Final Exam Blueprint Part 1 Flashcards
1
Q
What is the indication for disulfiram?
A
Alcohol use disorder ;maintenance of alcohol sobriety after detox
2
Q
What is the indication of methadone?
A
Opioid use disorder ; supress heroin withdrawal and block euphoric effects
3
Q
What are the normal levels for magnesium sulfate?
A
1.5-2.5 mEq/L
4
Q
Nursing interventions for magnesium sulfate overdose?
A
administer calcium gluconate for overdose
5
Q
Nursing interventions for IV magnesium
A
monitor cardiac and neuromuscular status, monitor VS, assess DTR, teach foods high in magnesium
6
Q
What food are high in magnesium
A
whole grain cereals, legumes, green leafy vegetables, bananas
7
Q
What is ferrous sulfate?
A
iron
8
Q
Patient teaching for ferrous sulfate
A
take on empty stomach if tolerable, rinse mouth and use straw to prevent teeth staining, dark stool is normal, increase water fiber and exercise to prevent constipation
9
Q
What food should we take with ferrous sulfate? Which foods should we avoid?
A
take with vitamin C ; avoid antacids, dairy, coffee, caffeine, and tea
10
Q
What foods high in iron should our patients on ferrous sulfate be taught to eat?
A
tofu, green leafy vegetables, dried peas and beans, dried fruit
11
Q
How to recognize beta blockers?
A
end in -olol
12
Q
Mechanism of action for selective beta blockers?
A
block beta 1 receptors (1 heart)
13
Q
Mechanism of action for nonselective beta blockers?
A
block beta 1 and 2 receptors (2 lungs)
14
Q
Who should not take a non-selective beta blocker?
A
those with respiratory disease (can cause bronchoconstriction)
15
Q
Indications for beta blockers?
A
hypertension
16
Q
Nursing considerations for beta blockers (-olol)
A
monitor VS (BP and HR), HOLD medication if HR less than 50; nonselective monitor blood glucose, taper dose to prevent rebound hypertension, monitor for orthostatic hypotension, monitor BUN/creatinine/LFTs
17
Q
Those on beta blockers should be monitored for what two adverse effects?
A
depression (beta-blocker blues) and sexual dysfunction
18
Q
How to recognize benzodiazepines?
A
end in -lams and -pams
19
Q
Indications for benzodiazepines?
A
Generalized anxiety disorder and panic disorder (trauma/stress disorders, hyperarousal, seizures), to induce sleep
20
Q
Side effects of benzodiazepines
A
hangover, REM rebound (vivid dreams and nightmares)
21
Q
Adverse effects of benzodiazepines
A
CNS and respiratory depression, anterograde amnesia, paradoxical response, withdrawal and dependence, hypersensitivity
22
Q
Symptoms of oral benzodiazepine toxicity
A
drowsy/lethargy, confusion
23
Q
Symptoms of IV benzodiazepine toxicity
A
respiratory depression, hypotension, cardiac and respiratory arrest
24
Q
What is a paradoxical response that can occur from benzodiazepines?
A
opposite reaction from expected: symptoms include euphoria, anxiety, excitation,agitation
25
Black box warning for benzodiazepines
risk of serious A/E if given with opioids
26
Nursing considerations for benzodiazepines
medication reconciliation, VS and LOC, fall precautions, renal function tests
27
Nursing considerations for benzodiazepine toxicity
gastric lavage, activated charcoal, saline cathartics. Flumazenil, VS, airway, floods for BP, crash cart
28
What is the reversal agent for benzodiazepines
flumazenil
29
What is anterograde amnesia
memory loss where you cannot remember new memories
30
Patient teaching for benzodiazepines
take only as ordered, take no more than 7-10 days, take before bed, go to ER if CNS/respiratory depression, avoid activities requiring alertness, avoid other CNS depressants, report amnesia and paradoxical response, s/s of withdrawal and tapering can prevent this, good sleep hygiene, avoid grapefruit juice
31
What drugs are nonbenzodiazepines
zolpidem, zaleplon, eszopiclone
32
What is the indications for nonbenzodiazepines
acute insomnia
33
What drugs are hydantoins?
phenytoin, ethotoin, fosphenytoin
34
Indications for phenytoin (hydantoins)
anticonvulsant
35
What are adverse effects of phenytoin? (hydantoins)
gingivial hyperplasia, CNS symptoms, blood dyscrasias, osteomalacia, Stevens-johnsons syndrome, liver damage, cardiac collapse, endocrine effects
36
What CNS effects can our patients on phenytoin see?
nystagmus, ataxia, slurred speech, confusion, dizziness, insomnia, nervousness
37
What endocrine effects can be seen in those with phenytoin
hirsutism
38
What is the blackbox warning for phenytoin
cardiac collapse, SI, raised BG levels
39
What are patient teachings for phenytoin?
take calcium and vitamin D, avoid herbs and OTC meds, take at same time each day. Similar to other anti seizure meds (do not drive, wear medical ID, do not abruptly stop, seizure precautions, contraceptives, avoid CNS depressants and grapefruit juice, monitor for skin rash/blisters)
40
Indications for carbamazepine
anticonvulsant
41
What is the therapeutic drug level for carbamazepine?
4-12 mcg/mL
42
What are adverse effects of carbamazepine?
stevens johnson, suicidal ideation, blood dyscasias, hepatotoxicity
43
What is the blackbox warning for carbamazepine
blood dycrasias, heart failure, fluid overload
44
Nursing considerations for carbamazepine
monitor for suicidal ideation. monitor CBC for blood dycrasias (anemia, thrombocytopenia, agranulocytosis, infections, bleeding) monitor serum drug level. monitor CNS changes, ECG, electrolytes. Lung sounds and edema (heart failure). Seizure precautions. LFT.
45
What is the indication for donepezil
alzheimers disease/ mild to moderate dementia
46
What are nursing considerations for donepezil
cholinergic crisis treated with atropine, crash cart in case of cholinergic crisis, assess for improvement in cognitive function
47
Donezepil should be used with caution in those that have?
respiratory disease (increased mucous can affect their breathing)
48
What indications for carbidopa-Levodopa
Parkinson's disease
49
What patient teaching should be provided to those on cabidopa levodopa
take as directed with evenly spaced intervals. do not stop abruptly. eat food after taking and avoid protein and multivitamins. change positions slowly (hypotension) and avoid activities requiring alertness. have good oral hygiene. darkening of urine is normal. risk of falls is high. increase fiber and fluids
50
What symptoms should those on carbidopa-levodopa report to the provider
palpitations, retentions, involuntary movements, behavioral changes, N/V, skin lesions
51
What is on-off syndrome seen in carbodopa levodopa
'On' means levodopa is working well and symptoms are subsided. 'off' means levodopa is not working and patients can experience tremors, rigidity, and slow movements
52
What is neostigmine used to treat
myasthenia gravis, diagnose MG, reverse neuromuscular blockade
53
What are side and adverse effects of neostigmine
excessive muscarininc stimulation, cholinergic crisis, myasthenic crisis (under medication) and cholinergic crisis (overmedication)
54
What are symptoms of myasthenic crisis ?
muscle weakness, quadriparesis/plegia, SOB, respiratory insufficiency, difficulty swallowing
55
How is myasthenic crisis treated
more medication
56
Symptoms of cholinergic crisis i
increased GI motility, diarrhea, cramping, bradycardia, pupillary construction (meiosis)
57
How is cholinergic crisis treated
atropine
58
How can nurses tell the difference between myasthenic and cholinergic crisis
administration of edrophonium IV can determine : if symptoms worsen treat with atropine, if symptoms improve need more cholinergic
59
What should we keep next to the patients bed while on neostigmine
crash cart and mechanical ventilation in case of cholinergic crisis. Bedpan/urinal.
60
What drugs are central acting muscle relaxants
baclofen, dantrolene, cyclobenzaprine
61
What is the indication for central acting muscle relaxants
muscle spasms
62
How to evaluate that central acting muscle relaxants have been effective?
pain decreases and ROM increases
63
What are the neuromuscular blocking drugs
succinylcholine,vancuronium, pancuronium
64
Adverse effects of succinylcholine
respiratory arrest, malignant hyperthermia, hyperkalemia
65
How to treat malignant hyperthermia caused by neuromuscular blocking drug
stop medication, administer dantrolene, administer o2 @ 100, do whatever we can to reduce body temp
66
symptoms of malignant hyperthermia
high fever, rigid muscles, tachycardia, sweating
67
What drugs are first generation typical antipsychotics
haloperidol, chlorpromazine
68
Indications of typical antipsychotics
acute and chronic psychotic disorders (schizophrenia, manic states, drug induced psychosis, management of aggressive patients)
69
Adverse effects of atypical antipsychotics?
DAW HADES
diabetes mellitus, anticholinergic effects, weight gain, hypercholesterolemia, agranulocytosis (clozapine) dizziness, elevated prolactin, sexual dysfunction
70
What are signs/symptoms of neuroleptic malignant syndrome
sudden high grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, diaphoresis, tachycardia, changes in LOC leading to coma
71
What drugs are atypical (second generation) antipsychotics
olanzapine, clozapine, risperidone
72
side and adverse effects of typical antipsychotics
neuroleptic malignant syndrome, acute dystonia (sudden movements of face, neck, back, and tongue), parkinsonism, tardive dyskinesia
73
patient teaching for atypical antipsychotics
report abnormal movements, may cause drowsiness, avoid CNS depressants, report s/s of DM, diet and exercise, change positions slowly, ways to manage anticholinergic effects
74
How to recognize benzodiazepines
end in -lams and -pams
75
Adverse affects of benzodiazepines for anxiety
CNS depression, anterograde amnesia, toxicity, paradoxical response, withdrawal effects
76
Patient teaching for benzodiazepines
dependence can occur, avoid other CNS depressants, avoid driving, must be tapered, administer with food and at bedtime, avoid grapefruit juice, pregnancy category D NEED TO ADD INTERACTIONS
77
What is the antidote for benzodiazepines
flumazenil
78
What drugs are SSRI's?
fluoxetine, sertraline, citalopram, escitalopram, fluvoxamine, paroxetine
79
Indications of SSRI's
treat major depression
80
adverse effects of SSRIs
CNS stimulation, sexual dysfunction, weight loss (early then gain), serotonin syndrome, rash, GI bleeding, bruxism, hyponatremia, withdrawal syndrome, sleepiness
81
What is serotonin syndrome that can occur with SSRIs
confusion, agitation, tachycardia, fever and diaphoresis, NVD, abdominal pain, seizures
82
What symptoms can occur from withdrawal syndrome on SSRIs
HA, nausea, tremors, anxiety, visual changes
83
How is serotonin syndrome treated with SSRIs
based on symptoms
84
How can we treat withdrawal symptoms of SSRIs
tapering dose
85
What drugs are MAOIs
phenelzine, isocarboxazid, selegiline transdermal, tranylcypromine
86
Indications for MAOIs
neurotic or atypical depression
87
Drug interactions with MAOIs
CNS stimulants, sympathomimetics, vasopressors, TCAs, SSRIs, general anesthetics
88
What drugs are CNS stimulants?
amphetamines
89
What drugs are sympathomimetics?
epinephrine, norepinephrine, phenylephrine, dopamine, dobutamine, ephedrine, isoproterenol, metoproterenol, and isoetharine
90
Food Interactions with MAOIs?
anything with tyramine (aged cheese, yogurt, coffee, chocolate, pickled foods, yeast, beer and red wine, liver, smoked meats, bananas
91
FINISH LITHIUM
92
What drugs are TCAs
amitriptyline, nortriptyline
93
Side and adverse effects of TCAs
orthostatic hypotension, anticholinergic effects, sedation, toxicity, decreased seizure threshold, excessive sweating, sexual dysfunction, arrhthymias
94
What are the indications for aspirin?
prevent heart attack (81 mg baby aspirin) , 325 mg for pain, platelet aggregation for bleeding
95
Aspirin suppresses?
inflammation, pain,fever
96
Drug interactions with aspirin?
warfarin increased risk of bleeding, alcohol increases risk of gastric ulcer, G herbs increase risk of bleeding
97
Adverse effects of Aspirin
bleeding, renal impairment, salicylism (overdose), Reye's syndrome
98
What is salicylism?
overdose of aspirin ; tinnitus, dizziness, headache, fever, AMS, sweating
99
What is Reye's syndrome?
occurs when children with a virus take aspirin. causes liver damage, hypoglycemia, CNS damage
100
What drugs are NSAIDs?
ibuprofen, naproxen, ibuprofen, indomethacin, ketorolac, diclofenac, meloxicam
101
Adverse effects of NSAIDs?
GI injury (ulcers, bleeding), nephrotoxic and hepatotoxic , prolonged bleeding
102
NSAIDs have a black box warning for>
cardiovascular event, GI bleeding
103
Nursing interventions for NSAIDs
take with food, increase fluid to flush kidneys, avoid alcohol, avoid G herbs, s/s of bleeding, may be prescribed with H2 blocker or PPI, s/s of stroke or MI
104
How long can patients take ketorolac? Why
limited to 5 day use. Can cause kidney damage
105
Indications for methotrexate?
slow or delay worsening of RA
106
contraindications of methotrexate
pregnancy, liver failure, alcohol use disorder, blood dycrasias
107
What are the anti-gout drugs?
colchicine (acute attack), allopurinol, probenecid
108
Nursing interventions/patient teaching for anti-gout drugs?
avoid salicylates with probenecid, the with food, avoid grapefruit juice/alcohol and foods high in purine, increase fluids, monitor for bleeding and infections, metallic taste with allopurinol is normal
109
What labs should nurses monitor if our patient is on anti-gout meds
uric acid, CBC (infection), LFTs, RFTs
110
