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Vn 16 Pharmacology > VN 16 Study Guide Test 7 > Flashcards

VN 16 Study Guide Test 7 Flashcards

1
Q
  1. What foods contain high levels of tyramine?(tyramine food list/ATI pg.57)
A

-Aged cheeses (cheddar, Swiss, parmesan, blue cheese & camembert)
-Processed & cured meats (salami, sausage, pepperoni, hot dogs)
-Pickled & fermented foods (herring in brine, sauerkraut, kimchi)
-Soy products (miso, tofu, tempeh)
- Soy sauce, fermented soybeans, fish sauce, teriyaki sauce
-alcohol, wine, beer
-meat, poultry or fish that has been stored in the fridge for 3-4 days
-sourdough bread
-caffeinated drinks, chocolate
-dry processed fruits

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2
Q
  1. Nursing consideration for SSRI (simple nursing video/ATI pgs.47/51)
A

(sertraline, citalopram, escitolpram)
“-talopram, -oxetine, -zodone”
Use: depression, anxiety & PTSD
-increase suicidal thoughts in first few weeks of treatment (especially young adults)
-reports more energy w/out change in depression
-slow onset( may take up to 4 weeks), tapper off dosage (don’t stop abruptly)
-Sexual dysfunction
-cause insomnia
-“take at Sunrise”
-2 wk wash out period is needed
-can cause weight changes (weight loss in early therapy, weight gain in long term treatment)
-Serotonin syndrome: no St. Johns worth, don’t mix w/MAOI’s or any other antidepressant (TCA, SNRI, SSRI), tramadol

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3
Q
  1. Nursing considerations for TCAs(simple nursing video/ ATI pg.55)
A

(amitriptyline,clomipramine,imipramine)
-“triptyline, -pramine”
Uses: depression, anxiety, neuropathic pain/fibromyalgia
-increased suicide risk especially young adults, increased energy w/out change in depression
-slow onset(2-3 weeks to work)
-sweating, seizures, sedation, hypotension (slow position changes)
-blurred vision/photophobia (use eyedrops & sunglasses)
-Anticholinergic effects: urinary retention, dry mouth, constipation (chew gum, increase fluids & fibers)
-2 week wash out period (never take w/MAOI or any other antidepressant)
-No Valarian root supplement (an increase in hypotension effect) :can cause dysrhythmias
-No St. Johns worth
-Get baseline EKG & periodic ones during treatment

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4
Q
  1. Adverse effects of paroxetine(ATI pg.51)
A

SSRI (depression, anxiety, PTSD)
-Sexual dysfunction, insomnia
-reports more energy w/out change in depression
- weight changes (weight loss in early therapy, weight gain in long term treatment)
-increased suicide risk (reports of more energy w/out change in depression)
-Serotonin syndrome
-may take up to 4 wks to reach therapeutic effect

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5
Q
  1. What are manifestations of serotonin syndrome?(Simple nursing video/pg.48)
A

sweaty& hot fever, rigid muscles, restlessness & agitation, tremors, hyperreflexia, Increased heart rate (tachycardia)
*Usually begins 2-72 hrs after initiation of treatment & resolves when medication is discontinued

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6
Q
  1. Benzodiazepine nursing considerations(in class notes & ATI pg.45/46)
A

“-pam”
Ex: lorazepam, diazepam, chlordiazepoxide, clorazepate
Use: anxiety
Antidote : flumazenil
Toxicity symptoms: drowsiness, lethargy, confusion, respiratory depression, severe hypotension, cardiac/respiratory arrest
-sedation : risk for falls, slow position changes, administer at night if possible
-risk for physical dependence/tolerance (short term use)
-no alcohol, no grapefruit juice, no fatty foods
-tapper off,don’t suddenly stop taking medication
-contraindicated: sleep apnea, respiratory depression, or glaucoma

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7
Q
  1. Haloperidol nursing considerations(pp. slide #8-10 & ATI pg.67)
A

Uses: schizophrenia & Tourette’s( Haldol high potency)
- Causes extrapyramidal symptoms (EPS): spasms of the neck, face, tongue, slurred speech, unsteady gait, slowness of movement “pseudo parkinsonism”
-Tardive dyskinesia(TD): potentially irreversible involuntary movements of the tongue, face, mouth, jaw & extremeties.
- Neuroleptic Malignant Syndrome (NMS) : high fever/diaphoresis, change in mental status, muscle rigidity, tremors [typically occurs w/in 1 month of administration]
- NMS Priority: hold med & assess pt., immediately notify HCP
- anticholinergic effects,nasal congestion, urticaria, photophobia/photosensitivity
- Sedation, hypotension, headache, sexual dysfunction
-agranulocytosis: flu like symptoms

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8
Q
  1. clozapine nursing considerations(Pp slide 7 & ATI pg.70)
A

2nd GEN drug
Uses: schizophrenia
-weight gain, hypersalivation, sedation
-agranular cytosis (high infection risk), obtain baseline WBC & monitor.
- Monitor for signs of infection: sore throat, fever, flu like symptoms
-Diabetes, increased cholesterol :monitor blood sugars periodically & Lipid panel
-Contraindicated: bone marrow depressed clients

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9
Q
  1. lithium nursing considerations(PP slide 18 & ATI pg.62)
A

Uses: bipolar disorder (long term treatment)
-long onset (up to 3 wks to work)

-Toxicity (normal levels less than 1.5) Diuretics can increase risk of toxicity
Early signs: n/v/d, tremors, extreme thirst, polyuria (1.5-2.0 early toxicity levels)
Advanced signs: tinnitus, involuntary extremity movement, blurred vision, hypotension(2.0-2.5)
Severe toxicity:Oliguria,seizures, coma & death(greater than 2.5)

-anticholinergic effects, drowsiness, fatigue, weight gain or decreased appetite
-give in divided doses to decrease tremors
-kidney disease pts/older pts at higher risk for toxicity
-do not limit sodium/water intake
-avoid NSAIDS

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10
Q
  1. carbamazepine nursing considerations(PP slide 16 & ATI pg.63)
A

Uses: bipolar, seizures, neuropathic pain
-CNS effects/sedation (avoid tasks that require mental alertness)
-blood dyscrasias: leukopenia: anemia ;Thrombocytopenia :report fever/bleeding/bruising (monitor labs routinely)
-Toxicity: nystagmus, ataxia, vertigo, staggering gait
-report fever & sore throat
- No oral contraceptives
-don’t stop abruptly, tapper off, take meds @ the same time daily

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11
Q
  1. phenytoin nursing considerations(PP slide16 & ATI pg.95)
A

Uses: seizures
-CNS effects, nystagmus, ataxia, difficulty talking, sedation
-Gingival hyperplasia: bleed easily (don’t stop med for this expected effect)
-overgrowth of gum tissue, inform dentist
-skin rash: could indicate steven Johnson syndrome REPORT
-Hypotension (low & slow vitals)
-no oral contraceptives
-suicidal thoughts

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12
Q
  1. Nursing consideration for MAOI(simple nursing video/ATI pg.56)
A

(Tranylcypromine, Isocarboxazid, Phenelzine,selegiline)
Use: depression, panic disorder, social phobia
-Massive HTN crisis risk (massive headache)
-major risk for stroke
-Avoid tyramine
-begin diet at least 2 weeks before beginning treatment & 2 weeks after treatment
- Avoid OTC drugs (calcium, antacids, acetaminophen, NSAIDS naproxen/ibuprofen)
- 2 wk wash out period (no other antidepressants)
-increase suicide risk, more energy w/out change in depression
-Can take up to 4 wks to work

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13
Q

12.NEED TO KNOW FOR VASSOPRESSIN (PP slide 5, simple nursing video)

A

USE: diabetes insipidus , cardiac arrest (increases blood flow to brain/heart)

AE:water intoxication , excessive vasoconstriction(high BP), decrease sodium

NURSING CONSIDERATIONS: reduce fluid intake, can casue MI, you will see swelling (edema), headaches can indicate decrease sodium(can lead to seizures)

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14
Q
  1. NEED TO KNOW FOR GROWTH HORMONES
A

deficiency in GH: somatropin
excess in GH: somatostatin

AE:hyperglycemia
neutralizing antibodies(makes drug ineffective-somatostin)

CONSIDERATIONS:
-caution w/diabetics

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15
Q
  1. NEED TO KNOW FOR LEVOTHYROXINE & LIOTHRYONINE(pp slide 9)
A

life long treatments
Levothyroxine
-take in AM 30-60 mins before bkfast
AE: tachycardia & tachypnea
-angina
-tremors
CONSIDERATIONS:
-monitor thyroid TSH levels at least once/twice a year
-warafin can intensify AE

LIOTHYRONINE
-Increase energy,mood & appetite

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16
Q
  1. NEED TO KNOW FOR METHIMAZOLE(PP slide 10)
A

-first line drug for hyperthyroidism
USE: given prior to thyroid removal from graves disease
AE: -agranulocytosis

NURSING CONSIDERATIONS:
-look out for flu like symptoms
-at risk for infections
-nonradioactive iodine(lugols solution) can leave bitter taste burning in mouth/teeth/gums known as iodism

17
Q
  1. NEED TO KNOW FOR ESTROGEN(pp slide 15,16
A

USE:hormone therapy after menopause, acne , female hypogonadism(little or no sex hormone production)
AE: DVT/PE , weight gain/loss, breakthru bleeding, yeast infections, mood changes & nausea
*combined estrogen & progestin can improve maintenance of bone density. Combined is contraindicatedin factor 5 leiden positive clients(inherited clotting disorder)

18
Q
  1. TYPES OF INSULIN (PP slide 5)
A

USE:replaces hormone in type 1
-supplements when diet/exercise & oral meds arent effective in type 2
-treates severe diabetic ketoacidosis/coma
-treats hyperkalemia w/glucose

RAPID ACTING (lispro,aspart,glulisine)
onset 15-30 mins peak 1/2- 3 hrs

SHORT ACTING (regular insulin)
onset 1/2 - 1hr peak 1-5 hrs

INTERMEDIATE ACTING(NPH neutral protaminehagedorn, detemir)
onset 1-2hrs peak 4-14hrs
-cloudy, roll in hands DONT shake

LONG ACTING (glargine)
onset1-4hr. no peak

19
Q
  1. Administration of insulin (pp slide 6)
A

subcutaneos (or infusion IV)
-do not shake but roll (cloudy insulin) NPH roll dont shake
-discard regular insulin if its cloudy (contaminated)
-rotate sites
-alcohol can be consumed during insulin treatment but has to be consumed w/food.

*Inject air into cloudy (NPH) first then regular
*When mixing: withdraw Regular first then NPH

20
Q
  1. METFORMIN NEED TO KNOW (slide 9)
A

*first choice drug
-BIGUANIDE- oral antidiabetic
USE: prediabetes, type 2 diabetes thats not controlled by diet & excersie alone

AE:
-hypoglycemia(sweating,pallor,hunger,irritability, sleepiness, lack of coordination)
-GI upset (n/v/d)
-metallic taste
-lactic acidosis
-hypotension(dizziness), weakness, bradycardia

NURSING CONSIDERATION:
-If NPO for surgery hold med 48 hrs prior
-take w/meal
-no alcohol

21
Q

21.REPAGLINIDE

A

oral antidiabetic-meglitinides
AE:angina

22
Q
  1. SULFONYLUREAS
A

oral antidiabetic
(glipizide, glyburide)
-watch for sulfa allergies
-no alcohol
-hypoglycemia(“cool & clammy, need some candy”)
-photosensitivity
-give 30 mins before meals

Vn 16 Pharmacology (10 decks)

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