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NCLEX: Pharmacology > Nervous System Medications > Flashcards

Nervous System Medications Flashcards

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1
Q

Diazepam (Valium), lorazepam (Ativan), midazolam (Versed), and chlordiazepoxide (Librium) are examples of

A

Benzodiazepines

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2
Q

Indications for benzodiazepines

A
  • anxiety
  • seizures
  • muscle spasms
  • alcohol withdrawal
  • induction/maintenance of anesthesia
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3
Q

Benzodiazepines enhance _____ in the CNS

A

GABA

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4
Q

Side effects of benzodiazepines

A

Sedation, respiratory depression, amnesia, dependency/withdrawal

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5
Q

Benzodiazepines are for _____-term use

A

Short

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6
Q

Patient education for benzodiazepines

A

Do NOT discontinue these meds abruptly

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7
Q

Nonbenzodiazepine indicated for anxiety, panic disorder, OCD, and PTSD

A

Buspirone (Buspar)

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8
Q

Compare buspirone (Buspar) to benzodiazepines

A

Buspirone has fewer side effects, does not cause sedation, dependency unlikely, and can be used for LONG-term treatment

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9
Q

Buspirone (Buspar) patient education

A
  • full effects not felt for several weeks
  • always take WITH OR WITHOUT food to prevent change in absorption level
  • NO grapefruit juice
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10
Q

Amytriptyline (Elavil) and imipramine (Tofranil) are examples of

A

Tricyclic antidepressants

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11
Q

Tricyclic antidepressants increase the effects of _________ and _________ in the CNS

A

Serotonin; norepinephrine

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12
Q

Side effects of tricyclic antidepressants

A

Sedation, orthostatic hypotension, anticholinergic effects, dysrhythmias, sweating, seizures

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13
Q

Patient education to counteract anticholinergic side effects

A

Chew gum, wear sunglasses, increase fiber and fluid intake

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14
Q

Phenelzine (Nardil) and tranylcypromine (Parnate) are examples of

A

MAOIs (for depression)

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15
Q

Side effects of MAOIs

A

Agitation/anxiety, orthostatic hypotension, HYPERTENSIVE CRISIS

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16
Q

MAOIs interactions

A

Many OTC cold medications and tyramine rich foods — result in severe hypertension

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17
Q

Bupropion (Wellbutrin, Zyban) and trazodone (Oleptro) are examples of

A

Atypical antidepressants

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18
Q

Medication indicated for depression and/or smoking deterrent

A

Bupropion (Wellbutrin, Zyban)

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19
Q

Side effects of bupropion (Wellbutrin, Zyban)

A

Insomnia, weight loss, agitation, seizures

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20
Q

Trazodone (Oleptro) side effects

A

Sedation, hypotension, dry mouth

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21
Q

Trazodone patient education

A

Avoid alcohol; hard candy or gum for dry mouth

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22
Q

Paroxetine (Paxil), sertraline (Zoloft), and fluoxetine (Prozac) are examples of

A

SSRIs

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23
Q

SSRIs for anxiety and depression work by increasing

A

Serotonin

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24
Q

SSRI side effects

A

Sexual dysfunction, weight gain, insomnia, serotonin syndrome

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25
Q

S/S of serotonin syndrome

A

Agitation, hallucinations, fever, diaphoresis, tremors

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26
Q

SSRI black box warning

A

Increased risk for suicidal thoughts

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27
Q

SSRI patient education

A
  • DO NOT take w/ St. John’s wort (increased risk for serotonin syndrome)
  • full effects not felt for 2 weeks or more
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28
Q

Duloxetine (Cymbalta) and venlafaxine (Effexor) are examples of

A

SNRIs

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29
Q

SNRIs for anxiety and depression work by increasing both

A

Serotonin and norepinephrine

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30
Q

Side effects of SNRIs

A

Fatigue, insomnia, GI upset (constipation, nausea), dysuria, decreased libido, serotonin syndrome

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31
Q

SNRI black box warning

A

Increased risk for suicidal thoughts

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32
Q

Common mood stabilizer for the treatment of bipolar disorder

A

Lithium (Lithobid)

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33
Q

Key lithium side effects (HINT: LITH)

A

Leukocytosis (elevated WBCs), Insipidus (DI, polyuria), Tremors (fine hand), Hypothyroidism

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34
Q

Additional side effects of lithium (excluding LITH)

A

Weight gain, KIDNEY TOXICITY, electrolyte imbalances

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35
Q

Lithium (Lithobid) black box warning

A

Lithium toxicity

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36
Q

Plasma levels > ___ mEq/L indicate lithium toxicity

A

1.5

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37
Q

S/S of lithium toxicity

A

Course tremors, confusion, hypotension, seizures, tinnitus

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38
Q

Medications to avoid on lithium (Lithobid)

A

Diuretics, anticholinergics, NSAIDs

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39
Q

Lithium (Lithobid) is contraindicated for patients with

A

Renal disease

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40
Q

Lithium (Lithobid) patient education

A

Need adequate fluid and sodium intake (closely monitor sodium levels!)

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41
Q

Carbamezapine (Carbatrol, Tegretol), valproic acid (Depakene), and lamotrigine (Lamictal) are examples of __________ for the treament of bipolar disorder and seizures/epilepsy

A

Mood stabilizers/anticonvulsants

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42
Q

Side effects of carbamazepine (Carbatrol, Tegretol)

A
  • blood dycrasias: anemia, leukopenia, thrombocytopenia
  • vision issues: nystagmus, diplopia
  • hypo-osmolarity (r/t SIADH)
  • skin rash
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43
Q

Carbamazepine (Carbatrol/Tegretol) nursing consideration

A

Monitor CBC levels and for S/S of infection

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44
Q

Side effects of valproic acid (Depakene)

A

Hepatoxicity, pancreatitis, thrombocytopenia

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45
Q

Is valproic acid (Depakene) safe for use during pregnancy?

A

NO! Black box warning for neural tube defects

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46
Q

Valproic acid (Depakene) nursing consideration

A

Monitor liver function tests d/t risk for hepatotoxicity (AST, ALT, LDH, bilirubin)

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47
Q

Lamotrigine (Lamictal) key side effects

A

Photosensitivity, skin rashes

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48
Q

Symptoms present in a schizophrenic patient that SHOULD NOT be there (delusions, hallucinations)

A

Positive symptoms

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49
Q

Lacking of symptoms that SHOULD be there in a schizophrenic patient (anergia, anhedonia)

A

Negative symptoms

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50
Q

List three examples of first generation (typical) antipsychotics

A

Chlorpromazine (Thorazine), haloperidol (Haldol), droperidol (Inapsine)

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51
Q

First generation (Typical) antipsychotics are indicated for psychotic disorders and schizophrenia and work by mainly controlling __________ symptoms

A

Positive

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52
Q

Side effects of first generation (Typical) antipsychotics

A

Extrapyramidal Symptoms (EPS), Neuroleptic Malignant Syndrome (NMS), agranulocytosis, anticholinergic effects, orthostatic hypotension, sedation, seizures

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53
Q

Extrapyramidal Symptoms (EPS)

A
  • Dystonia: involuntary muscle contractions
  • Parkinson’s symptoms: shuffling gait, rigidity)
  • tardive dyskinesia: lip smacking, tongue rolling
  • akathisia: restlessness, pacing
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54
Q

S/S of NMS

A

Fever, BP fluctuations, dysrhythmias, muscle rigidity

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55
Q

anticholinergics such as _________ can be used to control EPS symptoms associated with first generation (typical) antipsychotics

A

Benztropine

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56
Q

Muscle relaxants such as __________ can be used to treat NMS associated with first generation (typical) antipsychotics

A

Dantrolene

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57
Q

List three examples of second generation (atypical) antipsychotics

A

Risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril)

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58
Q

Second generation (atypical) antipsychotics work by

A

Controlling the positive and negative symptoms of schizophrenia

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59
Q

Many second generation (atypical) antipsychotics end in

A

-done or -pine

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60
Q

Side effects of second generation (atypical) antipsychotics

A

Diabetes, weight gain, increased cholesterol, sedation, orthostatic hypotension, anticholinergic effects, menorrhagia, decreased libido

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61
Q

Clozapine (Clozaril) carries risk for

A

Agranulocytosis (decreased WBC — risk for infection)

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62
Q

Second generation (atypical) antipsychotics nursing considerations

A

Monitor blood glucose levels and for s/s of infection

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63
Q

Methylphenidate (Methylin, Ritalin) and amphetamine mixtures (Adderall) are examples of

A

CNS stimulants for the treatment of ADHD and conduct disorders

64
Q

Side effects of CNS stimulants

A

Insomnia, dysrhythmias, decreased appetite, weight loss

65
Q

CNS stimulants black box warning

A

Drug abuse; dependence

66
Q

CNS stimulant patient education

A
  • do not administer meds at night; morning is better d/t risk for insomnia
  • take med 30-45 minutes before meals
67
Q

CNS stimulants nursing consideration

A

Monitor weight during therapy

68
Q

Disulfiram (Antabuse), naltrexone (Vivitrol) and acamprosate are maintenance medications for

A

Alcohol abuse

69
Q

Medication for alcohol abuse that results in unpleasant side effects (vomiting, sweating, palpitations, hypotension) if the patient ingests alcohol

A

Disulfiram (Antabuse)

70
Q

Alcohol abuse medication that suppresses craving for alcohol

A

Naltrexone (Vivitrol)

71
Q

Alcohol abuse medication that decreases abstinence symptoms (anxiety, restlessness)

A

Acamprosate

72
Q

T or F: Maintenance medications for alcohol abuse can be used to treat acute alcohol withdrawal

A

FALSE; these are for long-term abstinence from alcohol

73
Q

Alcohol withdrawal treatment is focused on stabilizing vital signs and preventing seizures through medications such as

A

Benzodiazepines, beta blockers, antiepileptic agents

74
Q

Buprenorphine (Subutex) and methadone (Methadose, Dolophine) are examples of

A

Maintenance medications for opioid dependence

75
Q

Varenicline (Chantix) is a medication used for

A

Smoking cessation

76
Q

Side effects of varenicline (Chantix)

A

Anxiety, depression, irritability, insomnia, muscle pain

77
Q

Acetaminophen (Tylenol) can cause __________ in high doses

A

Hepatotoxicity

78
Q

Do not exceed ___ g/day of acetaminophen (Tylenol)

A

4

79
Q

Ibuprofen (Advil, Motrin, Excedrin), naproxen (Aleve), ketorolac (Toradol), and indomethacin (Indocin) are examples of

A

NSAIDs

80
Q

NSAID used to close patent ductus arteriosis (PDA) in premature babies

A

Indomethacin

81
Q

NSAIDs side effects

A

GI upset, GI bleeding, renal toxicity, rash, headache

82
Q

NSAIDs are contraindicated in patients with

A

PUD, bleeding disorders

83
Q

NSAID patient education

A

Avoid alcohol (increases risk for GI bleed)

84
Q

Celecoxib (celebrex) is an example of

A

Cox 2 inhibitor NSAID

85
Q

Celecoxib (Celebrex) is indicated for

A

Osteoarthritis, RA

86
Q

Celecoxib (Celebrex) side effects

A

Thrombosis (MI, stroke), GI bleeding, rash

87
Q

Celecoxib (Celebrex) should not be administered to patients with allergy to

A

Aspirin, NSAIDs, or sulfonamides

88
Q

Salicylate that doubles as an analgesic and platelet aggregation inhibitor (prevention of TIAs/MIs)

A

Aspirin (Bayer)

89
Q

Aspirin (Bayer) side effects (HINT: ASPIRIN)

A

Abdominal pain, salicylism, Peptic ulcer disease, Intestinal blood loss (GI bleeding), Reye’s syndrome, Itchy rash, Noise (tinnitus)

90
Q

Aspirin (Bayer) is contraindicated in

A

Patients with PUD or bleeding disorders; children with fever (risk for Reye’s syndrome)

91
Q

S/S of salicylism

A

Tinnitus, vomiting/diarrhea, respiratory alkalosis

92
Q

Anticonvulsant that can be used to treat neuropathic pain

A

Pregabalin (Lyrica)

93
Q

Side effects of pregabalin (Lyrica)

A

Dizziness, drowsiness, dry mouth, edema

94
Q

Pregabalin (Lyrica) patient education

A

Avoid alcohol; discontinue medication gradually

95
Q

List four examples of opioid analgesics

A

Fentanyl, morphine, dilaudid, oxycodone (OxyContin)

96
Q

Side effects of opioid analgesics (HINT: RUSH)

A

Respiratory depression, urinary retention, sedation, hypotension; additional: constipation, GI upset

97
Q

Side effects of opioid analgesics (HINT: RUSH)

A

Respiratory depression, urinary retention, sedation, hypotension; additional: constipation, GI upset

98
Q

Naloxone (Narcan) reverse analgesia and can result in

A

Hypertension, tachycardia, agitation

99
Q

Example of a topical analgesic

A

Lidocaine (Xylocaine)

100
Q

Nursing consideration for Emla cremation (containing lidocaine)

A

Apply and cover with occlusive dressing 1 hour before procedure to help minimize pain

101
Q

Ergotamine (Ergomar) and sumatriptan (Imitrex) are examples of

A

Vascular headache suppressants

102
Q

Ergotamine (Ergomar) side effects

A

GI upset, hypertension

103
Q

Sumatriptan (Imitrex) side effects

A

Dizziness/vertigo, warm/tingling sensation

104
Q

Vascular headache suppressants are contraindicated in patients with

A

Ischemic coronary artery disease or peripheral vascular disease

105
Q

Non-selective beta blocker used to treat primary open angle glaucoma

A

Timolol (Timoptic)

106
Q

How does timolol (Timoptic) work?

A

Decreases aqueous humor production which decreases IOP

107
Q

Timolol (Timoptic) side effects

A

Mild: temporary stinging of eye

108
Q

Patient education for administration of antiglaucoma agents

A

Do not touch eye with applicator; hold lacrimal duct for 1 min after application to prevent systemic effects

109
Q

Systemic effects of timolol (Timoptic)

A

Effects of non-selective beta blockers: hypotension, bronchoconstriction, bradycardia

110
Q

Normal IOP

A

10-21 mmHg

111
Q

Carbonic anhydrase inhibitor used to treat glaucoma, heart failure, and altitude sickness

A

Acetazolamide (Diamox)

112
Q

Side effects of Acetazolamide (Diamox)

A

Flu-like symptoms, GI upset, electrolyte imbalances (Na, K), hyperchloremic acidosis

113
Q

Acetazolamide (Diamox) patient education

A

Take with food to minimize GI upset

114
Q

Pilocarpine (Diocarpine) and acetylcholine (Miochol-E) are examples of

A

Direct-acting cholinergic antiglaucoma agent

115
Q

Side effects of direct acting cholinergic agents for glaucoma

A

Blurred vision, stinging, eye pain

116
Q

Travoprost (Travatan) and latanoprost (Xalatan) are examples of

A

Prostaglandin agonist antiglaucoma agents

117
Q

Side effects of prostaglandin agonists for glaucoma

A

Stinging, eyelash growth, eye color change (increase in iris pigmentation)

118
Q

Cholinergic agent indicated for Alzheimer’s disease

A

Donepezil (Aricept)

119
Q

Patient education for Donepezil (Aricept)

A

Take at bedtime; does NOT CURE Alzheimer’s

120
Q

Neostigmine (Bloxiverz) and pyridostigmine (Mestinon) are cholinergic agents indicated for

A

Myasthenia gravis

121
Q

Cholinergics for myasthenia gravis work by increasing __________ at receptor sites by inhibiting __________

A

Ach; cholinesterase

122
Q

Side effects of cholinergics for myasthenia gravis

A

Excess ACh: increased salivation, diarrhea, N/V, sweating, bradycardia

123
Q

Cholinergic medication given to diagnose myasthenia gravis as opposed to cholinergic crisis

A

Edrophonium

124
Q

If the nurse administers edrophonium to a patient suspected of having myasthenia gravis and they __________, then diagnosis of MG is confirmed. If the patient’s symptoms __________, then they were likely having an anticholinergic crisis

A

Improve; worsen

125
Q

Levodopa/carbidopa (Sinemet) and Bromocriptine (Parlodel) are examples of

A

Dopamine agonists indicated for Parkinson’s disease

126
Q

Side effects of dopamine agonists for Parkinson’s disease

A

N/V, drowsiness, dyskinesias (tics), orthostatic hypotension, darkening of urine and sweat, psychosis, diarrhea, sweating, bradycardia

127
Q

High _________ meals decrease the effectiveness of levodopa/carbidopa

A

Protein

128
Q

Dopamine agonists work to increase _________ in the CNS for Parkinson’s disease (__________ is converted to dopamine in CNS, and __________ prevents breakdown of levodopa).

A

Dopamine; levodopa; carbidopa

129
Q

Anticholingeric indicated for Parkinson’s disease

A

Benztropine (Cogentin)

130
Q

Benztropine (Cogentin) works by decreasing __________ in the CNS

A

ACh

131
Q

Parkinson’s disease is characterized by too little __________ and too much __________

A

Dopamine, ACh

132
Q

Side effects of Benztropine (Cogentin)

A

Anticholinergic effects

133
Q

Patient education for Benztropine (Cogentin)

A

Chew gum, wear sunglasses, increase fiber and fluid to combat anticholinergic effects

134
Q

Phenytoin (Dilantin), topirimate (Topamax), levetiracetam (Keppra), and primidone (mysoline) are examples of

A

Antiepileptics

135
Q

Key side effect of phenytoin (Dilantin)

A

Gingival hyperplasia

136
Q

Phenytoin (Dilantin) patient education

A

Monitor blood levels during therapy; decreases effectiveness of oral contraceptives

137
Q

Phenytoin therapeutic range

A

10-20 mcg/mL

138
Q

Key side effect of topiramate (Topamax)

A

Metabolic acidosis

139
Q

A patient on topiramate (Topamax) will need to have serum __________ levels monitored before and during therapy

A

Bicarbonate

140
Q

Key side effect of levetiracetem (Keppra)

A

Agranulocytosis

141
Q

A patient on levetiracetam (Keppra) will need their __________ levels monitored

A

CBC

142
Q

Key side effect of primidone (Mysoline)

A

Blood dyscrasias

143
Q

Therapeutic range for primidone (Mysoline)

A

5-12 mcg/mL

144
Q

Primidone (Mysoline) patient education

A

Monitor blood levels during therapy; decreases effectiveness of oral contraceptives

145
Q

Zolpidem (Ambien) and eszopiclone (Lunesta) are hypnotic/sedatives indicated for

A

Insomnia

146
Q

Key side effects of hypnotic/sedatives for insomnia

A

Daytime sleepiness, dizziness, abnormal thinking and behavior

147
Q

Pentobarbital (Nembutal) and phenobarbital (Luminal) are examples of sedative/hypnotic __________

A

Barbiturates

148
Q

Barbiturates may be indicated for

A

Preoperate sedation, seizures, coma induction in patients with high ICP

149
Q

Patient education for insomnia medications

A

Allow for at least 8 hours of sleep

150
Q

Key side effects of barbiturates

A

Drowsiness, lethargy, hypotension, respiratory depression, constipation

151
Q

Barbiturates patient education

A

Avoid alcohol

152
Q

Barbiturates nursing considerations

A

Monitor vital signs, have resuscitation equipment at bedside

153
Q

General anesthetic agent used for induction and maintenance of general anesthesia, as well as sedation of intubated patients

A

Propofol (Diprivan)

154
Q

Side effects of propofol (Diprivan)

A

Amnesia, bradycardia, hypotension, respiratory depression

155
Q

T or F: general anesthetic agent propofol (Diprivan) provides analgesia

A

FALSE

156
Q

Propofol (Diprivan) nursing considerations

A

Monitor vital signs continuously; use unused portions of propofol within 6 hrs due to risk of bacterial contamination

NCLEX: Pharmacology (11 decks)

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