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Pharm > Neurological System > Flashcards

Neurological System Flashcards

1
Q

Centrally Acting muscle relaxants prototype and other drug names

A

baclofen (Lioresal)
Others: carisoprodol (Soma), cyclobenzaprine (Flexeril)

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2
Q

centrally acting muscle relaxants EPA

A

inhibits effects of GABA in the spinal cord = suppression of hypertensive reflexes

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3
Q

centrally acting muscle relaxants therapeutic uses

A

spinal cord injuries, MS, CP

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4
Q

centrally acting muscle relaxants administration

A

Administered PO (Baclofen also through intrathecal pump)

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5
Q

centrally acting muscle relaxants ADRs

A

most common = drowsiness/dizziness, weakness/fatigue
Also possible = N/V, constipation, and urinary retention

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6
Q

centrally acting muscle relaxants contraindications and interactions

A

ETOH (alc), MAOIs, SSRI/SNRI/tricyclic antidepressants
Use caution with older adults, children, severe mental disorder, and CVAs

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7
Q

centrally acting muscle relaxants RN intervention and client education

A

Take w/ food to decrease GI upset
Educate regarding activities requiring mental alertness
Change positions slowly
For clients with long term use (weeks to months) MUST BE TAPERED to prevent withdrawl (seizures/hallucinations)
*Intrathecal abrupt stop causes - rebound spasticity/fever and muscle damage

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8
Q

peripherally acting muscle relaxants prototype

A

dantrolene (Dantrium)

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9
Q

peripherally acting muscle relaxants EPA

A

acts directly on skeletal muscle by inhibiting calcium release (necessary for muscle contraction)

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10
Q

peripherally acting muscle relaxants therapeutic uses

A

spinal cord injuries, MS, CP, CVA, and malignant hyperthermia

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11
Q

peripherally acting muscle relaxants administration

A

PO and IV

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12
Q

peripherally acting muscle relaxants ADRs

A

muscle weakness, drowsiness/dizziness and diarrhea
At higher/more frequent doses: liver toxicity

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13
Q

peripherally acting muscle relaxants contraindications and interactions

A

avoid in clients w/ liver disease. Women age >35 y.o. Using estrogen have higher risk for liver toxicity. Avoid ETOH. Possibility of severe cardiac dysrhythmias in clients taking calcium channel blockers

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14
Q

peripherally acting muscle relaxants RN interventions and client education

A

Monitor for ADRs - CNS effects, diarrhea, liver function (check liver function tests - LFTs)
Client education regarding changing positions slowly - assist w/ ambulation
Client should call provider: prolonged diarrhea, muscle weakness
Education regarding activities requiring mental alertness
Client should report abdominal pain or jaundice

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15
Q

Traditional AEDs Hydanoins prototype and other drug names

A

phenytoin (Dilantin)
Others: fosphenytoin (Cerebyx)

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16
Q

hydantoins EPA

A

suppress sodium uptake in neurons thus reducing neuronal activity in seizure-generating cells of the brain

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17
Q

hydantoins therapeutic uses

A

tonic-clonic and partial seizures

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18
Q

hydantoins administration

A

PO and IV - slowly

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19
Q

hydantoins ADRs

A

CNS depression/mild drowsiness. Gingival hyperplasia. Skin rash

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20
Q

hydantoins contraindications and interactions

A

teratogenic. Avoid in clients w/ skin rash, bradycardia/heart block. MANY drug interactions (including oral contraceptives)

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21
Q

hydantoins RN intervention and client education

A

Monitor for CNS effects
Narrow therapeutic window!!!
- Serum level should be 10-20
- Monitor blood - lab draw
- Serum >20 - nystagmus, ataxia, sedation, blurred/double vision
Do NOT give IV too quickly! Cardiac collapse!
- No more than 50mg/min
- Monitor vital signs
Educate regarding activities requiring mental alertness
Educate about good oral hygiene! Regular dental check-ups, soft-bristled toothbrush, flossing
Educate to call provider if rash occurs
Do not stop abruptly!! Risk for seizure recurrance

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22
Q

traditional AEDs iminostilbenes prototype

A

carbamazepine (Tegretol)

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23
Q

iminostilbenes EPA

A

similar to hydantoins. Inhibits sodium influx through sodium channels = decreased neuronal activity

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24
Q

iminostilbenes therapeutic uses

A

tonic-clonic and partial seizures, mood stabilizer (bipolar), for trigeminal neuralgia pain

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25
Q

iminostilbenes administration

A

PO (immediate or ER)

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26
Q

iminostilbenes ADRs

A

neurological effects - visual disturbances, HA, ataxia, nystagmus, blurred vision. Fluid retention. Skin rash (SJS). Photosensitivity. Bone marrow suppression = decreased blood counts

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27
Q

iminostilbenes contraindications and interactions

A

teratogenic. Avoid in absence/myoclonic seizures, clients w/ hematologic disorders or heart failure. MANY drug interactions

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28
Q

iminostilbenes RN intervention and client education

A

Give w/ meals to decrease GI upset
Monitor CBC - will look at WBC and RBC
- Educate pt on s/sx infections/bleeding
Monitor skin and educate about photosensitivity
- PTs of asian decent w/ HLA-B*1502 - increased risk of skin reactions
Monitor for CNS effects
Educate pt to call provider if decreased urine output, edema, or SOB
Pt should avoid grapefruit juice
Educate child-bearing age clients to use back up protection if on oral contraception

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29
Q

traditional AEDs histone deacetylase inhibitor prototype

A

valproic acid (Depakote, Depacon, Depakene)

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30
Q

histone deacetylase inhibitor EPA

A

similar to phenytoin and carbamazepine. May also effect influx of calcium and enhance inhibitory effects of GABA

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31
Q

histone deacetylase inhibitor therapeutic uses

A

ALL seizure types. Mania (bipolar). Prevent migraine HA

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32
Q

histone deacetylase inhibitor administration

A

PO or IV (must be diluted)

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33
Q

histone deacetylase inhibitor ADRs

A

common - GI upset/indigestion. Bone marrow suppression (bruising, bleeding, prolonged bleeding time, decreased platelets). Skin rash. liver toxicity. Hyperammonemia (drowsy or altered mental state)

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34
Q

histone deacetylase inhibitor contraindications and interactions

A

teratogenic. Avoid in liver disorder, thrombocytopenia (low platelets), and hyperammonemia. Caution with other anticonvulsants

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35
Q

histone deacetylase inhibitor RN intervention and client education

A

Give with food to decrease GI upset
Monitor lab values:
- Platelet, bleeding time
- Ammonia
- LFTs - must obtain baseline
Monitor for and educate client to report: rash, N/V, abdominal pain, anorexia, Jaundice, Confusion and decreased mental status, Bruises, bleeding
Clients should avoid getting pregnant. If pregnant client MUST take folic acid supplement (prevent spinabifida)

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36
Q

local anesthetics prototype and other drug names

A

lidocaine (Xylocaine) - “amide” type
Others - “ester” type: procaine (Novocain), benzocaine (Americaine)

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37
Q

local anesthetics therapeutic uses

A

anesthesia to direct body area - suturing, dental procedures, nerve blocks, epidural/spinal anesthesia

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38
Q

local anesthetics adminstration

A

Topical, IV, oral solution (viscous)

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39
Q

local anesthetics EPA

A

blocks influx of sodium through sodium channels preventing depolarization = no action potential activated

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40
Q

local anesthetics ADRs

A

only occurs in systemic absorption of high doses - stimulation or depression of CNS. Most severe = respiratory depression, hypotension, and cardiac dysrhythmias

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41
Q

local anesthetics contraindications and interactions

A

Allergy to lidocaine or smide-type anesthetics. Avoid viscous solution in children < 3y.o. Caution in clients with bradycardia/heart block

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42
Q

local anesthetics RN interventions and client education

A

Monitor VS before, during, after
Monitor respiratory status
Monitor restlessness, tremors, dizziness, paresthesias
Monitor for hypotension with spinal anesthetics
Do not administer in eyes or broken skin

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43
Q

general anesthetics barbituates prototype and other drug names

A

methohexital sodium (Brevital) - 88propofol (Diprivan)

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44
Q

barbituates EPA

A

Enhances inhibitory effects of GABA and causes significant CNS depression

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45
Q

barbituates therapeutic uses

A

rapid induction of anesthesia and hypnosis

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46
Q

barbituates administration

A

IV only

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47
Q

barbituates ADRs

A

Respiratory depression and hypotension

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48
Q

barbituates contraindications and interactions

A

Caution in clients with hepatic or renal disease
Given with other CNS depressants = more CNS depression

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49
Q

barbituates RN intervention and client education

A

Close monitoring of VS, before during, and after
Close monitoring of respiratory status
resuscitation/emergency equipment close by! Airway maintenance supplies, IV fluids, vasopressors
Monitor IV site for extravastion

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50
Q

adjuncts to anesthesia/conscious sedation benzodiazepines prototype and other drug names

A

midazolam (Verses)
Others: diazepam (Valium), lorazepam (Ativan)

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51
Q

benzos EPA

A

enhance inhibitory effects of GABA = CNS depression, hypnosis, and amnesia

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52
Q

benzos therapeutic uses

A

conscious sedation, sedation PRIOR to general anesthesia, supplement inhaled anesthesia. Many others (active seizure, anxiety)

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53
Q

benzos administration

A

PO, IV, IM

54
Q

benzos ADRs

A

amnesia. Large dosages have potential for cardiac and respiratory arrest

55
Q

benzos RN intervention and client education

A

Educate on amnesia effects
Monitor VS and respiratory status before, during, and after administration
Have resuscitation equipment nearby

56
Q

benzos contraindications and interactions

A

Teratogenic
Greater CNS depression when given w/ other CNS depressants (use caution)
Herbal products may increase or decrease the effects of midazolam

57
Q

adjuncts to anesthesia/conscious sedation opioids prototype and other drug names

A

fentanyl (Duragesic, Actiq)
Others: morphine, hydromorphone (Dilaudid)

58
Q

opioids EPA

A

pain receptor agonists that cause analgesia and sedation. Narcotic

59
Q

opioids administration

A

IV, transdermal, oral lozenge

60
Q

opioids ADRs

A

sedation. Respiratory depression and hypotension. Nausea

61
Q

opioids contraindications and interactions

A

clients with hx of substance abuse. Teratogenic during OB delivery. Caution in clients with increased intracranial pressure, older adult, young children, debilitation clients. Caution with liver, respiratory, or kidney disorders
Do NOT give with MAOIs
Given with other CNS depressants = excessive sedation/respiratory depression

62
Q

opioids RN interventions and client education

A

Monitor VS, respiratory status, and LOC before during, and after administration
Have resuscitation equipment on hand = Naloxone
Educate client to report nausea
Schedule II controlled substance

63
Q

CNS stimulants amphetamines prototype and other drug names

A

amphetamine/dextroamphetamine sulfate (Adderall)
Others: methamphetamine hydrochloride (Desoxyn)

64
Q

amphetamines EPA

A

Increase norepinephrine and dopamine in brain and PNS = more alert, energy, improved mood (euphoria). When used in ADHD - increased ability to focus/attention span

65
Q

amphetamines therapeutic use

A

ADHD, narcolepsy

66
Q

amphetamines administration

A

PO (regular and ER)

67
Q

amphetamines ADRs

A

due to CNS stimulation. Insomnia, nervousness, hypertension, tachycardia/palpitations. Weight loss (appetite suppressant effect). Large doses can cause symptoms resembling paranoid schizophrenia

68
Q

amphetamines RN intervention and client education

A

Give in AM
Monitor weight in children
Drug “holiday”
Schedule II - high risk for abuse
Can develop tolerance, psychological and physical dependance
Taper - withdrawal symptoms = depression and fatigue
Monitor VS - HR and BP
Educate to avoid caffeine
Educate client on symptoms to report
Palpitations, anorexia

69
Q

amphetamines contraindications and interactions

A

avoid in clients with cardiovascular problems, severe hypertension, hyperthyroidism. Nerve take iwth MAOIs

70
Q

CNS stimulant amphetamine related prototype and other drug names

A

methylphenidate (Ritalin, Concerta)
Others: dexmethylphenidate (Focalin)

71
Q

amphetamine related EPA

A

Increase norepinephrine and dopamine in brain and PNS = more alert, energy, improved mood (euphoria). When used in ADHD - increased ability to focus/attention span

72
Q

amphetamine related therapeutic use

A

ADHD, narcolepsy

73
Q

amphetamine related administration

A

PO (reular and ER), transdermal

74
Q

amphetamine related ADRs

A

due to CNS stimulation. Insomnia, nervousness, hypertension, tachycardia/palpitations. Weight loss (appetite suppressant effect). Large doses can cause symptoms resembling paranoid schizophrenia. Toxicity symptoms = psychosis, dysrhythmias, seizures

75
Q

amphetamine-related RN intervention and education

A

Same as amphetamines
Applying patch: press in place for 30 sec, remove after 9 hours, do not touch drug side with fingers

76
Q

amphetamine related contraindications and interactions

A

Same as amphetamines
Do not use in clients with hx of psychosis/depression
Children younger than 6 y.o. Should not take (unless benefits outweigh risk)

77
Q

CNS stimulants non-amphetamines prototype and other drug names

A

modafinil (Provigil)
Others: armodafinil (Nuvigil)

78
Q

non-amphetamines EPA

A

precise mechanism unknown. Thought to block reuptake of norepinephrine

79
Q

non-amphetamines therapeutic uses

A

ADHD, narcolepsy. Also shift-work sleepiness and OSA

80
Q

non-amphetamines administration

A

PO

81
Q

non-amphetamines ADRs

A

common = nausea and diarrhea. HA, tachycardia, HTN. Rare = SJS

82
Q

non-amphetamines RN intervention and client education

A

Administer in AM for ADHD/narcolepsy
Administer 1hr prior to shift it for sleepiness
Take w/ food to minimize GI effects
Monitor for CNS effects (BP, HR)
Educate pt of childbearing age to use barrier contraceptives instead of oral contraceptive
Lower abuse potential but can lead to psychological dependence

83
Q

non-amphetamines contraindications and interactions

A

Avoid in pt with vascular heart disease. Caution in clients with cardiovascular problems, hypertension, renal, or hepatic failure. Interacts with oral contraceptives. Do not take with methylphenidate

84
Q

Antiparkinsons agent/MAOIs prototype and other drug names

A

selegiline (Elderpryl)
Other drugs: rasagiline (Azilect)* Monotherapy

85
Q

MAOIs EPA

A

indirect-acting dopamine receptor agonist
Inhibits the action of the of the enzyme MAO-B in the brain and other parts of the body
MAO-B inactivates dopamine

86
Q

MAOIs therapeutic uses

A

treat symptoms of Parkinson’s disease (PD)

87
Q

MAOIs administration

A

PO, take before morning meal

88
Q

MAOIs ADRs

A

insomnia

89
Q

MAOIs contraindications an dinteractions

A

Hypersensitivity
MAOIs, tricyclic, or SSRIs (can cause high fever, HTN, rigidity)
Food containing tyramine can cause HTN
Herbal drugs can cause severe HTN

90
Q

MAOIs RN intervention and client education

A

Instruct pt to take last dose of the day before noon to avoid insomnia
Notify provider before taking any new drugs
Instruct about foods and herbs to avoid

91
Q

direct acting dopamine receptor agonist prototype and other drug names

A

pramipexole (Mirapex)
Others: ropinirole (Requip)

92
Q

direct acting dopamine receptor agonists EPA

A

Binds to dopamine receptors and causes a response similar to the body’s natural dopamine

93
Q

direct acting dopamine receptor agonist therapeutic uses

A

Relieves symptoms of PD and restless leg syndrome

94
Q

direct acting dopamine receptor agonist administration

A

PO

95
Q

direct acting dopamine receptor agonist ADRs

A

nausea, drowsiness, muscle weakness, orthostatic hypotension, and dyskinesias

96
Q

direct acting dopamine receptor agonist contraindications and interactions

A

Pregnancy and lactation
Older adults
Renal dysfunction
ETOH and other CNS depressants increase risk for adverse effects

97
Q

direct acting dopamine receptor agonist RN intervention and client education

A

Nausea can lessen over time
Instruct pt to avoid driving or performing activities that require mental alertness if drowsiness occurs
Move slowly from a sitting/standing position

98
Q

dopamine replacement drugs prototype

A

levodopa-caridopa (Sinemet)

99
Q

dopamine replacement drugs EPA

A

Levodopa increases the availability of L-dopa, the precursor to dopamine, creating more dopamine. Carbidopa inhibits the breakdown of levodopa in peripheral tissues, so there is more dopamine available. Carbidopa does not cross the blood-brain barrier

100
Q

dopamine replacement drugs therapeutic uses

A

relieves symptoms of PD

101
Q

dopamine replacement drugs administration

A

PO, taken multiple times a day
Available in IR and ER

102
Q

dopamine replacement drugs ADRs

A

N/V, darkening urine and sweat, orthostatic hypotension, dyskinesias, and psychosis, hallucinations, paranoid (rare)

103
Q

dopamine replacement drugs contraindications and interactions

A

glaucoma, psychosis, existing renal dysfunction, vitamin B6 decreases action, MAOI antidepressants can cause HTN crisis, high-protein meals decrease action, anticholinergic drugs increase response

104
Q

dopamine replacement drugs RN intervention and client education

A

Educate pt that administration starts with low doses to reduce adverse effects
Can take up 6 months for full response
Monitor for “on-off” phenomenon
Don’t take with high protein meals

105
Q

cholinesterase inhibitors prototype

A

donepezil (Aricept)

106
Q

cholinesterase inhibitors EPA

A

Prevents the enzyme acetylcholinesterase from inactivating ACh, thus increase the amount of ACh available at receptor sites in the brain

107
Q

cholinesterase inhibitors therapeutic uses

A

Improved cognitive function in clients with mild to moderate Alzheimer’s disease

108
Q

cholinesterase inhibitors adminstration

A

PO (tablets, orally disintegrating tablets and syrup), given at bedtime with food

109
Q

cholinesterase inhibitors ADRs

A

Nausea, CNS effects (insomnia, dizziness, headaches) and bradycardia

110
Q

cholinesterase inhibitors contraindications and interactions

A

GI bleeding, children, NSAIDs increase risk for GI bleed, use with caution in clients with liver, renal, cardiac, GI, or pulmonary disorders and seizures

111
Q

cholinesterase inhibitors RN intervention and client education

A

Instruct pt to take with food at bedtime to decrease GI upset
Instruct client or caregiver to report adverse effects to provider
Safety alert-make sure caregivers are present if client is not able to remember instructions

112
Q

NMDA receptor antagonist prototype

A

memantine (Namenda)

113
Q

NMDA receptor antagonist EPA

A

Blocks excess glutamate from stimulating NMDA receptors, decreasing the influx of calcium into neurons in the brain. Reduces intracellular calcium to restore normal nerve transmissions. Reduces calcium.

114
Q

NMDA receptor antagonist therapeutic use

A

Slows progression of Alzheimer’s disease by preventing neuronal damage from high levels of calcium

115
Q

NMDA receptor antagonist administration

A

PO (tablet or liquid)

116
Q

NMDA receptor antagonist ADRs

A

CNS effects (dizziness, headache, increased confusion)

117
Q

NMDA receptor antagonist contraindications and interactions

A

renal failure, liver disorders, seizure disorders, and older adults
*OTC antacids increase levels of memantine and could cause possible toxicity

118
Q

NMDA receptor antagonist RN intervention and client education

A

Instruct client/caregiver to report presence of CNS effects

119
Q

immunomodulators prototype and other drug names

A

interferon beta-1a (Avonex and Rebif) and interferon beta-2a (Betaseron)

120
Q

immunomodulators EPA

A

inhibits the movement of leukocyte, a product of the body’s defective autoimmune response, across the blood-brain barrier. Inhibiting leukocytes from damaging myelin sheath of neurons

121
Q

immunomodulators therapeutic uses

A

slow progression of MS

122
Q

immunomodulators administration

A

IM weekly, or SQ daily for 3 days each week

123
Q

immunomodulators ADRs

A

Flu-like symptoms (will decrease with prolonged treatment), myelosuppression, liver toxicity, and pain/redness at injection site

124
Q

immunomodulators contraindications and interactions

A

Any drug that suppresses the immune system (ex Prednisone) - could increase the risk for myelosuppression

125
Q

immunomodulators RN intervention and client education

A

Educate client on how to administer medication
Rotate sites
Instruct client to pre-medicate with acetaminophen if flu symptoms occur
CBC and LFTs will be monitored before treatment begins and then periodically after
Instruct client to report easy bruising, bleeding, or fatigue
Instruct client to report abdominal tenderness, anorexia, and jaundice

126
Q

serotonin agonists prototype

A

sumatriptan (Imitrex)

127
Q

serotonin agonists EPA

A

reverse 5-HT (serotonin)/CGRP ratio by activating 5-HT receptors, which promote vasoconstriction and suppress the release of CGRP. This prevents inflammatory response from occuring

128
Q

serotonin agonists therapeutic uses

A

relieve symptoms of existing migraine or cluster HA

129
Q

serotonin agonists administration

A

PO, SQ, or by nasal spray

130
Q

serotonin agonists ADRs

A

chest pressure or “heaviness: may progress to angina pain caused by coronary vasospasm. CNS effects (tingling and vertigo)

131
Q

serotonin agonist contraindications and interactions

A

CAD, PVD, stroke, HTN, liver or kidney insufficiency. MAOIs taken w/in 2 weeks (can cause sumatriptan toxicity), use of another triptan w/in 24 rs, serotonin agonist with sumatriptan can cause serotonin syndrome, st johns wort can cause toxicity

132
Q

serotonin agonists RN interventions and client education

A

instruct client at once if they experience chest pressure or tightness/heaviness in back, jaw, or throat
Instruct client to report CNS symptoms
Educate pt on how to administer medication
Nasal spray one in a single nostril and repeat after 2 hrs if need
Take one oral tablet and repeat after 2 hrs if needed
Give one SQ injection and repeat once after 1 hr if no relief; no more than 2 doses in 24 hrs
The maximum dose is 200mg in 24 hrs

Pharm (13 decks)

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