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PHARMACOTHERAPEUTICS > PHARM 1 EXAM #2 > Flashcards

PHARM 1 EXAM #2 Flashcards

1
Q

Explain major responses to stimulation of adrenergic receptors

A
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2
Q

Differentiate between selective and nonselective adrenergic agonists.

A
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3
Q

Contrast the uses of alpha blockers and beta blockers

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4
Q

Compare the indications and general side effects of adrenergic agonists and adrenergic
blockers

A
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5
Q

Describe nursing interventions, including patient teaching, associated with adrenergic agonists and adrenergic blockers.

A
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6
Q

Apply the nursing process for the patient taking beta-adrenergic blockers

A
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7
Q

Compare the responses of cholinergic agonists and anticholinergic drugs

A

Cholinergic agonists — stimulate PSN/mimic neurotransmitter ACh
—Receptors: Musarinic (smooth muscles), Nicotinic (skeletal muscles)
Anticholinergic agonists — inhibit

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8
Q

GU drug: Tolterodine tartrate (Detrol)

A

Gotta go RIGHT NOW
Is an anticholinergic/antimuscarinic agent that is used to treat overactive bladder symptoms

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9
Q

The purpose of Atropine

A

Action
—Increases pulse, decreases motility and peristalsis, decreases salivary secretions
Side effects/adverse reactions
—Tachycardia, palpitations, nasal congestion, flushing, photophobia, blurred vision, dry mouth and skin, abdominal distention, urinary retention, impotence
Contraindicated in glaucoma
— Because anticholinergic drugs can increase intraocular pressure, they should not be administered to patients diagnosed with glaucoma.

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10
Q

RN Interventions for Atropine

A

Monitor vital signs, urine output, bowel sounds.
Monitor safety: bedside rails, driving motor vehicles.
Provide mouth care and eye drops.
Avoid hot environments.
Avoid alcohol, cigarettes, caffeine, and aspirin at bedtime.
Wear sunglasses in bright light.

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11
Q

Differentiate between direct-acting and indirect-acting cholinergic agonists

A

Direct-acting — muscarinic receptors (Heart, GI, GU, glands)
Drugs: Metoclopramide (Reglan); Pilocarpine (Pilocar)[Glaucoma]; Bethanoechol chloride (Urecholine) (check for hx of peptic ulcer, urinary obstruction, or asthma — contraindications)

Indirect-acting — Cholinesterase inhibitors inactivate the enzyme acetylcholinesterase (cholinesterase), thus permitting acetylcholine to react to the receptor.
Drugs: Achetylcholinesterase- inhibitor

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12
Q

Contrast the indications and major side effects of cholinergic agonists and antagonists

A

Cholinergic agonists = too wet, too drooly
Cholinergic antagonists = too dry, dilate eyes, bronchoconstrict lungs

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13
Q

Differentiate the uses of cholinergic agonists and antagonists

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14
Q

What drug is used for a patient post anesthesia

A

given as a short-term only, <2hr for acute respiratory insufficiency r/t COPD

Dopram is a prescription medicine used to treat the symptoms of COPD Associated with Acute Hypercapnia, Respiratory Depression Postanesthesia, and Drug-Induced CNS Depression

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15
Q

Apply the nursing process, including patient teaching associated with cholinergic agonists
and anticholinergic

A
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16
Q

Apply the nursing process for the patient taking neostigmine, a reversible cholinesterase
inhibitor

A

Edrophonium (Tensilon) is a VERY short-acting and often used for diagnostic purposes.
— Neostigmine methylsulfate and ambenonium chloride are used to treat myasentenia gravis.
— Physostigmine salicylate is used to treat anti-cholinergic syndrome or glaucoma.

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17
Q

Explain the effects of stimulants on the central nervous system (CNS)

A
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18
Q

What are the medically approved uses for CNS Stimulants?

A

— Attention deficit/hyperactivity disorder (ADHD)
— Narcolepsy
— Reversal of respiratory distress

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19
Q

Compare attention deficit/hyperactivity disorder and narcolepsy

A

ADHD
— Pathophysiology: Dysregulation of transmitters (Serotonin, Norepinephrine, Dopamine)
Characteristics
— Inattentiveness, inability to concentrate, restlessness, hyperactivity, inability to complete tasks, impulsivity
______________VS_________________________
Narcolepsy
Characteristics:
— Inability to control sleep/stay awake
— Recurrent attacks of drowsiness and sleep during daytime
— Falls asleep while driving, talking, eating, standing

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20
Q

Amphetamine drugs vs. Amphetamine-like drugs

A

Amphetamines:
— amphetamine sulfate (Adderall); destroamphetamine sulfate (Desedrine); lindexamfetamine dimesylate (Vyvanse)
VS
Amphetamine-like:
—methylphenidate HCl (Ritalin); modafinil (Provigil); dexmethylphenidate (Focalin); amodafinil (Nuvigil)

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21
Q

RN Implications/Interventions when taking *Methylphenidate (Ritalin)

A

— Give before breakfast and lunch (30-45 minutes)
— Report irregular heartbeat
— Watch growth in children who take this drug; ensure they’re growing at the standard pace
— Record height, weight, and growth + development of children.
— Avoid alcohol, caffeine
— Use sugarless gum/ice chips to relieve dry mouth.
— Do not stop abruptly; taper off to avoid withdrawal symptoms b/c changes the CNS neuro-chemicals chemistry**
— Counseling must also be used.
— Do not give after 2-3pm…will have insomnia

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22
Q

Side/Adverse Effects for Methylphenidate (Ritalin)

A

— Tachycardia, palpitations, dizziness, hypertension
— Sleeplessness, restlessness, nervousness, tremors, irritability
— Increased hyperactivity
— Anorexia, dry mouth, vomiting, diarrhea, weight loss
— Thrombocytopenia = decreased platelet count in blood

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23
Q

What are Extrapyramidal Symptoms (EPSs)

A

akathisia, dystonia, psuedoparkinsonism, and dyskinesia, are drug-induced side effects that can be problematic for persons who receive antipsychotic medications (APMs) or other dopamine-blocking agents. Pseudoparkinsonism, or neuroleptic-induced parkinsonism, includes slow pill-rolling finger tremors, masklike facial expression, weakened voice, absence of arm swing when walking, stiff stooped posture, and an impaired shuffling gait. Cogwheeling rigidity, assessed frequently in the arms, is a ratchet-like motion of the extremities during extension.

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24
Q

Drugs used for Parkinsonism

A

Drugs used - Anticholinergic/antiparkinsonism
— Benztropine (Cogentin)
— Biperiden (Akineton)
— Trihexyphenidyl HCl (Artane)
Action
Decreases involuntary movement, tremors, muscle rigidity
— These drugs (that decrease acetylcholine) can be used alone early in Parkinson’s, later they are combined with levodopa/cabidopa (which increases dopamine).

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25
Q

What are the contraindications for taking Methylphenidate (Ritalin)

A

Patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.

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26
Q

Side/Adverse Effects of Amphetamines

A

— Tachycardia, palpitations, hypertension
Sleeplessness, restlessness
— Irritability
— Anorexia, dry mouth, weight loss, diarrhea, constipation
— Impotence (no el sexo)

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27
Q

Methylphenidate (Ritalin) MOA + Uses + Interactions

A

MOA
— Modulates serotonergic pathways by affecting changes in dopamine transport
USES
— ADHD, fatigue, narcolepsy
INTERACTIONS
— Caffeine may increase effects (decrease or eliminate, plsss)
— Decreased effects when using with decongestants, anti-HTN’ves, barbiturates
— May alter insulin effects

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28
Q

Drugs used for Narcolepsy

A

Methylphenidate (Ritalin)
Modafinil (Provigil) — don’t fully understand the MOA
Uses: increases the amount of time patients with narcolepsy feel awake

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29
Q

Drugs used for ADHD

A

Amphetamines MOA: stimulate release of norepinephrine + dopamine
high abuse potential due to euphoria-feeling

Amphetamine-Like drugs: Methylphenidate (Ritalin), Dexmethylphenidate (Focalin)

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30
Q

Differentiate the action of drugs used for attention deficit/hyperactivity disorder and
narcolepsy

A

Amphetamines & Amphetamine-Like Drugs
— MOA: stimulate release of norepinephrine + dopamine; has a paradoxical effect to be able to increase attention span and cognitive performance
Runs potential for abuse/addiction
___________________
For Narcolepsy
— MOA:

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31
Q

Contrast the common side effects of amphetamines, anorexiants, analeptics, doxapram, and
caffeine

A
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32
Q

Respiratory CNS Stimulants for Adults

A

Drug — Doxapram (Dopram)
Uses — Respiratory depression caused by overdose, pre/post-anesthetic respiratory depression, and hx of COPD; trying to get off ventilators and need a little push to help you become more awake
Onset of action — 20-40 seconds, peak within 2 minutes
Side Effects — HTN, Tachycardia, trembling, convulsions

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33
Q

Analeptic Drugs, Use, + Side Effects

A

Drugs — Caffeine, Theophylline
Uses — Stimulate respiratory effort in newborns
Side Effects
— Restlessness, tremors, twitching, palpitations, insomnia
— Diuresis, tinnitus, nausea, diarrhea
— Psychological dependence

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34
Q

Anorexiant Drugs + Side Effects

A

— Benzphetamine HCl (Didrex)
— Diethylpropion HCl (Tenuate)
— Phentermine HCl (Suprenza)
— Phentermine-topiramate (Qsymia)
— Phendimetrazine (Bontril)
— Lorcaserin (Belviq)
Side effects
Nervousness, restlessness, irritability, insomnia, heart palpitations, and hypertension
___________________
NOTE: tolerance and abusive tendencies may arise if on the drug long enough therefore not chosen often

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35
Q

Apply the nursing process for the patient taking CNS stimulants

A
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36
Q

Apply the nursing process for the patient taking doxapram (Dopram)

A

MOA — stimulates the medullary respiratory centre both by a direct action and by peripheral stimulation of the carotid body
Uses — Respiratory depression caused by overdose, pre/post-anesthetic respiratory depression, and hx of COPD; trying to get off ventilators and need a little push to help you become more awake
Onset of action — 20-40 seconds, peak within 2 minutes
Side Effects — HTN, Tachycardia, trembling, convulsions

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37
Q

Differentiate the types and stages of sleep

A

— Rapid eye movement (REM)
— Nonrapid eye movement (NREM)
________________________________
NOTE: It is difficult to arouse someone who is in REM sleep)* therefore interrupting a person’s sleep (before reaching REM cycle), results in the person having to go through these stages from the beginning in order to reach REM**
COHORT YOUR CARE TO PREVENT THIS

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38
Q

Explain several nonpharmacologic ways to induce sleep

A

— No daytime naps
— Warm fluids to drink
— Caffeine avoided 6 hr before bedtime
— Heavy meals and exercise avoided before bedtime
— Warm bath, reading, listening to music

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39
Q

Differentiate among these adverse effects: hangover, dependence, tolerance, withdrawal
symptoms, and rapid eye movement (REM) rebound, respiratory depression, & hypersensitivity

A

Hangover — residual drowsiness
Dependence — results in withdrawal symptoms
Tolerance — need to increase dosage to get desired effect
Withdrawal symptoms — due to being dependent on a drug
Rapid eye movements (REM) rebound — vivid dreams and nightmares
Respiratory depression — suppression of respiratory center in the medulla; CNS depressants/EtOH/opioids = need ambubag
Hypersensitivity — skin rashes

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40
Q

Sedative/Hypnotic effect is determined by the _____. Differentiate between the two.

A

Dose
________
Sedative = give a smaller dose
Hypnotic = give a larger dose

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41
Q

Sedative-Hypnotic Drugs

A

Sedatives produce mildest form of CNS depression
Drugs — Barbiturates, Benzodiazepines, Nonbenzodiazepines

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42
Q

OTC Sedative-Hypnotics

A

— Sominex
— Tylenol PM
— Diphenhydramine (Benadryl)

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43
Q

Difference between the 1st generation antihistamines vs. the 2nd

A

1st generation — crosses the BBB —> drowsiness
— e.g. Diphenhydramine (Benadryl)
2nd generation — does NOT cross the BBB —> no drowsiness/non-sedating
— e.g. Claritin, Zyrtec, Xyzal, Allegra

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44
Q

Discuss the uses of benzodiazepines

A

Drugs used as hypnotics —
— Flurazepam (Dalmane)
— Alprazolam (Xanax)
— Temazepam (Restoril)
— Triazolam (Halcion)
— Estazolam (ProSom)
— Quazepam (Doral)
Drugs used for anxiety
— Lorazepam (Ativan); can give higher dose to abort seizures
— Diazepam (Valium)
________
**NOTE: high doses = hypnotic-sedatives vs. low doses = anxiolytic

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45
Q

Apply the nursing process for the patient taking benzodiazepines for hypnotic use

A
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46
Q

Benzodiazepines

A

— When using as a sedative — anxiolytic to reduce anxiety
— When using as a hypnotic — Tx insomnia (increasing dose)
Side Effects — Respiratory depression (very old/young, outside normal BMI)

47
Q

What is the difference between anterograde amnesia vs. retrograde amnesia? Why is this a benefit in the hospital regarding a side effect?

A

Retrograde: “Oh, I forgot what I did yesterday.”
Anterograde: Forget what’s happening coming up/what’s going to happen

Why? Forget what’s happening presurgery, pre-chemo, preprocedure therapy b/c don’t want patient to feel miserable during the incoming process

48
Q

Which drugs are safer Barbiturates or Benzodiazepines? Why?

A

Benzodiazepines
Enhance patient’s own GABA to quiet the brain, and increase efficacy of own GABA neurotransmitters

Barbiturates = mimic GABA so adding more towards brain = increase in abuse potential

49
Q

Barbiturates

A

These drugs directly mimic GABA, the principal inhibitory neurotransmitter, in the CNS = “putting brain to sleep”
Scheduled II & III = highly addictive/abusive potential
____________
— Long-acting
— Intermediate-acting
— Short-acting
— Ultrashort-acting
— Restricted to short-term use (2 weeks or less) because of side effects, including drug tolerance
Interactions — alcohol, opioids, other sedative-hypnotics

50
Q

Sedative + Hypnotics for Older Adults

A

— Identify cause.
— Use nonpharmacologic methods first.
— Use short- to intermediate-acting benzodiazepines such as estazolam (ProSom), temazepam (Restoril), and triazolam (Halcion).
— Avoid benzodiazepines such as flurazepam, quazepam (Doral), and diazepam (Valium).
— Eszopiclone (Lunesta) – benzo-like drug
These drugs will INCREASE fall risk

51
Q

Sedative-Hypnotics drug interactions + RN Interventions

A

Drug interactions
— Alcohol, CNS depressants

Nursing interventions
— First use nonpharmacologic methods.
— Be attentive to safety.
— Avoid alcohol, other CNS depressants.
— Take 15 to 45 minutes before bedtime.
— Report hangover effect.
— Monitor BP, RR.
— Withdraw gradually

52
Q

Drug interactions + nursing interventions: Melatonin agonist hypnotics

A

— Ramelteon (Rozerem)
— First FDA-approved hypnotic not classified as a controlled substance
— Selectively targets melatonin receptors to regulate circadian rhythm in the treatment of insomnia
— Not been shown to decrease REM sleep

Adverse effects: drowsiness, dizziness, fatigue, headache, nausea, and suicidal ideation
Also used as an antianxiety (anxiolytic) drug — great for older adult population to reduce abuse potential with other drugs

53
Q

Name the routes of anesthesia

A

Inhalation
Intravenous (IV)
Topical
Local
Spinal

54
Q

Spinal Anesthesia

A

— Go through menengial covering
— injected medication into the cerebral spinal fluid and may circulate/drift upward

Interventions
— Have HOB slightly raised (medication may move up higher into the spinal cord and don’t want to happen); DO NOT WANT TO HAVE A NUMB DIAPHRAGM!

55
Q

Compare the stages of anesthesia

A

Stage 1: Analgesia (don’t sense pain)
Stage 2: Excitement or delirium (acute loss of sensorium; don’t know what’s going on around you)
Stage 3: Surgical
Stage 4: Medullary paralysis — (TOXIC)

In order to perform surgery, must past stages 2 + 3 (pain perception)

56
Q

Define balanced anesthesia

A

Several drugs used to ensure smooth induction and adequate muscle relaxation in your patient (prior/during procedure) to make it as pleasant as possible for the patient

May include
— A hypnotic given the night before to ensure adequate rest
— Premedication with an opioid analgesic or benzodiazepine (e.g., midazolam [Versed]) plus an anticholinergic (e.g., atropine) given about 1 hour before surgery to decrease secretions
— A short-acting barbiturate such as thiopental sodium (Pentothal)
— An inhaled gas—often a combination of nitrous oxide and oxygen; for anxious children to start an IV
— A muscle relaxant given as needed

57
Q

Drugs used for inhalation anesthesia

A
58
Q

Inhalation anesthetics + its uses

A

— Methoxyflurane, enflurane (Ethrane), isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane)
— Usually combined with a barbiturate (e.g., thiopental), a strong analgesic (e.g., morphine), and a muscle relaxant (e.g., pancuronium)
— Adverse effects: respiratory depression, hypotension, dysrhythmias, and hepatic dysfunction
— Malignant hyperthermia (genetic)

59
Q

Explain the problems with malignant hyperthermia. What is the antidote?

A

Malignant hyperthermia (MH) is a rare, genetically determined, life-threatening reaction to general anesthetics. Coadministration of succinylcholine, a neuromuscular blocker, increases the risk of the reaction.

ANTIDOTE: dantrolene (Dantrium) – muscle relaxant; comes in po & IV – IV used to treat MH
___________________
Dantrolene = generic
(Dantrium), (Ryanodex) = brand/trade name

60
Q

Explain the uses for topical anesthetics

A

Use
— Mucous membranes, broken or unbroken skin surfaces, and burns
Forms
— Solution, liquid spray, ointment, cream, gel, and powder
— Decrease the sensitivity of nerve endings of the affected area
Cocaine often used for anesthesia of the ear, nose & throat – causes vasoconstriction also…good for epistaxis

61
Q

Differentiate general and local anesthetics and their major side effects

A

General anesthetics:
— Purpose: depress the CNS, alleviate pain, and cause a loss of consciousness
__________________________
Local anesthetics
— Purpose: analgesia in limited area
Dose related r/t effects: lose sensation order first pain, then temperature, touch, and finally motor sensation

62
Q

Name the order in which sensation is lost when given anesthesia

A

Perception of pain is lost first, followed in order by perception of cold (temperature), warmth, touch and deep pressure.

NOTE: Blocks not only sensory but also motor neurons, which is why you can’t smile when you leave the dentist

63
Q

Contrast the two international classifications of seizures with characteristics of each type

A
  1. Focal onset
  2. Generalized onset
64
Q

Differentiate between the types of seizures

A

GENERALIZED = grand-mal & petit mal
Tonic-clonic — aka grand mal
— most common; tonic = rigidity & clonic =spasms w/ jerkiness
Tonic seizure = “drop attack” losing muscle tone
Absence (petit mal):
— aka petit mal
— a brief LOC (for 10 seconds or less)
— usually occurs in children
______________________________
PARTIAL (Focal Onset Seizure)
—Psychomotor = repetitive behavior (e.g. chewing/swallowing motions)
— Behavioral changes
— Motor seizures
Simple Partial = remains conscious
Complex Partial = lose consciousness w/ potential of 2ndary results leading to—> Generalized

65
Q

Summarize the pharmacokinetics, side effects and adverse reactions, therapeutic plasma,
contraindications for use, and drug interactions of phenytoin (Dilantin)

A

Pharmacokinetics:
Side Effects:
Adverse Rxns:
Therapeutic plasma:
Contraindications:
Drug Interactions

66
Q

Summarize the pharmacokinetics, side effects and adverse reactions, therapeutic plasma,
contraindications for use, and drug interactions of phenytoin (Dilantin)

A

Pharmacokinetics:
Side Effects: gingival hyperplasia (gum will grow upward)
Adverse Rxns:
Therapeutic plasma: 10-20 mcg/mL must keep blood level within range in order for the drug to remain effective and not toxic for patient
Contraindications: DO NOT USE during pregnancy (teratogenic)
Drug Interactions:
TEACHING: brush teeth with soft toothbrush and brush downward

67
Q

What is a febrile seizure and when do they occur?

A

— Seizures associated with fever usually occur in children between the ages of 3 months and 5 years.
— Temperature = >102.2 ºF (39ºC) for when seizures may occur

68
Q

Do febrile seizures increase risk for developing epilepsy? T/F.

A

FALSE
— Epilepsy develops in approximately 2.5% of children who have had one or more febrile seizures.
— Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy

69
Q

What is the prophylactic anticonvulsant Tx?

A

Prophylactic anticonvulsant treatment such as phenobarbital or diazepam may be indicated for high-risk patients.

70
Q

What drug should NOT be given to children who suffer from febrile seizures?

A

Valproic acid should not be given to children younger than 2 years because of its possible hepatotoxicity

71
Q

Name the RN interventions (teaching) for patient taking Hydantoins class medication phenytoin (Dilantin)

A

— Shake suspension well for 5 minutes
— Monitor serum drug levels
— Safety: Protect env’tal hazards, driving
— Warn female patient taking oral contraceptives to use additional contraception
— Warn patient to avoid certain herbs, EtOH, and other CNS depressants
— Warn patient not to discontinue abruptly
—Patient will need to frequent oral hygiene and dental check-ups; brush with soft toothbrush, brush downward to prevent gingival hyperplasia
— Diabetics must monitor glucose levels
— Tell each patient to take drug at same time every day
— Warn of harmless pinkish/red or brown urine
— Teach patient to report sore throat, bruising, nosebleeds
— Encourage patient to wear medical-alert identification
__________________
Note
GENERIC NAME: PHENYTOIN
BRAND/TRADE NAME: DILANTIN

72
Q

Benzodiazepines drugs used for AEDs

A

— Clonazepam
— Clorazepate dipotassium
— Diazepam (Valium)

73
Q

Types of Barbiturates

A

Phenobarbital

74
Q

RN Interventions for Phenobarbital

A

— Shake suspension well for 5 minutes.
— Treats partial seizures, grand mal seizures, acute episodes of status epilepticus seizures, meningitis, toxic reactions, and eclampsia
— Therapeutic serum range of phenobarbital is 20 to 40 mcg/mL.
— Risks–sedation and patient tolerance to the drug
— Discontinuance of phenobarbital should be gradual to avoid recurrence of seizures.

75
Q

What are the therapeutic serum levels for AEDs from least to greatest margins

A

— Carbamazepine: 5 to 12 mcg/mL
— Hydantoins: 10 to 20 mcg/mL
— Phenobarbital: 20 to 40 mcg/mL
— Ethosuximide (Zarontin): 40-100 mcg/mL
— Valproic acid: 50 to 150 mcg/mL

76
Q

What is the purpose of Anticonvulsants/Antiepileptic Drugs (AEDs)? What are their MOAs?

A

To suppress abnormal neuron firing

77
Q

What is the drug of choice for active repetitive seizures and/or *status epilepticus? Route?

A

— Diazepam (Valium) OR Lorazepam (Ativan) administered IV
— Followed by IV administration of phenytoin (Dilantin) = essential

78
Q

What is an orphan drug?

A

A pharmaceutical agent that has been developed specifically to treat a rare medical condition, the condition itself being referred to as an orphan disease.

79
Q

What medication is used for continued seizures? Goals?

A

Midazolam (Versed) or propofol (Diprivan)
_________
Goals:
— Maintain ventilation
— Terminate seizures
— Correct hypoglycemia
— Initiate or continue long term suppression medication

80
Q

Which AED medication is short/long acting? Which is preferred?

A

Short-acting: Diazepam
Long-acting: Lorazepam w/ effects lasting up to 72 hours — generally preferred
______________________
Note: If diazepam is used follow up treatment with a long acting drug is essential (i.e. Dilantin or fosphenytoin/Cerebyx)

81
Q

What is DIASTAT AcuDial? What is it used for?

A

It is a diazepam rectal gel that has a unique locking mechanism that ensures that your patients receive the correct dose
_________________
NOTE: Remind your patients and their caregivers to inspect each DIASTAT AcuDial syringe BEFORE leaving the pharmacy.

82
Q

Phenobarbital

A

— Mechanism of Action:
Enhances GABA activity
— Use: Tonic–clonic, partial, myoclonic seizures, status epilepticus
— Therapeutic serum range:
20 to 40 mcg/mL
— Side effects:
Sedation, tolerance
— Discontinuation:
Should be gradual

83
Q

What are the drugs that suppress sodium influx for anticonvulsants/anti-epileptic drugs (AEDs)?

A

— Phenytoin (Dilantin)
— Fosphenytoin
— Carbamazepine
— Oxcarbazepine
— Valproic acid
— Topiramate
— Zonisamide
— Lamotrigine

84
Q

IMINOSTILBENE

A

— Carbamazepine: effective in Tx’ing refractory seizure d/o’s that have not responded to other anticonvulsant therapies
A derivative of Iminostilbene
_________________________
— Used to control grand-mal + partial seizures and a combination of these seizures
— Also used for psychiatric d/o (e.g. bipolar d/o), trigeminal neuralgia (as an analgesic), and alcohol withdrawal
— Therapeutic serum range of carbamazepine: 5-12mcg/mL
— An interaction may occur when grapefruit juice is taken with Carbamazepine (Tegretol) causing possible toxicity

85
Q

Most common neuro adverse effects for Iminostilbene (Carbamazepine)

A

Nystagmus, ataxia, diplopia, drowsiness, dizziness, headache

86
Q

RN Interventions for Iminostilbene (Carbamazepine)

A

— Water retention can be dangerous in those with heart failure
— Periodic CBC should be done due to risk (though rare) of hematologic side effects which can include aplastic anemia

87
Q

What are the drugs that suppress calcium influx for anticonvulsants/anti-epileptic drugs (AEDs)?

A

— Valproic acid (Depakane)
— Ethosuximide

88
Q

If you perform multimodal approach to a problem, you will have an enhanced pharmacodynamic effect? T/F

A

TRUE

89
Q

VALPROATE

A

Brand/Trade names: Dyzantil, Epilim, Episenta, Epival

MOAction:
Valproic acid: Used to treat petit mal, grand mal, and mixed types of seizures
— Safety and efficacy of this drug has not been established for children younger than 2 years of age.
— Caution in patients with liver disorders, because hepatotoxicity is one of the possible adverse reactions. — Liver enzymes should be monitored.
—Therapeutic serum range is 50 to 150 mcg/mL

90
Q

Mechanism of Action: Hydantoins

A

— Stabilizes neuronal membranes by decreasing sodium and calcium ion influx into the neurons
— Also decreases post-tetanic potentiation and repetitive discharge.

91
Q

Mechanism of Action: Long-acting Barbiturates

A

Enhances GABA activity

92
Q

Mechanism of Action: Succinimides

A

Decreases calcium influx

93
Q

MOA: Oxazolidones

A

Binding P site, inhibition of initiation complex and also translocation of peptidyl-tRNA from A site to P site

94
Q

MOA: Benzodiazepines

A

— They act by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS
— Results in the sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties for which the drugs are prescribed.

95
Q

MOA: Iminostilbenes

A

— Enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials
— Action on synaptic transmission.

96
Q

MOA: Valproate

A

— Inhibit succinic semialdehyde dehydrogenase
— This inhibition results in an increase in succinic semialdehyde which acts as an inhibitor of GABA transaminase ultimately reducing GABA metabolism and increasing GABAergic neurotransmission.

97
Q

Apply the nursing process to anticonvulsants, including patient teaching

A

ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION

98
Q

If you perform multimodal approach to a problem, you will have an enhanced pharmacodynamic effect? T/F

A

TRUE

99
Q

Mechanism of Action: Long-acting Barbiturates

A

Enhances GABA activity

100
Q

What is DIASTAT AcuDial? What is it used for?

A

It is a diazepam rectal gel that has a unique locking mechanism that ensures that your patients receive the correct dose
_________________
NOTE: Remind your patients and their caregivers to inspect each DIASTAT AcuDial syringe BEFORE leaving the pharmacy.

101
Q

Do febrile seizures increase risk for developing epilepsy? T/F.

A

FALSE
—
— Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy

102
Q

Do febrile seizures increase risk for developing epilepsy? T/F.

A

FALSE
—
— Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy

103
Q

What are the contraindications for taking Methylphenidate (Ritalin)

A

Methylphenidate (Ritalin) is contraindicated in patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.

104
Q

Define balanced anesthesia

A

Several drugs used to ensure smooth induction and adequate muscle relaxation in your patient (prior/during procedure) to make it as pleasant as possible for the patient

May include
— A hypnotic given the night before
— Premedication with an opioid analgesic or benzodiazepine (e.g., midazolam [Versed]) plus an anticholinergic (e.g., atropine) given about 1 hour before surgery to decrease secretions
— A short-acting barbiturate such as thiopental sodium (Pentothal)
— An inhaled gas—often a combination of nitrous oxide and oxygen; for anxious children to start an IV
— A muscle relaxant given as needed

105
Q

Drugs used for inhalation anesthesia

A

Methoxyflurane, enflurane (Ethrane), isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane), Nitrous Oxide

106
Q

Differentiate Nitrous Oxide with other inhaled anesthetics

A

— Also known as “laughing gas”
— Very low anesthetic potency
— Very high analgesic potency
— Never used as primary anesthetic
— Frequently combined with other inhalation agents to enhance analgesia
— 20% nitrous oxide = Pain relief of morphine
— No serious side effects (nausea and vomiting)
___________
NOTE: Because of its low anesthetic action, cannot produce surgical anesthesia alone – even if administered at 100% (not enough to cause respiratory depression)

107
Q

Intravenous (IV) Anesthetics

A

Trying to consciously sedate person for a procedure; do not want them anxious or in pain
— Droperidol (Innovar), etomidate (Amidate), ketamine hydrochloride (Ketalar)
— Rapid onsets and short durations of action
— Midazolam (Versed) and propofol (Diprivan)
— Induction and maintenance of anesthesia or conscious sedation for minor surgery or procedures like mechanical ventilation or intubation
— Patients are sedated and relaxed but responsive to commands.

108
Q

Risks/Benefits when using Proprofol

A

— Short-acting, lipophilic intravenous general anesthetic. The drug is unrelated to any of the currently used barbiturate, opioid, benzodiazepine, arylcyclohexylamine, or imidazole intravenous anesthetic agents.
— With propofol - unconsciousness develops within 60 seconds and lasts 3–5 minutes; can cause profound respiratory depression

Risks for propofol abuse:
— Schedule 4 drug
— Supplies are not closely monitored
— Widely available in operating rooms and other areas of hospitals and clinics
— No “high”
— Instantaneous but brief sleep period
— Patients awaken “refreshed” and talkative; many report feeling elated and even euphoric

109
Q

Purpose of Local Anesthetics

A

Block pain at the site where the drug is administered
Consciousness is maintained.
Use:
— Dental procedures, suturing skin lacerations, short-term (minor) surgery at a localized area, blocking nerve impulses (nerve block) below the insertion of a spinal anesthetic, and diagnostic procedures such as lumbar puncture and thoracentesis

110
Q

Location + side effects of spinal anesthesia

A

Location
— Local anesthetic injected in the subarachnoid space at the third or fourth lumbar space
Side effects/adverse reactions
—Respiratory distress, headache, hypotension (hence the IV is needed)

111
Q

Differentiate between the 2 groups regarding local anesthetics

A

Esters
— higher percentage of allergic rxns
e.g.
— Procaine (Novocain) – since 1905
— Cocaine – since 1884
— Benzocaine

Amides
— have a very low incidence of allergic reaction (MUCH safer)
e.g.
Procaine hydrochloride (Novocain)
Lidocaine hydrochloride (Xylocaine) — 1948
Bupivacaine (Marcaine)
Dibucaine

112
Q

Differentiate the types of Spinal Blocks

A

— Spinal block: penetration of the anesthetic into the subarachnoid membrane, the second layer of the spinal cord
—Epidural block: placement of the local anesthetic in the outer covering of the spinal cord, or the dura mater
— Caudal block: placed near the sacrum
— Saddle block: administered at the lower end of the spinal column to block the perineal area

113
Q

Nursing interventions for Anesthetics

A

Monitor patient’s level of consciousness.
Monitor vital signs (respirations, HR, BP)
Respiratory status
Cardiovascular status (check for HoTN)
Monitor pre-and post-operative urine output.
Administer analgesics cautiously until patient fully recovers.
Dosage may need to be decreased.

PHARMACOTHERAPEUTICS (11 decks)

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