, heat packs
mechanism of action for Dantrolene
- direct acting (muscle)
- muscle spasticity
- drug of choice for malignant hyperthermia
side effects of Dantrolene
- hepatotoxicity = monitor LFTs
- muscle weakness
- drowsiness
nursing considerations for Dantrolene
- therapeutic effects take 1 wk
- discourage alcohol = added sedation
- monitor VS (especially wth IV admin. = EKG)
- teach s/s liver dysfunction
mechanism of action of Hydroxycloroquine
- decrease inflammation in RA
- treatment of malaria
- treatment of lupus
contraindications of Hydroxychloroquine
antacids = affects absorption
side effects of Hydroxycholoroquine
A, N, V
nursing considerations for Hydroxycholoroquine
- monitor vision = more frequent eye exams
- give with food or milk to decrease GI upset
- no alcohol
- discontinue for s/s of extreme weakness, hearing loss, bruising, bleeding
- don’t participate in hazardous activities
- need to wear sunglasses: photosensitivity
mechanism of action & classify Alendronate
- biphosphonate
- osteoporosis (bone resorption)
- slows rate of bone resorption (Ca+ being sucked out of bones to increase blood Ca+)
- lowers serum alkaline phosphatase
- used postmenopausal
- used for steroid induced osteoporosis
side effects of Alendronate
irritation
nursing considerations for Alendronate
- take 30 min before eating, empty stomach
- encourage Ca+ foods & Vitamin D supplements, but not within 2 hrs. taking med
- encourage weight bearing exercise
- pt. needs to stay upright for at least 30 min (esophagus burning)
- s/s hypocalcemia: muscle spasms/twitching
mechanism of action & classify Raloxifene
- hormonal: SERMs
- osteoporosis; bone resorption
- binds with estrogen receptors
- decreases bone resorption increased bone density in postmenopausal women
- estrogen agonist: encourages bones build up, Ca+ placement in bone = increase bone strength
- estrogen antagonist: doesn’t act on uterine or breast tissue like estrogen normally would = benefit of med
contraindications of Raloxifene
lactation
side effects of Raloxifene
- hot flashes
- leg cramps
- weight gain
nursing consideration for Raloxifene
- BLACK BOX: pregnancy category X
- monitor lipid levels
- monitor for thrombolytic events
- report calf pain or dyspnea
- don’t sit for long periods of time
- don’t take with other estrogen drugs or herbal meds
- NO MEN! Only postmenopausal
mechanism of action for Calcium Carbonate
- hypocalcemia
- to increase serum calcium because we want more Ca+ in bone & maintain normal neuromuscular function
side effects of Calcium Carbonate
- oral: hypercalcemia, kidney stones
nursing considerations for calcium carbonate
- monitor IV & EKG
- administer Ca+ supplements through IV slowly
- encourage Ca+ foods (milk, dark green veggies, soy beans, tofu, canned fish, sardines)
- can take c meals with oral admin.
- hypercalcemia: lethargy, N, V
- hypocalcemia: muscle twitching/spasms
- encourage weight bearing exercise
- avoid Zinc rich foods (nuts, legumes, seeds, sprouts)
