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PRNU 228 > Lecture Week 4 - Neuro 2 and Musculoskeletal > Flashcards

Lecture Week 4 - Neuro 2 and Musculoskeletal Flashcards

1
Q

Benzodiazepines - therapeutic use

diazepam (Valium)
alprazolam (Xanax)

A

anxiety disorder and panic disorder

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2
Q

benzodiazepines prototypes

A

diazepam (Valium)
alprazolam (Xanax)

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3
Q

benzodiazepines - expected pharmacologic action

diazepam (Valium)
alprazolam (Xanax)

A

Enhance inhibitory effects of gamma-aminobutyric acid (GABA)

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4
Q

benzodiazepines - adverse drug reactions

diazepam (Valium)
alprazolam (Xanax)

A

CNS depression
hypotension
tachycardia
respiratory distress
Tolerance and physical dependence

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5
Q

benzodiazepine toxicity

diazepam (Valium)
alprazolam (Xanax)

A

sedation, hypotension, respiratory depression, cardiac arrest

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6
Q

benzodiazepines contraindications

diazepam (Valium)
alprazolam (Xanax)

A

pregnancy
glaucoma

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7
Q

benzodiazepines interactions

diazepam (Valium)
alprazolam (Xanax)

A

concurrent use of CNS depressants

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8
Q

benzodiazepines - RN interventions

diazepam (Valium)
alprazolam (Xanax)

A

Monitor for withdrawal symptoms: insomnia, anxiety, tremors, diaphoresis, hypertension, seizures
Monitor for phlebitis - inflammation of vein
Assess/Monitor Falls
Regular Vital Signs
Do not stop abruptly
Assess CNS and Respiratory depression

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9
Q

benzodiazepine antidote

A

flumazenil (Anexate, Romazicon)

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10
Q

non-benzodiazepine anxiolytic prototype

A

buspirone (BuSpar)

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11
Q

non-benzodiazepine anxiolytic - therapeutic use

buspirone (BuSpar)

A

Short term treatment of Generalized anxiety disorder (GAD)

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12
Q

non-benzodiazepines anxiolytic - expected pharmacologic action

buspirone (BuSpar)

A

Binds to serotonin & dopamine receptors

agonistic action on dopamine

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13
Q

non-benzodiazepine anxiolytic - adverse drug reactions

buspirone (BuSpar)

A

Paradoxical effects:
- insomnia
- anxiety
- restlessness
- headache
- dizziness.

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14
Q

non-benzodiazepine anxiolytic contraindications

buspirone (BuSpar)

A

MAOI will cause hypertension
grapefruit juice, ketoconazole, erythromycin will increase blood levels

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15
Q

non-benzodiazepine anxiolytic - RN interventions

buspirone (BuSpar)

A

monitor for paradoxical effects
monitor falls

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16
Q

tricyclic antidepressants prototype and others

A

Amitriptyline (Elavil)

Imapramine (Torfranil)
Nortriptyline (Aventyl)

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17
Q

tricyclic antidepressant expected pharmacologic action

Amitriptyline (Elavil)

A

Block norepinephrine reuptake pump & serotonin reuptake pump

boosts availability of serotonin, norepinephrine, acetylcholine, dopamine

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18
Q

tricyclic antidepressant - therapeutic use

Amitriptyline (Elavil)

A

treats major depression

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19
Q

tricyclic antidepressant - adverse drug reactions

Amitriptyline (Elavil)

A

Anticholinergic effects; sedation

abrupt discontinuation can cause withdrawal (anxiety, headache, muscle pain, nausea)

high risk for overdose (life threatening dysrhythmias, confusion, seizure)

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20
Q

Tricyclic antidepressants contraindications

Amitriptyline (Elavil)

A

MAOIs
anticholinergics
CNS depressants
cardiac dysrhythmias
seizures
recent myocardial infarction

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21
Q

Tricyclic antidepressants RN interventions

Amitriptyline (Elavil)

A

give at bedtime
orthostatic vital signs
monitor suicidal ideation
taper over 2 weeks
Patient has only 1 week supply at a time

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22
Q

SSRI prototype and others

A

fluoxetine (Prozac)

Citalopram (Celexa)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)

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23
Q

SSRI expected pharmacologic action

Fluoxetine (Prozac)

A

Block reuptake of serotonin

strengthened transmission of serotonin at serotonergic synapses

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24
Q

SSRI therapeutic use

Fluoxetine (Prozac)

A

Depression
anxiety
OCD
bulimia nervosa
premenstrual dysphoric disorder

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25
Q

SSRI adverse drug reactions

Fluoxetine (Prozac)

A

Insomnia
nervousness
Sexual dysfunction
Weight gain
risk for GI bleeding
Hyponatremia - low sodium
risk for suicidal ideation
Serotonin syndrome

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26
Q

SSRI contraindications/interactions

Fluoxetine (Prozac)

A

MAOI
St Johns Wort
Ibuprofen
can decrease glucose control in diabetic patients

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27
Q

SSRI RN interventions

Fluoxetine (Prozac)

A

monitor for adverse effects - anxiety, insomnia, weight gain, decreased libido
monitor sodium levels
monitor for depression or suicidal ideation
do not stop abruptly
notify provider of persistent headaches

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28
Q

serotonin syndrome

A

Hypertensive crisis, hyperpyrexia, agitation

can cause coma, muscle rigidity, seizure

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29
Q

SNRI prototype and others

A

venlafaxine (Effexor XR)

duloxetine (Cymbalta)

30
Q

SNRI expected pharmacologic action

vanlafaxine (Effexor XR)

A

Block neuronal reuptake of serotonin AND norepinephrine

increased amt of serotonin/norepinephrine available

31
Q

SNRI therapeutic use

vanlafaxine (Effexor XR)

A

Major depression
social anxiety disorder
generalized anxiety disorder (GAD)

32
Q

SNRI adverse drug reactions

vanlafaxine (Effexor XR)

A

similar to SSRI but sexual dysfunction less common
can cause hypertension

33
Q

SNRI contraindications and interactions

vanlafaxine (Effexor XR)

A

MAOIs
first gen antipsychotics
ibuprofen

34
Q

SNRI RN interventions

vanlafaxine (Effexor XR)

A

take in morning
monitor for insomnia, sexual dysfunction, weight gain
monitor sodium
monitor for depression or suicidal ideation
monitor BP periodically

35
Q

monoamine oxidase inhibitors expected pharmacologic action

A

blocks monoamine oxidase A and B

36
Q

MAOI therapeutic use

A

Depression that hasn’t responded to other medications
Depression in Bipolar

37
Q

MAOI prototype and other

A

phenelzine (Nardil)

isocarboxazid (Marplan)

38
Q

MAOI adverse drug reactions

A

CNS stimulation
GI: constipation, dry mouth, nausea, weight gain
sexual dysfunction
hypotension
hypertensive crisis when eating foods that have tyramine (the food stuff: cheese, meat, yeast, chocolate, alcohol)

39
Q

MAOI contraindications and interactions

A

renal failure or liver disease
cardiac disease
age over 60
SSRIs
glaucoma

40
Q

MAOI RN interventions

A

monitor vitals and BP
give patient list of foods to avoid
patient should report severe anxiety, insomnia, agitation

41
Q

atypical antidepressant prototype

A

bupropion (Wellbutrin)

42
Q

bupropion (Wellbutrin) expected pharmacologic action

A

Inhibits dopamine reuptake
increases dopamine availability

43
Q

bupropion (Wellbutrin) therapeutic use

A

depression, SAD
adjunct to smoking cessation

44
Q

adverse drug reactions of bupropion (Wellbutrin)

A

nausea and vomiting
weight loss and appetite suppression
seizures and CNS stimulation

45
Q

contraindications for bupropion (Wellbutrin)

A

eating disorder history
seizure disorder
MAOI
head trauma or CNS tumor

46
Q

RN interventions wiith bupropion (Wellbutrin)

A

give in morning with food
weigh weekly
assess for increased depression/suicidal ideation

47
Q

mood stabilizer prototype

A

lithium carbonate (Lithobid)

48
Q

lithium carbonate expected pharmacologic action

A

Changes to transport of sodium ions in nerve cells and alters metabolism of catecholamines (fight or flight) in response to stress.

49
Q

lithium carbonate therapeutic use

A

Controls acute mania and acute manic episodes assoc. w/bipolar disorder

50
Q

lithium carbonate adverse drug reactions

A

GI distress
fatigue
confusion
muscle weakness
memory impairment
fine hand tremors

51
Q

lithium carbonate contraindications

A

pregnancy/lactation
cardiac disorders
dehydration
hyponatremia
renal insufficiency
make sure to avoid NSAIDs

52
Q

RN considerations for lithium carbonate

A

very narrow therapeutic range
regular bloodwork
2-3 L fluid per day
avoid caffeine
consume sodium

53
Q

first generation antipsychotics prototype

A

chlorpromazine

54
Q

chlorpromazine expected pharmacologic action

A

Block several receptors: norepinephrine, acetylcholine, dopamine, histamine

55
Q

chlorpromazine therapeutic use

A

suppress symptoms of schizophrenia and acute manic phase of BP

56
Q

adverse drug reactions of chlorpromazine

A

extrapyramidal - abnormal muscle contraction
inability to sit still
dry mouth, dizziness, urinary retention
liver failure

57
Q

chlorpromazine contraindications

A

alcohol or CNS depressants
SSRIs can cause serotonin syndrome
hyponatremia
pregnancy/lactation

58
Q

second generation antipsychotic prototype

A

risperidone (Risperdal)

59
Q

risperidone (Risperdal) expected pharmacologic action

A

Block receptors for dopamine and serotonin

60
Q

risperidone (Risperdal) therapeutic use

A

schizophrenia and bipolar disorder

61
Q

risperidone (Risperdal) contraindications

A

pregnancy/lactation
parkinson’s drugs
older adults with dementia

62
Q

nonbiological DMARDs prototype

A

methotrexate (Rheumatrexate)

63
Q

methotrexate (Rheumatrexate) therapeutic use

A

decrease inflammation/joint damage

64
Q

methotrexate (Rheumatrexate) expected pharmacologic action

A

immunosuppression

65
Q

methotrexate (Rheumatrexate) adverse drug reactions

A

dizziness
blurred vision
nausea and vomiting
decrease blood cells

66
Q

methotrexate (Rheumatrexate) RN interventions and patient education

A

use contraceptives
2L per day
call provider for jaundice, infection, SOB, bleeding

67
Q

methotrexate (Rheumatrexate) contraindications

A

pregnancy/lactation
peptic ulcer disease
alcohol and liver disease
reduce effectiveness by caffeine

68
Q

biological DMARDs prototype

A

etanercept (Enbrel)

69
Q

etanercept (Enbrel) therapeutic use

A

Decrease joint inflammation and subsequent damage

70
Q

etanercept (Enbrel) EPA

A

Inactivates tumor necrosis factor (TNF)

71
Q

etanercept (Enbrel) adverse drug reactions

A

immunosuppression
pancytopenia - pan = all blood cells
heart failure
dizziness
abdominal pain
psoriasis

72
Q

etanercept (Enbrel) contraindications

A

no live vaccines
active infection
hematologic malignancy

PRNU 228 (19 decks)

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