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2021 Pharm 2 > module 3 > Flashcards

module 3 Flashcards

1
Q

expected therapeutic action

A

destroy bacteria by weaknening the cell walls

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2
Q

penicillin types

A
  • narrow-spectrum
  • broad-spectrum
  • antistaphylococcal
  • antipsudomonas
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3
Q

narrow-spectrum penicillins

A
  • PCN G
  • PCN V
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4
Q

broad-spectrum penicillins

A
  • amoxicillin/clavulanate (Augmentin)
  • ampicillin
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5
Q

antistaphylococcal penicillin

A

nafcillin (Nallpen)

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6
Q

antipseudomonas penicillins

A
  • ticarcillin/clavulanate (Timentin)
  • piperacillin/tazobactam (Zosyn)
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7
Q

penicillin G

A
  • trade name: Bicillin, Permapen
  • abbreviation: PCN G
  • class: antibiotic, penicillin
  • spectrum: narrow
  • route: IM, IV
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8
Q

penicillin V

A
  • abbreviation: PCN V, PCN VK
  • class: antibiotic, penicillin
  • spectrum: narrow
  • route: PO
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9
Q

amoxicillin/clavulanate

A
  • trade name: Augmentin
  • class: antibiotics, aminopenicillins, beta lactamase inhibitors
  • spectrum: broad
  • route: PO
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10
Q

ampicillin

A
  • class: antibiotic, aminopenicillin
  • spectrum: broad
  • route: PO, IM, IV
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11
Q

nafcillin

A
  • trade name: Nallpen
  • class: antibiotic, penicillinase-resistant penicillin
  • spectrum: antistaphylococcal
  • route: IM, IV
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12
Q

ticarcillin/clavulanate

A
  • trade name: Timentin
  • class: antibiotic, extended-spectrum penicillin
  • spectrum: antipseudomonas
  • route: IV
  • OFF-MARKET
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13
Q

piperacillin/tazobactam

A
  • trade name: Zosyn
  • class: antibiotic, extended-spectrum penicillin
  • spectrum: antipseudomonas
  • route: IV
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14
Q

penicillin uses

A
  • prophylaxis against bacterial endocarditis
  • UTI
  • gonorrhea
  • perionitis
  • pneumonia, other RTIs
  • septicemia
  • meningitis
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15
Q

penicillin SE

A
  • GI distress
  • oral/vaginal candidiasis
  • generalized rash
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16
Q

penicillin patient education

A
  • report S/Sx of allergic rxn
  • complete entire round of abx
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17
Q

If IVPB penicillin, and pt shows S/Sx of allergic rxn, what’s the priority action?

A

STOP THE INFUSION

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18
Q

Each generation of cephalosporins is _____, less likely to develop _____, and more likely to cross into CSF.

A
  • stronger
  • develop resistance
  • cross into CSF
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19
Q

cephalosporins spectrum

A

broad

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20
Q

cephalosporin uses

A
  • UTI
  • post-op infections
  • pelvic infections
  • meningitis
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21
Q

Cephalosporins have cross-sensitivity with _____, and should not be given to pts with Hx of _____ _____ to those.

A
  • PCN
  • severe rxn
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22
Q

cephalosporin prototype

A

cephalexin (Keflex; 1st-gen)

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23
Q

1st-gen cephalosporins

A
  • cephalexin (Keflex; prototype)
  • cefazolin (Ancef)
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24
Q

2nd-gen cephalosporins

A
  • cefaclor (Ceclor)
  • cefotetan (Cefotan)
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25
Q

3rd-gen cephalosporins

A
  • ceftriaxone (Rocephin)
  • cefotaxime (Claforan)
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26
Q

4th-gen cephalosporin

A

cefepime (Maximpime)

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27
Q

cephalosporin SE

A
  • thrombophlebitis (IV infusion)
  • pain with IM injection
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28
Q

To minimize pain with cephalosporin IM injection, give the injection _____ and _____ in which _____ muscle?

A
  • deep and slow
  • in large muscle
  • ventrogluteal
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29
Q

preventing thrombophlebitis with cephalosporin IV infusion

A
  • rotate sites
  • give as diluted intermittent infusion
  • if bolus, give over 3-5 min in dilute solution
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30
Q

cephalosporin interactions

A
  • ETOH-intolerance rxn with
    • cefotetan
    • cefazolin
    • cefoperazone
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31
Q

carbapenems

A
  • drugs
    • imipenem/cliastatin (Primaxin)
    • meropenem (Merrem)
  • spectrum: broad
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32
Q

carbapenems SE

A
  • allergic rxn
  • GI Sx
    • nausea
    • vomiting
    • diarrhea
  • suprainfection
    • diarrhea
    • oral or vaginal candidiasis
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33
Q

imipenem/cilastatin

A
  • trade name: Primaxin
  • class: carbapenem, antibiotic
  • spectrum: broad
  • uses: severe infections of lower resp. tract, GU, peritoneum, bone, joint, skin, endocardium, etc.
  • route: IV
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34
Q

meropenem

A
  • trade name: Merrem
  • class: antibiotic, carbapenem
  • spectrum: broad
  • uses: severe infections (lower resp. tract, GU, peritoneum, septicemia, skin, meninges)
  • route: IV
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35
Q

other abx for serious infections

A
  • vancomycin (Vancocin, Firvanq)
  • aztreonam (Azactam, Cayston)
  • fosfomycin (Monurol)
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36
Q

Vancomycin, aztreonam, and fosfomycin are indicated for _____ infections caused by what 3 bacteria?

A
  • serious infections
  • bacteria
    • MRSA
    • E. coli
    • Staphylococcus epidermidis
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37
Q

Vancomycin is used to treat what diarrhea-inducing bacterial infection?

A

Clostridium difficile (C. diff)

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38
Q

pharm Tx for mild C. diff

A

PO metronidazole or vancomycin

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39
Q

pharm Tx for moderate-severe C. diff

A
  • IV vancomycin
  • infusion of vanc directly into intestine
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40
Q

vancomycin SE/AE

A
  • ototoxicity
    • assess hearing
    • teach pt to report
    • monitor vanc trough levels
  • renal toxicity: monitor
    • I&O
    • kidney fxn labs
    • vanc trough levels
  • infusion rxn: give over 60 min
  • IV site thrombophlebitis
    • rotate sites
    • monitor for inflammation
    • check IV patency before admin
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41
Q

drawing peak and trough levels of vanc

A
  • wait until after 3rd dose
  • peak: 1-2 hrs after dose
  • trough: 30 min before dose
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42
Q

cephalexin

A
  • prototype
  • trade name: Keflex
  • class: antibiotic, cephalosporin (1st-gen)
  • spectrum: broad
  • route: PO
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43
Q

cefazolin

A
  • trade name: Ancef
  • class: antibiotic, cephalosporin (1st-gen)
  • spectrum: broad
  • route: IM, IV
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44
Q

cefaclor

A
  • trade name: Ceclor
  • class: antibiotic, cephalosporin (2nd-gen)
  • spectrum: broad
  • route: PO
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45
Q

cefotetan

A
  • trade name: Cefotan
  • class: antibiotic, cephalosporin (2nd-gen)
  • spectrum: broad
  • route: IM, iV
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46
Q

ceftriaxone

A
  • trade name: Rocephin
  • class: antibiotic, cephalosporin (3rd-gen)
  • spectrum: broad
  • route: IM, IV
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47
Q

cefotaxime

A
  • trade name: Claforan
  • class: antibiotic, cephalosporin (3rd-gen)
  • spectrum: broad
  • route: IM, iV
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48
Q

cefepime

A
  • trade name: Maxipime
  • class: antibiotic, cephalosporin (4th-gen)
  • spectrum: broad
  • route: IM, iV
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49
Q

vancomycin

A
  • trade name: Vancocin
  • class: glycopeptide antibiotic
  • spectrum: narrow; gram-positive bacteria
  • route: PO, IV, IT
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50
Q

aztreonam

A
  • trade name: Azactam, Cayston
  • class: antibiotic, monobactam
  • spectrum: narrow; gram-negative aerobic bacteria
  • route: IM, IV, inhaln
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51
Q

fosfomycin

A
  • trade name: Monurol
  • class: antibiotic
  • spectrum: narrow; E. faecalis and E. coli
  • route: PO
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52
Q

abx that inhibit protein synthesis

A
  • tetracyclines
  • macrolides
  • aminoglycosides
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53
Q

tetracyclines

A
  • minocycline (Dynacin, Minocin, etc.)
  • doxycycline (Doryx, Doxy, etc.)
  • demeclocycline
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54
Q

tetracycline uses

A
  • top and PO: acne and periodontal dz
  • first-line Tx for
    • rocky mountain spotted fever
    • chlamydia
    • brucellosis
    • Mycoplasma pneumonia
    • Lyme dz
    • anthrax
    • H. pylori
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55
Q

tetracycline SE AE

A
  • GI discomfort
    • cramping
    • N&V
    • diarrha
    • esophageal ulceration
  • yellow/brown tooth discoloration
  • hypoplasia of tooth enamel
  • hepatotoxicity
  • photosensitivity
  • suprainfection of bowel
  • dizziness and lightheadedness (minocycline)
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56
Q

interventions/education for tetracycline GI discomfort

A
  • monitor
    • for N&V, diarrhea
    • I/O
  • take doxy and mino with meals if needed
  • avoid taking at bedtime to reduce esophageal ulceration
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57
Q

interventions/education for yellow/brown tooth discoloration and/or hypoplasia of tooth enamel

A

avoid in children < 8 yo and pregnant women (cat. D)

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58
Q

interventions/education for tetracycline hepatotoxicity

A
  • monitor for lethargy, jaundice
  • avoid high daily doses IV
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59
Q

education for suprainfection of bowel r/t tetracyclines

A

report diarrhea to provider

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60
Q

education about dizziness/lightheadedness r/t minocycline

A

be careful walking and report to provider

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61
Q

minocycline

A
  • trade name: Dynacin, Minocin, etc.
  • class: antibiotic, tetracycline
  • spectrum: broad
  • route: PO, IV
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62
Q

doxycycline

A
  • trade name: Doxy, Doryx, etc.
  • class: antibiotic, tetracycline
  • spectrum: broad
  • route: PO, IV
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63
Q

demeclocycline

A
  • trade name: Declomycin
  • class: antibiotic, tetracycline
  • spectrum: broad
  • route: PO
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64
Q

tetracycline interactions

A
  • nonabsorbable chelate formation, ↓ absorption
    • milk products
    • Ca supplements
    • Fe supplements
    • Mg laxatives/antacids
  • ↓ effectiveness of oral contraceptives
  • ↑ risk of digoxin toxicity: minocycline and doxycycline
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65
Q

interventions/education for tetracycline + Ca, Fe, or Mg

A
  • take on empty stomach w/ full glass of water
    • take w/ food if GI distress occurs
    • minocycline: take with meals
  • give tetracyclines 1 hr before or 2 hrs after food and supplements w/ Ca and Mg
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66
Q

education/interventions for digoxin + minocycline or doxycycline

A

monitor digoxin level carefully

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67
Q

macrolides

A
  • drugs
    • erythromycin
    • azithromycin
  • for pts w/ PCN allergy
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68
Q

macrolides uses

A
  • Legionnaires’
  • pertussis
  • diphtheria
  • chlamydia
  • respiratory infections (Z-pack)
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69
Q

macrolides SE/AE

A
  • GI discomfort
    • N&V
    • epigastric pain
  • prolonged QT interval
    • dysrhythmias
    • possible sudden cardiac death
  • ototoxicity w/ high-dose therapy
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70
Q

interventions/education for GI discomfort with macrolides

A
  • take erythromycin w/ meals
  • observe for and report Sx
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71
Q

interventions/education for prolonged QT interval w/ macrolides

A
  • use in pts with prolonged QT not recommended
  • avoid concurrent use w/ meds that affect hepatic drug metabolizing enzymes
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72
Q

interventions/education for ototoxicity w/ macrolides

A
  • monitor for
    • hearing loss
    • vertigo
    • ringing in ear
  • notify provider
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73
Q

erythromycin interactions

A
  • inhibits metabolism of
    • antihistamines
    • theophylline
    • carbamazepine
    • warfarin
    • digoxin
  • can lead to toxicity of these meds
  • avoid concurrent use or monitor carefully
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74
Q

nursing admin of macrolides

A
  • PO: on empty stomach
  • monitor PT/INR in pts taking warfarin
  • monitor LFT if taking > 1-2 wks
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75
Q

aminoglycosides

A
  • drugs
    • gentamicin
    • amikacin
    • tobramycin
    • neomycin
    • streptomycin
    • paromomycin
  • toxicity: oto and nephro
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76
Q

aminoglycoside AEs

A
  • ototoxicity
  • nephrotoxicity
  • ↑ neuromuscular blockade
  • hypersensitivity
  • neurologic d/o (streptomycin)
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77
Q

ototoxicity from aminoglycoside use

A
  • damage
    • cochlear (hearing)
    • vestibular (balance)
  • S/Sx
    • tinnitus
    • HA
    • hearing loss
    • nausea
    • dizziness
    • vertigo
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78
Q

monitoring for ototoxicity with aminoglycoside use

A
  • S/Sx
    • tinnitus
    • HA
    • hearing loss
    • nausea
    • dizziness
    • vertigo
  • baseline audiometric study
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79
Q

pt education for ototoxicity r/t aminoglycoside use

A
  • stop drug and notify HCP for
    • tinnitus
    • hearing loss
    • HA
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80
Q

nephrotoxicity r/t aminoglycosides

A
  • 2/2 high cumulative dose → acute tubular necrosis
  • S/Sx
    • proteinuria
    • casts in urine
    • dilute urine
    • ↑ BUN
    • ↑ creatinine
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81
Q

nursing actions for nephrotoxicity r/t aminoglycoside use

A
  • monitor
    • I&O
    • BUN
    • creatinine
  • notify HCP of
    • hematuria
    • cloudy urine
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82
Q

pt education for nephrotoxicity r/t aminoglycoside use

A

report hematuria or cloudy urine

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83
Q

neuromuscular AE of aminoglycosides

A
  • intensified neuromuscular blockade → respiratory depression or muscle weakness
  • closely monitor use in
    • myasthenia gravis
    • general anesthetics
    • skeletal muscle relaxants
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84
Q

neurologic d/o with aminoglycosides

A
  • peripheral neuritis
  • optic nerve dysfunction
  • tingling/numbness in hands and feet
  • promptly report manifestations to HCP
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85
Q

nursing admin of aminoglycosides

A
  • topical: wash w/ soap and water before application
  • measure levels to prevent toxicity
    • for once daily dosing: only measure trough
    • peak: 30 min after dose
    • trough: 30 min before dose
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86
Q

Meds for UTI are used to treat _____ infections and as _____ in high-risk pts.

A
  • active infections
  • prophylaxis in high-risk pts
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87
Q

meds for UTI Tx

A
  • sulfonamides
  • urinary tract antiseptics
  • floroquinolones
  • urinary tract analgesics
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88
Q

sulfonamides

A
  • drugs
    • sulfamethoxazol/trimethoprim (SMZ-TMP; Bactrim, Septra)
    • sulfadiazine
    • trimethoprim (Primsol)
  • action: inhibit bacterial growth by preventing synthesis of folic acid
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89
Q

erythromycin

A
  • trade name: Erythrocin
  • class: antibiotic, macrolide
  • spectrum: broad
  • route: IV, PO, top
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90
Q

azithromycin

A
  • trade name: Zithromax
  • class: antibiotic, macrolide
  • spectrum: broad
  • route: PO, IV
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91
Q

gentamicin

A
  • trade name: Garamycin
  • class: antibiotic, aminoglycoside
  • spectrum: broad
  • route: IM, IV, IT, topical
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92
Q

amikacin

A
  • trade name: Arikayce
  • class: antibiotic, aminoglycoside
  • spectrum: broad
  • route: IM, IV, inhaln
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93
Q

tobramycin

A
  • trade name: Bethkis, TOBI, Kitabis
  • class: antibiotic, aminoglycoside
  • spectrum: broad
  • route: IM, iV, inhaln
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94
Q

neomycin

A
  • class: antibiotic, aminoglycoside
  • spectrum: broad
  • route: PO
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95
Q

streptomycin

A
  • class: antibiotic, aminoglycoside
  • spectrum: broad
  • route: IM
  • can cause neurologic d/o
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96
Q

paromomycin

A
  • class: antibiotic, aminoglycoside, amebicide
  • spectrum: broad
  • route: PO
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97
Q

sulfamethoxazol/trimethoprim

A
  • abbreviation: SMZ-TMP
  • trade name: Bactrim, Septra
  • class: antibiotic, antiprotozoal, sulfonamide
  • spectrum: broad
  • route: PO, IV
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98
Q

trimethoprim

A
  • trade name: Primsol
  • class: antibiotic, sulfonamide
  • spectrum: broad
  • route: PO
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99
Q

sulfadiazine***

A
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100
Q

sulfonamide AE

A
  • hypersensitivity including SJS
  • blood dyscrasias
  • crystalluria
  • kernicterus
  • photosensitivity
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101
Q

sulfonamide interactions

A
  • ↑ effects of
    • warfarin
    • phenytoin
    • sulfonylurea oral hypoglycemics
    • tolbutamide
  • ↓ dosages may be required during SMZ-TMP therapy
  • Labs: PT/INR, phenytoin, and BG
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102
Q

hypersensitivity to sulfonamides

A
  • do not give SMZ-TMP to pt with allergy to
    • sulfa drugs
    • thiazides
    • sulfonylureas
    • loop diuretics
  • stop drug at first sign of hypersensitivity
  • report to HCP
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103
Q

blood dyscrasias r/t sulfonamide use

A
  • dyscrasias
    • hemolytic anemia
    • agranulocytosis
    • leukopenia
    • thrombocytopenia
    • aplastic anemia
  • baseline and periodic CBC
  • monitor for and report
    • bleeding
    • sore throat
    • pallor
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104
Q

crystalluria r/t sulfonamide use

A
  • crystalline aggregates in kidneys, ureters, bladder → irritation and obstruction → acute kidney injury
  • prevention: 2-3 L/day PO fluid intake
  • monitor UOP: ≥ 1200 mL/day
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105
Q

kernicterus r/t sulfa drugs

A
  • avoid giving SMZ-TMP to prevent
    • birth defects: 1st trimester
    • kernicterus
      • near-term pregnancy
      • breastfeeding
      • infants < 2 mo
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106
Q

sulfonamide complications: SULFA

A
  • SJS
  • Urine precipitation/Useful for UTIs
  • Leukopenia/anemia/thrombocytopenia
  • Fotosensitivity
  • Added effect of warfarin, phenytoin, and oral antidiabetics
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107
Q

urinary tract antiseptics

A
  • drugs
    • nitrofurantoin
    • nitrofurantoin macrocrystals
  • spectrum: broad
  • action: damages bacterial DNA
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108
Q

urinary tract antiseptic pt teaching

A
  • take nitrofurantoin w/ milk or meals
  • ↑ oral fluid intake
  • urine will be dark brown
  • notify HCP of
    • HA, drowsiness, dizziness
    • easy bruising, epistaxis
    • paresthesias, muscle weakness
    • SOB, CP, fever, cough, chills
    • anorexia, N&V, diarrhea
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109
Q

AE of urinary tract antiseptics

A
  • GI discomfort
  • hypersentivity rxn
  • blood dyscrasias
  • peripheral neuropathy
  • HA, drowsiness, dizziness
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110
Q

GI discomfort w/ nitrofurantoin

A
  • Sx
    • anorexia
    • N&V
    • diarrhea
  • give with milk or meals
  • ↓ dosage, use macrocrystalline tablet to reduce GI discomfort
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111
Q

hypersensitivity rxn w/ nitrofurantoin

A
  • w/ severe pumonary Sx
    • dyspnea
    • cough
    • CP
    • fever
    • chills
    • alveolar infiltrations
  • stop med and call HCP
  • Sx should subside w/in several days after D/C
  • don’t take nitrofurantoin again
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112
Q

blood dyscrasias w/ nitrofurantoin

A
  • dyscrasias
    • agranulocytosis
    • leukopenia
    • thrombocytopenia
    • megaloblastic anemia
    • hepatotoxicity
  • baseline/periodic CBC
  • monitor for easy bruising and epistaxis
  • notify HCP of S/Sx
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113
Q

peripheral neuropathy w/ nitrofurantoin

A
  • Sx
    • numbness, tingling of hands and feet
    • muscle weakness
  • notify HCP
  • avoid chronic use
  • not recommended for pts w/ kidney failure
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114
Q

HA, drowsiness, and dizziness w/ nitrofurantoin use

A

notify HCP

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115
Q

fluoroquinolones

A
  • drugs (-floxacin)
    • ciprofloxacin
    • ofloxacin
    • moxifloxacin
    • levofloxacin
    • morfloxacin
  • spectrum: broad
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116
Q

fluoroquinolone uses

A
  • alternative to parenteral abx for severe infection
  • infections of
    • GU
    • GI
    • respiratory
    • bone
    • skin
    • soft tissue
  • anthrax
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117
Q

AE of floroquinolones

A
  • GI discomfort
  • Achilles’ tendon rupture
  • suprainfection
  • phototoxicity
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118
Q

GI discomfort w/ fluoroquinolones

A
  • usually mild
  • Sx: N&V, diarrhea
  • Tx for SE
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119
Q

Achilles’ tendon rupture w/ fluoroquinolones

A
  • look for Sx at site
    • pain
    • swelling
    • redness
  • notify provider
  • D/C cipro
  • don’t exercise until inflammation subsides
  • do not give to pts < 18 yo
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120
Q

suprainfection w/ fluoroquinolones

A
  • types
    • candidiasis: vaginal, oral
    • ↑ risk of C. diff
  • S/Sx
    • cottage cheese-like lesions in mouth or genitals
    • diarrhea
  • notify HCP
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121
Q

phototoxicity w/ fluoroquinolones

A
  • severe sunburn, even with sunscreen
  • exposure: direct and indirect sunlight, sun lamps
  • pt education
    • avoid sun exposure
    • wear protective clothing and sunscreen at all times
  • D/C immediately if occurs
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122
Q

nursing implications for fluoroquinolone admin

A
  • add metronidazole if C. diff develops
  • don’t take within 2 hrs of
    • milk and dairy
    • Al/Mg antacids
  • IV cipro: diluted, in large vein over 1 hr
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123
Q

urinary tract analgesics

A
  • phenazopyridine (Pyridium)
  • works as local anesthetic
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124
Q

phenazopyridine

A
  • trade name: Pyridium, Baridium
  • class: non-opioid analgesic, urinary tract analgesic
  • route: PO
  • available OTC in lower strength
  • azo dye
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125
Q

phenazopyridine use

A
  • local anesthetic
  • relieves
    • dysuria
    • urinary frequency
    • urinary urgency
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126
Q

Phenazopyridine turns urine _____ and stains _____.

A
  • urine orange
  • stains clothes
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127
Q

ciprofloxacin

A
  • trade name: Cipro
  • class: antibiotic, fluoroquinolone
  • spectrum: broad
  • route: PO, IV
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128
Q

ofloxacin

A
  • trade name: Floxin
  • class: antibiotic, fluoroquinolone
  • spectrum: broad
  • route: PO, otic
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129
Q

moxifloxacin

A
  • trade name: Avelox
  • class: antibiotic, fluoroquinolone
  • spectrum: broad
  • route: PO, IV
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130
Q

levofloxacin

A
  • trade name: Levaquin
  • class: antibiotic, fluoroquinolone
  • spectrum: broad
  • route: PO, IV
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131
Q

norfloxacin

A
  • trade name: Noroxin
  • class: antibiotic, fluoroquinolone
  • spectrum: broad
  • route: PO
  • off-market
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132
Q

nitrofurantoin

A
  • trade name: Macrobid, Macrodantin, Furadantin
  • class: antibiotic, urinary tract antiseptic
  • spectrum: broad
  • route: PO
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133
Q

antimycobacterial agents (anti-TB)

A
  • highly specific for mycobacteria
  • drugs
    • isoniazid
    • pyrazinamide
    • ethambutol
    • rifapentine
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134
Q

latent TB Tx options

A
  • isoniazid only for 6-9 months
  • isoniazid with rifapentine 1x/wk for 3 months
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135
Q

active TB Tx

A
  • must use combo therapy to ↓ resistance
  • primary med: isoniazid
  • minimum Tx period: 6 months
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136
Q

isoniazid

A
  • trade name: INH
  • class: antitubercular, antimycobacterial
  • spectrum: narrow
  • route: PO, IM
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137
Q

isoniazid precautions

A
  • older adults
  • ETOH abuse
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138
Q

AE of isoniazid

A
  • peripheral neuropathy
  • hepatotoxicity
  • hyperglycemia and ↓ BG control in DM
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139
Q

peripheral neuropathy w/ isoniazid

A
  • Sx
    • tingling
    • numbness
    • burning
    • pain
  • cause: pyridoxine (B6) deficiency
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140
Q

pt teaching for isoniazid

A
  • peripheral neuropathy
    • take 50-200 mg vitamin B6 daily
    • observe for Sx and notify HCP
  • hepatotoxicity
    • observe for Sx and notify HCP
    • avoid ETOH
  • hyperglycemia in DM
    • monitor BG
    • may need additional DM meds
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141
Q

hepatotoxicity w/ isoniazid

A
  • S/Sx
    • anorexia
    • malaise
    • fatigue
    • nausea
    • jaundice
  • monitor LFTs: may D/C if elevated
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142
Q

↓ BG control in DM w/ isoniazid

A
  • monitor BG
  • DM pts may need extra DM meds
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143
Q

DOT

A

direct observation therapy

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144
Q

direct observation therapy for active TB

A

med is given by public health nurse to ensure compliance

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145
Q

pyrazinamide

A
  • class: antimycobacterial, antitubercular
  • spectrum: narrow
  • route: PO
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146
Q

ethambutol

A
  • trade name: Myambutol
  • class: antimycobacterial, antitubercular
  • spectrum: narrow
  • route: PO
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147
Q

rifapentine

A
  • trade name: Priftin
  • class: antimycobacterial, antitubercular
  • spectrum: narrow
  • route: PO
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148
Q

rifampin

A
  • trade name: Rifadin, Rimactane
  • class: antitubercular, rifamycin
  • spectrum: broad
  • route: PO, IV
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149
Q

rifampin AE

A
  • discoloration of body fluids
  • hepatotoxicity
  • mild GI discomfort
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150
Q

rifampin: discoloration of body fluids

A
  • teach pt
  • orange urine, saliva, sweat, and tears
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151
Q

hepatotoxicity w/ rifampin

A
  • Sx
    • jaundice
    • anorexia
    • fatigue
    • malaise
  • monitor LFT
  • notify provider
  • avoid ETOH
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152
Q

mild GI discomfort w/ rifampin

A
  • mild and usually doesn’t require intervention
  • Sx
    • anorexia
    • abd discomfort
    • nausea
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153
Q

antiprotozoals

A

metronidazole

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154
Q

metronidazole uses

A
  • intestinal amoebas
  • trichomoniasis
  • abx-induced C. diff
  • gardnerella vaginalis
  • bacterial vaginitis
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155
Q

contraindications of metronidazole

A
  • active CNS d/o
  • blood dyscrasias
  • lactation
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156
Q

metronidazole precautions

A
  • older adults
  • d/o of
    • sz
    • heart
    • kidneys
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157
Q

metronidazole interactions and interventions

A
  • ETOH-intolerance rxn: avoid ETOH
  • metronidazole inhibits inactivation of warfarin
    • monitor PT/INR
    • adjust warfarin dosage as necessary
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158
Q

metronidazole AE

A
  • GI discomfort
  • darkening of urine
  • CNS Sx
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159
Q

GI discomfort w/ metronidazole

A
  • S/Sx
    • N&V
    • dry mouth
    • metallic taste
  • report to provider
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160
Q

Dark urine is a _____ SE of metronidazole.

A

harmless

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161
Q

CNS Sx with metronidazole

A
  • Sx
    • numbness of extremities
    • ataxia
    • sz
  • notify provider
  • stop metronidazole
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162
Q

antifungals

A
  • IV only: amphotericin B
  • PO only: ketoconazole
  • PO, top
    • flucytosine
    • nystatin
    • miconazole
    • clotrimazole
    • terminafine
    • fluconazole
    • griseofulvin
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163
Q

amphotericin B AE

A
  • infusion rxn
  • thrompophlebitis
  • nephrotoxicity
  • bone marrow suppression
  • hypokalemia
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164
Q

infusion rxn w/ amphotericin B

A
  • S/Sx
    • fever
    • chills
    • rigors
    • HA
  • timing: 1-3 hrs after infusion start
  • test dose: 1 mg, slowly via IV
  • pre-Tx: diphenhydramine, acetaminophen
  • rigors Tx: meperidine, dantrolene, or hydrocortisone
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165
Q

thrombophlebitis w/ amphotericin B

A
  • monitor infusion site
  • rotate injection sites
  • give in large vein
  • pre-Tx: heparin
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166
Q

nephrotoxicity w/ amphotericin B

A
  • baseline and weekly BUN and creatinine
  • monitor I&O
  • infuse 1 L saline on day of ampho infusion
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167
Q

bone marrow suppression w/ amphotericin B

A

baseline and weekly CBC

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168
Q

hypokalemia w/ amphotericin B

A
  • monitor electrolyte panel, esp. K+
  • give K+ supplements as indicated
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169
Q

ketoconazole AE

A
  • hepatotoxicity
    • anorexia
    • N&V
    • jaundice
    • dark urine
    • clay-colored stools
  • baseline and monthly LFTs
  • notify HCP and D/C med
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170
Q

aminoglycosides + antifungals =

A
  • additive nephrotoxic risk
  • avoid concurrent use
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171
Q

azole abx + antifungals =

A
  • ↑ levels of some meds, including
    • digoxin
    • warfarin
    • sulfonylureas
  • if concurrent use necessary, monitor more closely for toxicity
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172
Q

nursing implications for antifungals

A
  • amphotericin B
    • bad: only use for life-threatening infection
    • give IVPB over 2-4 hrs
    • watch closely for rxn
  • PO liquid nystatin for thrush
    • swish around and hold in mouth as long as possible, then swallow
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173
Q

antibiotic

A
  • antimicrobial
  • treats infection caused by
    • bacteria
    • viruses
    • fungi
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174
Q

3 ways antimicrobials work to fight infection

A
  • destroy bacterial cell wall
  • inhibit conversion of enzymes necessary for bacteria
  • impair protein synthesis to inhibit growth
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175
Q

conjugation

A

changes in micro-organism DNA that causes resistance

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176
Q

suprainfection

A

when normal flora killed of by abx and new, hard-to-treat infection develops

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177
Q

classes of antimicrobial meds

A
  • by susceptible microbe
    • narrow-spectrum
    • broad-spectrum
  • by action
    • bactericidal
    • bacteriostatic
  • type of microbe
    • antibacterial
    • antifungal
    • antiviral
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178
Q

methods of identifying causative organism in infection

A
  • testing body fluids
    • blood
    • urine
    • sputum
    • wound
  • collect specimen before med is started
  • avoid contamination
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179
Q

sensitivity testing

A
  • done after microbe of infection is identified
  • gram stain: gram-negative bacteria harder to treat w/ impermeable wall
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180
Q

Immunocompromised pts may require _____ _____ to treat infections.

A

stronger abx

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181
Q

host factors affecting Tx of infection

A
  • immune system
  • site of infection
  • age
  • pregnancy
  • allergies
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182
Q

age as a factor in Tx of infection

A
  • infants: toxicity r/t immature kidney and liver fxn
  • older adults: toxicity r/t slowed metabolism and excretion
How well did you know this?
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Not at all
2
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183
Q

PG as a factor in Tx of infection

A
  • not gentamicin: ototoxicity in baby
  • no tetracycline: tooth damage in baby
184
Q

sites of infection that are harder to treat

A
  • CSF: abx must cross BBB
  • heart
  • places w/ poor circulation
  • foreign objects: i.e., synthetic joints and heart valves
185
Q

Combo abx therapy can cause what 3 types of effects?

A
  • additive
  • potentiative
  • antagonistic
186
Q

pros of combo abx therapy

A
  • Tx of
    • severe infection
    • infections caused by more than one microbe
  • prevents bacterial resistance from causing infection
  • ↓ chance of toxicity (↓ overall dosage)
  • more effective Tx
187
Q

cons of combo abx therapy

A
  • ↑ resistance to abx
  • ↑ cost of therapy
  • ↑ risk for adverse or toxic rxn
  • antagonistic effects of various abx
  • ↑ risk for suprainfection
188
Q

prophylactic use of antimicrobial therapy in surgical pts

A
  • GI
  • cardiac
  • vascular
  • orthopedic
  • some GYN surgeries
189
Q

prophylactic use of antimicrobials

A
  • surgical pts
  • exposure to flu
  • exposure to STDs
  • special cases: heart valve, recurring UTI
190
Q

retrovirus

A

must attach to host cell to replicate

191
Q

antiretrovirals

A
  • Tx for HIV
  • not a cure
  • methods of action
    • prevent virus from entering cells
    • inhibit enzymes needed to replicate
192
Q

goals of antiretroviral therapy

A
  • ↓ viral load to undetectable level →
    • ↓ risk of transmission
    • longer life expectancy
193
Q

ART

A

antiretroviral therapy

194
Q

HAART

A
  • highly active antiretroviral therapy
  • 3-4 meds concurrently
  • ↓ resistance, AE, and dosages
195
Q

noncompliance with ART →

A
  • resistance
  • possible Tx failure
196
Q

NRTI

A

nucleoside reverse transcriptase inhibitor

197
Q

NRTIs

A
  • drugs
    • zidovudine
    • didansocine
    • stavudine
    • lamivudine
    • abacavir
  • first-line ART for HIV
  • many combos in one tablet or capsule
198
Q

AE of NRTIs

A
  • zidovudine: bone marrow suppression
  • lactic acidosis
  • nausea, vomiting, diarrhea
  • hepatomegaly/fatty liver
199
Q

labs for NRTIs

A
  • bone marrow suppression: CBC/platelets
  • GI distress: fluids and electrolytes
  • hepatomegaly/fatty liver: LFTs
200
Q

S/Sx of lactic acidosis

A
  • hyperventilation
  • nausea
  • abd pain
201
Q

NRTIs: GI distress

A
  • take med with food
  • monitor fluids/electrolytes
202
Q

Teach pts taking NRTIs to take all meds daily to avoid _____ _____.

A

medication resistance

203
Q

types of antiretrovirals

A
  • NRTIs
  • protease inhibitors
  • acyclovir
  • ganiclovir
204
Q

protease inhibitors

A
  • drugs
    • rionavir
    • sazuinavir
    • indinavir
    • fsamprenavir
    • nelfinavir
    • lopinavir
  • action: inactivate virus by inhibiting enzymes needed for replication
  • lots of interactions; get COMPLETE medication Hx
205
Q

AEs of protease inhibitors

A
  • bone loss/osteoporosis
  • hyperglycemia
  • hypersensitivity rxn
  • N&V
  • ↑ serum lipids
  • thrombocytopenia, leukopenia
206
Q

labs for protease inhibitors

A
  • BG: hyperglycemia
  • lipids: hyperlipidemia
  • CBC: thrombocytopenia, leukopenia
207
Q

bone loss r/t protease inhibitors

A
  • eat diet high in Ca and vitamin D
  • possible Tx for severe bone loss: raloxifene, alendronate
208
Q

hyperglycemia r/t protease inhibitors

A
  • adjust diet
  • give antidiabetic meds as prescribed
  • monitor for 3 Ps: polydipsia, polyuria, polyphagia
209
Q

hypersensitivity rxn to protease inhibitors

A

rash

210
Q

N&V r/t protease inhibitors

A

take with food

211
Q

hyperlipidemia r/t protease inhibitors

A

adjust diet

212
Q

blood dyscrasias r/t protease inhibitors

A
  • monitor
    • CBC
    • S/Sx of infection
    • S of bleeding
213
Q

acyclovir uses

A
  • HSV
  • varicella-zoster
214
Q

acyclovir contraindications

A
  • dehydration
  • renal impairment
  • other nephrotoxic meds
215
Q

AE of acyclovir

A
  • phlebitis
    • rotate injection sites
    • monitor IV site
  • nephrotoxicity
    • give slowly over 1 hr
    • ensure adequate hydration; PO and IV fluids
216
Q

ganciclovir uses

A
  • CMV
  • prophylaxis in some pts
    • HIV
    • organ transplant
    • immunosuppression/compromise
217
Q

ganciclovir contraindication

A

pts w/ neutrophils < 500/mm3

218
Q

ganciclovir AE

A

bone marrow suppression

219
Q

zidovudine

A
  • trade name: Retrovir
  • class: antiretroviral, NRTI
  • route: PO, iV
220
Q

didansocine

A
  • trade name: Videx
  • class: antiretroviral, NRTI
  • route: PO
221
Q

stavudine

A
  • trade name: Zerit
  • class: antiretroviral, NRTI
  • route: PO
222
Q

lamivudine

A
  • trade name: Epivir
  • class: antiretroviral, NRTI
  • route: PO
223
Q

abacavir

A
  • trade name: Ziagen
  • class: antiretroviral, NRTI
  • route: PO
224
Q

rionavir

A
  • trade name: Norvir
  • class: antiretroviral, protease inhibitor
  • route: PO
225
Q

sazuinavir

A
  • trade name: Invirase
  • class: antiretroviral, protease inhibitor
  • route: PO
226
Q

indinavir

A
  • trade name: Crixivan
  • class: antiretroviral, protease inhibitor
  • route: PO
227
Q

fosamprenavir

A
  • trade name: Lexiva
  • class: antiretroviral, protease inhibitor
  • route: PO
228
Q

nelfinavir

A
  • trade name: Viracept
  • class: antiretroviral, protease inhibitor
  • route: PO
229
Q

lopinavir/ritonavir

A
  • trade name: Kaletra
  • class: antiretroviral, protease inhibitor (lopinavir), metabolic inhibitor (ritonavir)
  • route: PO
230
Q

acyclovir

A
  • trade name: Sitavig, Zovirax
  • class: antiviral, purine analog
  • route: PO, buccal, IV, topical
231
Q

genciclovir

A
  • trade name: Cytovene
  • class: antiviral
  • route: IV
232
Q

DSM 5 anxiety d/o

A
  • generalized
  • panic d/o
  • OCD
  • social
  • PTSD
233
Q

interventions for anxiety

A
  • therapy
  • biofeedback
  • relaxation techniques
  • medications
234
Q

common anxiety Sx

A
  • nervousness
  • restlessness
  • feeling tense
  • sense of impending danger, panic, or doom
  • ↑ HR
  • hyperventilation
  • sweating
  • trembling
  • feeling weak or tired
  • trouble concentrating or thinking about anything other than the present worry
  • trouble sleeping
  • GI problems
  • difficulty controlling worry
  • urge to avoid things that trigger anxiety
235
Q

classes of meds for anxiety

A
  • benzodiazepines
  • atypical/non-barbiturate anxiolytics
  • SSRIs
  • SNRIs
  • TCAs
236
Q

therapeutic uses of benzodiazepines

A
  • sedative
  • hypnotic
  • anxiolytic
237
Q

less common meds for anxiety

A
  • MAOIs
  • mirtazapine (tetracyclic)
  • trazodone
  • hydroxyzine (antihistamine)
  • propranolol (stage fright)
  • prazosin (alpha blocker, for nightmares)
  • gabapentin (anticonvulsant)
238
Q

benzodiazepines

A
  • mostly -pam and -lam names
  • generally used short-term (risk for dependence)
  • drugs
    • alprazolam (Xanax)
    • diazepam (Valium)
    • lorazepam (Ativan)
    • chlordiazepoxide (Librium)
    • clonazepam (Klonopin)
  • Schedule IV
239
Q

MOA: benzodiazepines

A
  • work fast: rapid relief
  • enhances inhibitory effects of GABA in CNS
240
Q

uses for benzodiazepines

A
  • GAD and panic d/o
  • trauma d/o
  • sz d/o
  • insomni
  • muscle spasm
  • acute manifestations of ETOH withdrawal
  • induction of anesthesia
  • amnesic before surgery/procedure
241
Q

complications of benzos

A
  • CNS depression
  • anterograde amnesia
  • toxicity
  • paradoxical response
  • withdrawal Sx (long-term use)
242
Q

CNS depression w/ benzos

A
  • sedation
  • lightheadedness
  • ataxia
  • ↓ cognitive fxn
243
Q

toxicity S/Sx w/ benzos

A
  • oral
    • drowsiness
    • lethargy
    • confusion
  • IV
    • respiratory depression
    • hypotension
    • cardiac arrest
244
Q

paradoxical response S/Sx w/ benzos

A
  • insomnia
  • excitation
  • euphoria
  • anxiety
  • rage
245
Q

withdrawal from benzos

A
  • with long-term use
  • taper dose
  • Sx
    • anxiety
    • insomnia
    • diaphoresis
    • tremors
    • lightheadedness
246
Q

retrograde amnesia

A

inability to recall past memories

247
Q

anterograde amnesia

A

inability to create new memories

248
Q

Tx for benzo OD

A
  • PO
    • gastric lavage
    • activated charcoal or saline cathartics
  • IV
    • flumazenil to counteract sedation
    • maintain airway
    • IV fluids for BP
    • be ready to resuscitate
249
Q

diazepam

A
  • trade name: Valium, Diastat
  • class: benzodiazepine, anxiolytic, anticonvulsant, centrally acting muscle relaxant, sedative/hypnotic
  • Schedule IV
  • route: PO, IM, IV, rectal
250
Q

diazepam contraindications and precautions

A
  • pregnancy: D
  • contra
    • sleep apnea
    • respiratory depression
    • glaucoma
  • cuation
    • liver dz
    • Hx of mental illness or substance abuse
251
Q

benzodiazepine interaction

A
  • CNS depressants: may result in respiratory depression
    • ETOH
    • barbiturates
    • opioids
    • other
252
Q

nursing admin for benzodiazepines

A
  • take as prescribed
  • taper dose to prevent withdrawal
  • don’t crush or chew sustained-release or enteric-coated
  • notify provider of concerns about developing dependence
253
Q

atypical/non-barbiturate anxiolytic

A

buspirone

254
Q

buspirone

A
  • trade name: BuSpar
  • class: atypical/non-barbiturate anxiolytic
  • route: PO
255
Q

buspirone action

A
  • not fully understood
  • does not bind to serotonin and dopamine receptors
  • dependency much less likely
  • no sedation or potentiation of effects of other CNS depressants
256
Q

buspirone uses

A
  • panic d/o
  • social anxiety d/o
  • OCD
  • PTSD/trauma
257
Q

complications of buspirone use

A
  • dizziness
  • HA
  • lightheadedness
  • agitation
  • nausea: take with food
  • teaching: most effects are self-limiting
258
Q

buspirone onset

A
  • onset: 7-10 days
  • peak: 3-4 wks
  • 7 days to notice effects
  • up to 2-6 wks for full effect
259
Q

nursing admin of buspirone

A
  • schedule dosage, not PRN
  • tolerance dependence, and withdrawal not an issue
260
Q

SSRIs for anxiety

A
  • American Association of Family Physicians
    • 1st-line Tx
    • therapy can be as effective as meds
  • antidepressants can work as anxiolytics
261
Q

depressive d/o

A
  • major
  • dysthymia
  • postpartum
  • w/ psychotic features
  • atypical
  • PMDD
  • bipolar
  • situational
262
Q

therapies for depression

A
  • cognitive behavioral
  • behavioral
  • psychotherapy
263
Q

meds for depression

A
  • antidepressants
  • antipsychotics
264
Q

other interventions for depression

A
  • ECT
  • hospitalization
265
Q

common mood Sx of depression

A
  • anxiety
  • apathy
  • general discontent
  • guilt
  • hopelessness
  • loss of interest
  • loss of interest or pleasure in activities
  • mood swings
  • sadness
266
Q

common cognitive Sx of depression

A
  • poor concentration
  • slowness in activity
  • thoughts of suicide
267
Q

common behavioral Sx of depression

A
  • agitation
  • excessive crying
  • irritability
  • restlessness
  • social isolation
268
Q

common sleep Sx of depression

A
  • early awakening
  • excess sleepiness
  • insomnia
  • restless sleep
269
Q

common GI Sx of depression

A
  • excessive hunger
  • loss of appetite
  • wt gain or loss
270
Q

2 other common Sx of depression

A
  • fatigue
  • repeatedly going over thoughts
271
Q

5 main classes of antidepressants

A
  • SSRIs
  • SNRIs
  • atypical
  • TCAs
  • MAOIs
272
Q

SSRIs

A
  • 1st-line Tx for depression
  • drugs
    • fluoxetine (Prozac)
    • citalopram (Celexa)
    • escitalopram (Lexapro)
    • paroxetine (Paxil)
    • sertraline (Zoloft)
    • fluvoxamine (Luvox)
    • vortioxetine (Trintellix)
273
Q

SSRI action

A
  • selectively blocks reuptake of serotonin in synaptic space
  • intensifies effects of serotonin
274
Q

SSRI uses

A
  • major depression
  • OCD
  • bulimia nervosa
  • PMDD
  • panic d/o
  • PTSD
275
Q

early complications of SSRI use

A
  • 1st few days to wks
  • SE
    • nausea
    • tremor
    • diaphoresis
    • fatigue
    • drowsiness
  • report to provider
  • take med as prescribed
  • effects usually subside
276
Q

later complications of SSRI use

A
  • 5-6 wks
  • sexual dysfunction
    • impotence
    • delayed/absent
      • orgasm
      • ejaculation
    • ↓ libido
  • report to HCP
  • management
    • ↓ dose
    • med holiday
    • changing meds
277
Q

other complications of SSRIs

A
  • bruxism
  • wt gain
  • hyponatremia
  • GI bleed
  • withdrawal syndrome
  • serotonin syndrome
278
Q

bruxism w/ SSRIs

A
  • grinding/clenching teeth, usually in sleep
  • report to provider
    • switch to another med class
    • Tx w/ low-dose buspirone
    • use mouth guard
279
Q

hyponatremia w/ SSRIs

A
  • more likely in older adults taking diuretics
  • baseline/periodic serum Na+
280
Q

GI bleed w/ SSRIs

A
  • report S/Sx
  • avoid NSAIDs
281
Q

withdrawal syndrome w/ SSRIs

A
  • S/Sx
    • nausea
    • sensory disturbances
    • anxiety
    • tremor
    • malaise
    • unease
  • minimize by tapering
  • DO NOT D/C ABRUPTLY
282
Q

S/Sx of serotonin syndrome

A
  • agitation
  • confusion
  • disorientation
  • difficulty concentrating
  • anxiety
  • hallucinations
  • hyperreflexia
  • incoordination
  • tremor and rigidity
  • fever
  • diaphoresis
  • shivering/↑ temp
283
Q

onset of serotonin syndrome

A

2-72 hrs after start of Tx

284
Q

Serotonin syndrome resolves within ___ hrs of _____ of meds affecting serotonin, and can be _____.

A
  • resolves within 24 hrs of D/C
  • can be lethal
285
Q

serotonin syndrome pt education

A
  • S/Sx
  • watch for a report immediately
286
Q

D/C MAOIs ___ days before starting an SSRI.

A

14 days

287
Q

factors ↑ risk of serotonin syndrome

A
  • concurrent use of
    • St. John’s wort
    • other meds affecting serotonin
    • MAOIs
    • TCAs
    • tryptophan
288
Q

serotonin syndrome

A

toxic state caused by ↑ in brain serotonin activity

289
Q

SSRI interactions

A
  • MAOIs, TCAs, St. John’s wort: serotonin syndrome
  • fluoxetine
    • can displace warfarin from bound protein → ↑ warfarin level
    • can ↑ levels of TCAs, lithium
    • suppresses platelet aggregation
290
Q

fluoxetin + warfarin =

A
  • ↑ warfarin level
  • cause: fluoxetine displaces warfarin from bound protein
  • interventions
    • monitor PT/INR
    • assess for bleeding
    • may need dosage adjustment
291
Q

fluoxetine + TCA or lithium =

A
  • ↑ TCA or lithium levels
  • avoid concurrent use
292
Q

suppressed platelet aggregation in fluoxetine use

A
  • ↑ risk of bleeding
  • avoid concurrent use of
    • NSAIDs
    • anticoagulants
  • pt education
    • monitor for bruising, hematuria, other s of bleeding
    • notify provider
293
Q

SSRI precautions

A
  • Hx of GI bleed or ulcers
  • meds affecting coagulation
  • Hx of sz
  • debilitation (risk of sz)
  • chronic illness
  • multiple-drug therapy
  • DM
  • angle-closure glaucoma
  • hepatic impairment
    • dz
    • peds
    • geri
  • pregnancy: C
294
Q

SSRI contraindications

A
  • hypersensitivity
  • concurrent use of
    • MAOIs or MAO-like drugs
    • pimozide
    • thioridazine: D/C fluoxetine ≥ 5 wks before therapy
295
Q

atypical antidepressant

A

bupropion (Wellbutrin)

296
Q

bupropion uses

A
  • depression
  • SAD
  • alternate to SSRI if sexual dysfunction is major problem
  • ADHD
  • smoking cessation
  • wt loss
297
Q

bupropion action

A
  • not fully understood
  • likely inhibits dopamine uptake
298
Q

bupropion AE

A
  • HA
  • dry mouth
  • GI distress
  • constipation
  • ↑ HR
  • restlessness
  • insomnia
  • suppressed appetite
  • wt loss
  • sz
299
Q

pt education and interventions for bupropion AE

A
  • notify provider if effects intolerable
  • HA: mild analgesic
  • dry mouth: sip fluids
  • constipation: ↑ fiber and fluids
  • monitor pt wt and food intake
  • avoid use in pts w/ sz risk
  • monitor for sz, treat
300
Q

buproprion + MAOIs =

A
  • ↑ risk of toxicity
  • D/C MAOI 2 wks before starting bupropion
301
Q

TCAs

A
  • prototype: amitriptyline
  • action: blocks reuptake of norepinephrine and serotonin
302
Q

TCA uses

A
  • depression
  • depressive episodes of bipolar d/o
  • neuropathic pain
  • fibromyalgia
  • anxiety d/o
  • insomnia
303
Q

AEs of TCAs

A
  • orthostatic hypotension
  • anticholinergic effects
  • sedation
  • toxicity → cholinergic blockade, cardiac toxicity
  • ↓ sz threshold: monitor pts w/ sz d/o
  • excessive sweating
304
Q

S/Sx of TCA toxicity

A
  • early
    • dysrhythmias
    • confusion
    • agitation
  • late
    • sz
    • coma
    • death
305
Q

nursing actions for TCA toxicity

A
  • monitor ECG
  • monitor VS frequently
  • monitor for S/Sx of toxicity
  • notify provider of signs
306
Q

anticholinergic effects and interventions

A
  • dry mouth: sugarless gum, sip water
  • blurred vision
  • photophobia: sunglasses outdoors
  • urinary hesitancy or retention: void just before taking
  • constipation: ↑ fiber, 2-3 L fluid/day
  • exercise regularly
  • notify provider if effects persist
307
Q

TCA interactions

A
  • avoid concurrent use
    • MAOIs, St. John’s wort: serotonin syndrome
    • antihistamines, other anticholinergics
    • ↑ effects of epinephrine, dopamine
    • ↓ effects of ephedrine, amphetamine
    • CNS depressants: additive effect
308
Q

MAOI prototype

A

phenelzine (Nardil)​

309
Q

uses for MAOIs

A
  • depression
  • bulimia nervosa
310
Q

MAOI action

A
  • block MAO action in brain
  • → ↑ available norepinephrine, dopamine, and serotonin
311
Q

MAOI complications

A
  • CNS stim
  • orthostatic hypotension
312
Q

S/Sx of CNS stim in MAOI use

A
  • anxiety
  • agitation
  • mania
  • notify provider
313
Q

MAOI interactions

A
  • vasopressors: HTN
  • dietary tyramine: HTN crisis
  • TCAs, SSRIs: serotonin syndrome
314
Q

vasopressor + MAOI =

A
  • HTN
  • avoid foods containing PEA, caffeine
315
Q

PEA

A

phenylethylamine

316
Q

phenylethylamine

A
  • organic compound that acts as neurotransmitter
  • found in foods like
    • chocolate
    • nuts
    • beans
  • byproduct of phenylalanine
317
Q

dietary tyramine + MAOI =

A
  • hypertensive crisis
  • call 911 or go to ER
318
Q

TCA or SSRI + MAOI =

A
  • serotonin syndrome
  • seek medical attention immediately
319
Q

hypertensive crisis

A
  • systolic ≥ 180
  • diastolic ≥ 120
320
Q

tyramine-rich foods

A
  • aged cheese
  • pepperoni
  • salami
  • smoked fish
  • avocados
  • figs
  • bananas
  • protein supplements
  • soups
  • soy sauce
  • some beers
  • red wine
321
Q

S/Sx of hypertensive crisis

A
  • ↑ BP
  • Nausea
  • ↑ HR
  • Severe HA
  • Epistaxis
  • Blurred vision
  • SOB
  • Severe anxiety
  • ​*bold: most common
  • italic: call 911*
322
Q

nursing admin for all antidepressants

A
  • teaching
    • regimen
    • withdrawal
    • duration
  • assess for suicide risk: highest in < 25 yo
323
Q

antidepressant regimen

A
  • onset: 1-3 wks for therapeutic effect
  • full effect: 2-3 months
  • duration
    • usually 6 months after Sx resolve
    • can continue ≥ 1 yr
324
Q

Antidepressants can _____ risk for suicide, esp. during _____ Tx. Pt starts to feel better, has _____ to act on negative feelings.

A
  • increase risk
  • during initial Tx
  • has motivation to act
325
Q

pt teaching for SSRIs

A
  • take in morning to minimi sleep disturbance
  • take with food to minimize GI issues
326
Q

nursing admin: TCAs

A
  • monitor for toxicity (cardiac dysrhythmias)
  • take at bedtime (sedation, orthostatic hypotension
327
Q

nursing admin for MAOIs

A
  • tyramine-rich food list for pt
  • avoid any other meds unless approved by HCP
328
Q

SSRI nursing admin

A
  • pt education: take in morning w/ food
  • older adults: baseline/periodic Na+
329
Q

evaluation of antidepressant effectiveness

A
  • verbalizing improvement in mood
  • ability to perform ADLs
  • improved sleeping/eating habits
  • increased peer interaction
330
Q

bipolar d/o

A
  • bipolar I
  • bipolar II
  • rapid cycling
  • mixed bipolar
  • cyclothymia
331
Q

therapies for bipolar d/o

A
  • support group
  • cognitive behavioral
  • psychoeducation
  • family therapy
  • psychotherapy
332
Q

meds for bipolar

A
  • first-line: mood stabilizers
  • anticonvulsants
  • antipsychotics
  • SSRIs
333
Q

mood stabilizers prototype

A

lithium carbonate (Lithan, Eskalith, Lithotabs)

334
Q

mood stabilizer action

A
  • neurochemical changes including serotonin receptor blockade
  • can show
    • ↓ in neuronal atrophy
    • ↑ in neuronal growth
335
Q

mood stabilizer uses

A
  • Tx of bipolar d/o
    • controls acute mania episodes
    • helps prevent mania or depression
    • ↓ incidence of suicide
  • other
    • ETOH use disorder
    • bulimia nervosa
    • psychotic d/o
336
Q

other classes of meds used for bipolar d/o

A
  • anticonvulsants
  • atypical antipsychotics
  • anxiolytics
  • antidepressants
337
Q

complications of mood stabilizers

A
  • GI distress
  • fine hand tremors
  • wt gain
  • polyuria and mild thirst
  • renal toxicity
  • goiter/hypothyroidism
  • bradycardia, hypotension, electrolyte imbalance
338
Q

Fine hand tremors with mood stabilizer use is an early sign of _____.

A

toxicity

339
Q

labs with mood stabilizers

A
  • baseline/periodic renal fxn
  • baseline annual thyroid fxn
340
Q

early lithium toxicity serum level

A

< 1.5 mEq/L

341
Q

early lithium toxicity manifestations

A
  • diarrhea
  • N&V
  • thirst
  • polyuria
  • muscle weakness
  • fine hand tremor
  • slurred speech
342
Q

early lithium toxicity interventions/education

A
  • withhold med
  • notify provider
  • new dosage based on serum level
343
Q

advanced lithium toxicity serum level

A

1.5-2.0 mEq/L

344
Q

advanced lithium toxicity manifestations

A
  • ongoing GI distress
    • N&V
    • diarrhea
  • mental confusion
  • poor coordination
  • coarse tremors
345
Q

advanced lithium toxicity interventions

A
  • withhold med
  • notify provider
  • new dosage
  • severe: may ↑ excretion
346
Q

severe lithium toxicity serum level

A

> 2.0 mEq/L

347
Q

S/Sx of severe lithium toxicity

A
  • serum level 2.0-2.5 mEq/L
  • extreme polyuria of dilute urine
  • tinnitus
  • blurred vision
  • ataxia
  • sz
  • severe hypotension →
    • coma
    • possibly death from respiratory complications
348
Q

severe lithium toxicity Tx (2.0-2.5 mEq/L)

A
  • emetic for alert pt
  • gastric lavage
  • one of these meds to ↑ rate of excretion
    • urea
    • mannitol
    • aminophylline
349
Q

severe lithium toxicity manifestations (> 2.5 mEq/L)

A

rapid progression of Sx → coma and death

350
Q

severe lithium toxicity Tx (> 2.5 mEq/L)

A

hemodialysis

351
Q

lithium contraindications

A
  • pregnancy
    • D
    • teratogenic, especially in 1st trimester
  • breastfeeding
352
Q

lithium precautions

A
  • renal dysfunction
  • heart dz
  • sodium depletion
  • dehydration
353
Q

lithium interactions

A
  • diuretics: ↓ serum Na+ → ↓ lithium excretion → toxicity
  • NSAIDs
  • anticholinergics
354
Q

pt teaching for lithium

A
  • take in adequate sodium
  • get 2-3 L water/day
  • need regular labs to check level
    • ​risk of toxicity
    • look for
      • diarrhea
      • vomiting
      • excessive sweating
  • regimen: 2-3 doses daily
  • onset: 1-2 wks
355
Q

nursing admin for lithium

A
  • periodic plasma levels
    • periodic
    • more frequent for older adults
    • draw in morning
  • toxicity
    • need care in acute setting
    • supportive measures
    • hemodialysis possible
356
Q

monitoring lithium levels

A
  • initially: q 2-3 days
  • periodic: q 1-3 months
  • draw in morning, usually 12 hr after last dose
  • therapeutic range: 0.4-1.0 mEq/L
357
Q

psychotic d/o

A
  • disorders
    • schizophrenia (most common)
    • schizoaffective d/o
    • schizophreniform d/o
    • brief psychotic d/o
    • delusional d/o
    • substance-induced psychotic d/o
  • clinical course: acute exacerbations w/ intervals of semi-remission
358
Q

positive Sx of schizophrenia

A
  • presence of problematic behaviors
  • examples
    • hallucinations, esp. auditory
    • delusions, esp. persecutory
    • disorganized thought
    • nonsensical speech
    • bizarre behaviors
359
Q

negative Sx of schizophrenia

A
  • absence of healthy behaviors
  • examples
    • flat affect
    • ↓ social interaction
    • anhedonia
    • avolition
    • alogia
    • catatonia
360
Q

anhedonia

A

lack of pleasure in acts that are usually pleasurable

361
Q

avolition

A

lack of motivation, initiative, or focus on tasks

362
Q

alogia

A
  • complete speechlessness
  • poverty of speech
  • negative Sx of schizophrenia
363
Q

catatonia

A
  • moving less
  • characterized by motor immobility, behavioral abnormalities, and stupor
364
Q

delusions

A
  • illusory beliefs
  • fixed, false belief that is not grounded in reality and persists despite clear evidence that it is mistaken
365
Q

hallucinations

A
  • false perception having no relation to reality and not accounted for by any exterior stimulus
  • dreamlike or nightmarish perception occurring while awake
  • can affect any of the 5 senses
    • auditory
    • visual
    • tactile
    • gustatory
    • olfactory
366
Q

goals of pharmacological Tx in psychotic d/o

A
  • suppressing acute episodes
  • decrease in psychotic findings
  • preventing acute recurrence
  • maintaining highest possible level of fxn
367
Q

first-generation (conventional) antipsychotics

A
  • works mostly to control positive Sx
  • reserved for those
    • using them successfully and tolerating SE
    • with violent or aggressive behaviors
  • ​prototype: chlorpromazine (Thorazine)
368
Q

2nd- and 3rd-gen (atypical) antipsychotics

A
  • meds of choice for psychotic d/o
  • fewer SE
  • more effective
  • relief of positive AND negative Sx
  • ↓ affective manifestations
  • improve cognitive deficits
  • ↓ relapse
369
Q

other 1st-gen (conventional) antipsychotics

A
  • high-potency
    • haloperidol (Haldol)
    • fluphenazine (Prolixin)
    • thiothixene (Navane)
  • medium-potency: perphenazine (Trilafon)
370
Q

MOA: 1st-gen (conventional) antipsychotics

A
  • blocks brain receptors for
    • dopamine (D2)
    • acetylcholine
    • histamine
    • norepinephrine (NE)
  • inhibition of psychotic manifestations (D2)
371
Q

uses for 1st-gen (conventional) antipsychotics

A
  • acute and chronic psychotic d/o
  • schizophrenia spectrum d/o
  • bipolar d/o, esp. manic phase
  • Tourette’s d/o
  • prevention of N&V
372
Q

chlorpromazine

A
  • trade name: Thorazine
  • class: antiemetic, antipsychotic, phenothiazine
  • route: PO, IM, IV
373
Q

haloperidol

A
  • trade name: Haldol
  • class: antipsychotic, butyrophenone
  • potency: high
  • route: PO, IM, IV
374
Q

fluphenazine

A
  • trade name: Prolixin
  • class: antipsychotic, phenothiazine
  • potency: high
  • route: PO, IM
375
Q

thiothixene

A
  • trade name: Navane
  • class: antipsychotic, thioxanthene
  • potency: high
  • route: PO
376
Q

perphenazine

A
  • trade name: Trilafon
  • class: antipsychotic, phenothiazine
  • potency: medium
  • route: PO
377
Q

EPS

A

extrapyramidal side effects

378
Q

EPS of medications

A
  • muscular rigidity
  • tremor
  • bradykinesia
  • difficulty walking (neuroleptic meds)
  • drug-induced parkinsonism
379
Q

EPS of 1st-gen (conventional) antipsychotics

A
  • acute dystonia
  • parkinsonism
  • akathisia
  • tardive dyskinesia (TD)
380
Q

TD

A

tardive dyskinesia

381
Q

acute dystonia r/t conventional antipsychotics

A
  • crisis situation: rapid Tx needed
  • Sx: severe spasms of
    • tongue
    • neck
    • face
    • back
  • onset: 5 hrs to 5 days after first dose
382
Q

Tx for acute dystonia r/t conventional antipsychotics

A
  • anticholinergic agent
    • benztropine
    • diphenhydramine
  • PO for less acute
  • IM or IV for serious effects
383
Q

parkinsonism r/t conventional antipsychotics

A
  • S/Sx
    • bradykinesia
    • rigidity
    • shuffling gait
    • drooling
    • tremors
  • onset: within 1 month of start of therapy
384
Q

Tx for parkinsonism r/t conventional antipsychotics

A
  • possible meds
    • benztropine
    • diphenhydramine
    • amantadine
  • D/C these to see if resolved
  • if Sx return, give atypical antipsychotic
385
Q

akathisia r/t conventional antipsychotics

A
  • S/Sx
    • inability to stand or sit still
    • continually pacing and agitated
  • onset: within 2 months of start of Tx
386
Q

management of akathisia r/t conventional antipsychotics

A
  • beta blocker
  • benzodiazepine
  • anticholinergic
387
Q

TD r/t conventional antipsychotics

A
  • S/Sx: involuntary movements
    • tongue and face (lip-smacking)
    • arms, legs, or trunk
  • onset: months or yrs after start of Tx
  • can improve w/ med change or become permanent
388
Q

management of TD r/t conventional psychotics

A
  • lowest dosage possible to control Sx
  • evaluate after 12 months of therapy, then q 3 months
  • if TD appears, ↓ dosage or switch to atypical agent
389
Q

other complications of conventional antipsychotics

A
  • neuroleptic malignant syndrome
  • anticholinergic effects
  • neuroendocrine effects
  • sz
  • photosensitivity
  • dermatitis
  • orthostatic hypotension
  • severe dysrhythmias
  • sedation
  • sexual dysfunction
  • agranulocytosis
390
Q

neuroleptic malignant syndrome S/Sx

A
  • sudden high-grade fever
  • BP fluctuations
  • dysrhythmias
  • muscle rigidity
  • change in LOC → coma
391
Q

non-pharm Tx for neuroleptic malignant syndrome

A
  • stop antipsychotic med
  • monitor VS
  • apply cooling blankets
  • ↑ fluid intake
  • wait 2 wks before resuming therapy
  • consider switch to atypical
392
Q

pharm management for neuroleptic malignant syndrome

A
  • antipyretics: ASA, acetaminophen
  • diazepam (Valium) for anxiety
  • dantrolene (Dantrium) to relax muscles
393
Q

anticholinergic effects

A
  • dry mouth
  • blurred vision
  • photophobia
  • urinary hesitance/retention
  • constipation
  • tachycardia
394
Q

neuroendocrine effects of conventional antipsychotics

A
  • gynecomastia
  • galactorrhea
  • menstrual irregularities
395
Q

Pts need regular health care visits and _____ about conventional antipsychotics and potential _____.

A
  • teaching about
  • potential complications
396
Q

substance use disorder substances

A
  • ETOH
  • caffeine
  • cannabis
  • hallucinogens
  • inhalants
  • opioids
  • sedatives/hypnotics/anxiolytics
  • stimulants
  • tobacco
  • anabolic steroids
  • betel nut
  • others
397
Q

abstinence

A

suddenly withdrawing from a substance to which a physical dependence has developed

398
Q

tolerance

A

requirement for increased amounts of a substance to achieve the desired effect

399
Q

withdrawal

A

physiological manifestations occurring upon decline of the blood concentration of a substance to which a person is physically dependent

400
Q

Degree of withdrawal severity depends on the _____.

A

substance

401
Q

withdrawal manifestations

A
  • GI distress
  • neurological and behavioral changes
  • CV changes
  • sz
  • coma
  • death
402
Q

ETOH withdrawal timing

A
  • onset: within 4-12 hrs of last intake
  • peak: after 24-48 hrs
  • duration: 5-7 days, unless delirium occurs
403
Q

ETOH withdrawal manifestations

A
  • N&V
  • tremors
  • restlessness
  • insomnia
  • depression
  • irritability
  • ↑ VS
  • toni-clonic sz
  • illusions
404
Q

delirium timing

A
  • onset: 2-3 days after cessation of ETOH
  • duration: 2-3 days
405
Q

ETOH withdrawal delirium is a medical _____.

A

emergency

406
Q

ETOH withdrawal delirium findings

A
  • severe disorientation
  • hallucinations
  • severe HTN
  • cardiac dysrhythmias that may → death
407
Q

most important question about alcohol withdrawal

A

When was your last alcoholic drink?

408
Q

drugs to manage ETOH withdrawal

A
  • chlordiazepoxide (Librium)
  • diazepam (Valium)
  • lorazepam (Ativan)
409
Q

therapeutic actions of pharm management in ETOH withdrawal

A
  • maintenance of VS WNL
  • ↓ risk of sz
  • ↓ intensity of Sx
410
Q

ETOH abstinence maintenance drug prototype

A
  • disulfiram (Antabuse)
  • daily PO med
  • aversion (behavioral) therapy
411
Q

disulfiram + ETOH =

A

acetaldehyde syndrome

412
Q

S/Sx of acetaldehyde syndrome

A
  • N&V
  • weakness
  • sweating
  • palpitations
  • hypotension
  • can →
    • respiratory depression
    • CV suppression
    • sz
    • death
413
Q

Pts taking disulfiram should be taught about the potential danges of drinking any _____. This includes what common products?

A
  • alcohol
  • products
    • mouthwash
    • cough syrup
    • aftershave lotion
414
Q

pt education for disulfiram/abstinence maintenance

A
  • dangers of any alcohol intake
  • wear medical alert bracelet
  • participate in 12-step program
  • effects persist for 2 wks after D/C of disulfiram
  • will need frequent LFTs
415
Q

labs for disulfiram

A

frequent LFTs

416
Q

other drugs for ETOH abstinence maintenance

A
  • naltrexone
  • acamprosate
417
Q

naltrexone for ETOH abstinence

A
  • opioid antagonist
  • suppresses cravings and pleasurable effects of ETOH
  • take an accurate Hx
    • ask if pt also dependent on opioids
    • natrexone + opioids = ↑ risk of opiate OD
418
Q

acamprosate for ETOH abstinence

A
  • ↓ unpleasant effects (anxiety, restlessness)
  • pt education
    • possible SE: diarrhea
    • maintain adequate fluid intake
    • get adequate rest
419
Q

opioid withdrawal timing

A

within 1 hr to several days after cessation

420
Q

Manifestations of opioid withdrawal are non_____-______, but _____ may occur.

A
  • nonlife-threatning
  • SI may occur
421
Q

opioid withdrawal clinical findings

A
  • agitation
  • insomnia
  • flu-like Sx
  • rhinorrhea
  • yawning
  • sweating
  • diarrhea
422
Q

Tx for opioid cessation

A
  • withdrawal: clonidine
  • substitution/maintenance (must be tapered)
    • methadone
    • buprenorphine
  • encourage 12-step
423
Q

clonidine for opioid withdrawal

A
  • centrally acting alpha agonist
  • won’t reduce cravings
  • Tx for Sx of withdrawal
424
Q

methadone for opioid substitution/maintenance

A
  • PO
  • opioid agonist
  • prevents withdrawal
  • can be used long-term
425
Q

buprenorphine for opioid substitution/maintenance

A
  • partial opioid agonist
  • ↓ cravings
  • may help with adherence
426
Q

nicotine withdrawal Sx

A
  • dry mouth
  • insomnia
427
Q

drugs for nicotine withdrawal

A
  • bupropion (Wellbutrin)
  • nicotine replacement therapy
  • varenicline (Chantix)
428
Q

bupropion for nicotine cessation

A
  • ↓ nicotine craving
  • ↓ withdrawal manifestations
429
Q

Use of nicotine replacement therapy approximately _____ the rate of smoking cessation.

A

doubles

430
Q

nicotine replacement therapy products

A
  • gum: not recommended for > 6 months
  • patch
  • nasal spray: rapid rise in blood level like smoking
431
Q

pt education for nicotine replacement therapy

A
  • avoid nicotine products while PG or breastfeeding
  • avoid use of other nicotine products while using replacement
432
Q

varenicline for nicotine cessation

A
  • nicotinic receptor agonist
  • promotes release of dopamine
  • ↓ cravings and severity of withdrawal
  • blocks desired effects of nicotine
  • ↓ incidence of relapse
433
Q

contraindications for varenicline

A
  • chronic depression
  • serious mental illness
  • SI
434
Q

pt education for varenicline

A
  • take after meal
  • monitor
    • BP
    • BG if DM
  • follow instructions for titration to minimize AE
  • notify provider of
    • N&V
    • insomnia
    • new-onset depression
    • suicidal thoughts
435
Q

evaluation for substance cessation

A
  • absence of injury, legal issues, etc.
  • ↓ cravings for substance
  • abstinence
  • regular attendance of self-help group
  • improved coping skills to replace use
436
Q

meds for children and adolescents with mental health issues

A
  • antidepressants
  • antipsychotics
  • nonbarbiturate anxiolytics
  • CNS stimulants
437
Q

Parents should understand that pharm management of mental health issues in children and adolescents is most effective when accompanied by techniques to _____ _____.

A

modify behavior

438
Q

CNS stimulants for children and adolescents

A
  • methylphenidate (Rialin, Methylin)
  • dexmethylphenidate (Focalin)
  • destroamphetamine (Dexedrine)
  • amphetamine mixture (Adderall)
  • lisdexamfetamine dimesylate
439
Q

CNS stimulant action

A
  • ↑ CNS levels of
    • norepinephrine
    • serotonin
    • dopamine
440
Q

CNS stimulant use in children and adolescents

A
  • ADHD
  • oppositional defiant d/o
  • conduct d/o
  • intermittent explosive d/o
  • autism spectrum d/o
441
Q

methylphenidate trade names

A
  • ​short-acting: Ritalin, Methylin
  • intermediate-acting: Ritalin SR, Methylin ER
  • long-acting: Ritalin LA, Concerta, Daytrana (TD)
442
Q

dexmethylphenidate trade names

A
  • short-acting: Focalin
  • long-acting: Focalin XR
443
Q

dextroamphetamine trade names

A
  • short-acting: Dexedrine
  • long-acting: Dexedrine Spansule
444
Q

amphetamine mixture trade names

A
  • short-acting: Adderall
  • long-acting: Adderall XR
445
Q

lisdexamfetamine dimesylate trade name

A

long-acting: Vyvanse

446
Q

AE of CNS stimulants

A
  • insomnia, restlessness
  • wt loss
  • CV effects
  • hallucinations, paranoia
  • withdrawal rxn
  • hypersensitivity skin rxn (TD formula)
447
Q

contraindications for CNS stimulants

A
  • Hx of
    • substance use d/o
    • CV d/o
    • severe anxiety
    • psychosis
448
Q

pt education for insomnia, restlessness r/t CNS stimulants

A
  • notify provider of Sx
  • give last dose before 1600
449
Q

interventions/education for wt loss r/t CNS stimulants

A
  • baseline/periodic wt and ht
  • give med immediately before or after meals
  • promote good nutrition in children
  • eat at regular meal times
  • avoid unhealthy snacks
450
Q

interventions/education for CV effects r/t CNS stimulants

A
  • S/Sx
    • dysrhythmias
    • CP
    • high BP
  • ↑ risk of sudden death w/ heart abnormalities
  • monitor VS, ECG
  • observe for effects and notify provider
451
Q

pt education: psychotic manifestations r/t CNS stimulants

A
  • includes hallucinations, paranoia
  • D/C med
  • report immediately
452
Q

withdrawal rxn r/t CNS stimulants

A
  • do not stop abruptly
  • may cause depression and severe fatigue
453
Q

pt education for hypersentivity skin rxn to TD CNS stimulant

A

remove patch and notify provider

454
Q

CNS stimulant interactions

A
  • ↑ CNS stimulation w/
    • caffeine
    • OTC cold/decongestant meds
    • sympathomimetics
  • avoid concurrent use
455
Q

pt education for CNS stimulants

A
  • give on regular schedule
  • patch: place on one hip every morning for ≤ 9 hrs; alternate hips daily
  • family and cognitive therapy will improve outcomes
  • handwritten Rx required (controlled substance)
  • safety and storage
  • high potential for substance use d/o
456
Q

evaluation of CNS stimulant use

A
  • improvement in
    • manifestations
    • behavior
    • grades
    • task completion
    • peer interaction
    • impulse control

2021 Pharm 2 (18 decks)

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