Week 8 Flashcards
What is the prototype drug of Adrenergic Agents or Sympathometics?
phenylephrine (Neo-Synephrine)
How should the nurse explain to the patient that has increased HR and a strong pulse?
You might be in cardiac arrest, shock, heart failure
What will a patient feel if they are taking Beta1 receptor adrenergic agent?
increased HR and a strong pulse
What are three actions to take with phenylephrine to avoid extravasation?
Dilute drug before administering
Use an infusion pump
Assess for blanching at the infusion site
What are is something to assess when someone is taking phenylephrine?
Extravasation, so look for blanching
What should you ask if a patient will take phenylephrine?
Do you wear contacts?
Are you pregnant?
What type of patient should you be careful about when giving phenylephrine parentally?
Used with caution in patients with advanced coronary artery disease, hypertension, or hyperthyroidism
What is the prototype drug for Adrenergic Agents?
phenylephrine (Neo-Synephrine)
What will you see if a patient is taking phenylephrine parenterally?
Anxiety, restlessness, and tremor may occur due to the drug’s stimulation effect on the C N S
What might a patient say if they are taking phenylephrine parenterally?
I am so nervous.
I cannot sleep.
I really want to walk around the room
How much coffee did you drink.
Did you eat chocolate
What will we see if a patient takes too much sympathomimetics? (2)
Tachycardia, HTN
What findings should the nurse expect about HR and HTN of OD on sympathomimetics?
HR from above 84 bpm to 120 bpm
HTN from above 120/80 mmHg to 200/110 mmHg
What are some treatments to a patient who has HR from above 84 bpm to 120 bpm
HTN from above 120/80 mmHg to 200/110 mmHg
after taking sympathomimentics?
Alpha blocker such as phentolamine (Regitine)
What would you review before administering Sympathomimetics?
MOAIs – hypertensive crisis
Tricyclic antidepressants – potentiate the effect of Phenylephrine
Digoxin - dysrhythmias
Iron supplements – incompatible with phenylephrine
What information should you give to the provider when they are giving sympathomimetics?
MOAIs – hypertensive crisis
Tricyclic antidepressants – potentiate the effect of Phenylephrine
Digoxin - dysrhythmias
Iron supplements – incompatible with phenylephrine
What is a drug that will give you a hypertensive crisis with MAOIs?
sympathomimetics
What drug will potentiate the effect of phenylephrine?
Tricyclic antidepressants
What drug will give dysrhythmias when taken with sympathomimetics?
digoxin
What drug is incompatible with phenylephrine?
Iron supplements
What are some things to teach the patient when taking intranasal sympathomimetics? (5)
Do not share spray with anyone
Sit upright when using the spray
Only use for 3-5 days
Assess breathing patterns
Assess for rhinorrhea and epistaxis
What are some things to teach the patient when taking eye drops of sympathomimetics? (4)
Do not drive until the effect of the eye drop wear off
Wear sunglasses when in bright light
You may be more comfortable in a dark room
Observe patient’s responsiveness to light
How will you know if a patient is affected by eye drops of sympathomimetics?
Observe patient’s responsiveness to light
What is the prototype drug for Adrenergic-Blocking Agents?
Prazosin (Minipress)
What is the MOA for adrenergic-blocking agents?
to inhibit the sympathetic nervous system
What are some adrenergic-blocking agents uses? (7)
hypertension, dysrhythmias, angina, heart failure, benign prostatic hypertrophy, narrow-angle glaucoma
What are some adrenergic-blocking agents ADR? (6)
dizziness, drowsiness, headache, loss of energy and strength, palpitations, dry mouth
What actions should the nurse take to avoid unconsciousness about 30 minutes after the first dose?
the first dose should be very low and given at bedtime.
What may happen with prazosin administration?
Reflex tachycardia may result from the rapid fall in blood pressure.
Alpha blockade may cause nasal congestion or inhibition of ejaculation.
What actions should the nurse take to reduce dizziness, drowsiness, or light-headedness that may occur with Prazosin?
To avoid give at bedtime.
Who should not take prazosin?
Safety during pregnancy and lactation is not established.
Alcoholics
What should a patient not eat when on prazosin?
Palmetto or nettle roots
Why should a patient not take palmetto or nettle roots?
Saw palmetto blocks alpha1 receptors, resulting in the dilation of blood vessels and a hypotensive response.
What are some drug-drug interactions of prazosin?
antihypertensives and diuretics results in extremely low blood pressure. Alcohol should be avoided.
What are signs that a patient has ADHD?
Distractible in school
Can’t complete assignments
Interrupts other when they are speaking
What would you do if a patient is easily distractible in school, cannot complete assignments, interrupts other while they are speaking?
Nsg Action – Have child tested, could be ADHD
What is the outcome of medications for ADHD?
Impulsiveness, hyperactivity, and disruptive behavior usually reduced within a few weeks.
Promote improved
What is the priority outcome for children on Ritalin?
They can focus in school, avoid altercations, and interact with peers appropriately
How long will it take to see effects of methylphenidate?
A few weeks
What is the prototype drug for ADHD drugs?
Methylphenidate (Ritalin)
What are some things to tell the patient about epilepsy drugs?
Medications must be continued indefinitely
Take the medication at the same time every day
Avoid taking kava products
keto
What are some things to avoid taking when on epilepsy drugs?
Kava because it adds to the sedating effects
What kind of drug should an epileptic take?
keto
What kind of patients should not take epileptic levels?
Pregnant if you want to have a baby
What happens if you take kava with epilepsy drugs?
Adds to sedating effects
What drugs do phenytoin interact with?
Oral hyperglycemics, insulin, etc
What may happen with phenytoin and serum glucose?
Hyperglycemia and need to increase insulin
What is the prototype drug for epileptics?
Phenytoin (Dilantin)
How should Dilantin be taken and not taken?
Taken orally, or IV, not IM
What is the purpose of Ethosuximide?
used to control absence (petit mal) seizures in patients with epilepsy
What might happen if you administer phenytoin IM?
Extravasation and local tissue damage
Why should you avoid hand veins when giving phenytoin?
causes purple glove syndrome and local vasoconstriction
What are three considerations when giving Dilantin IV?
Use large vein like aortic
Need a filter in an IV line
Flush line with NS
What are some symptoms of parkinson’s?
Pill rolling
Tremor
Bradykinesia, slow speech, difficulty chewing, shuffling
What aere some symptoms of toxicity of Stalevo?
Muscle twitching and spasmodic winking are early signs of toxicity.
What is the prototype drug of Parkinsons?
Stalevo
What is Stalevo contradindcations?
Contraindicated in narrow-angle glaucoma
What are symptoms of Alzheimers?
Impaired memory and judgment
Confusion and disorientation
Inability to recognize family and friends
Aggressive behavior
Depression
Psychoses, including paranoia and delusions
Anxiety
What are some medications for Alzheimers?
Donepezil (Aricept)
What are some general adverse effects of zarontin? (4)
Impair mental and physical activities
Psychosis
Behavioral changes
CNS effects include dizziness
Wha is the primary use of Donepezil (Aricept)
slow progression of the disease
Will only help symptoms for a little while
Why must a patient on Zarontin avoid activities?
may impair mental and physical abilities.
What are three classic signs of Parkinson’s?
Pill rolling
Termor
Bradykinesia
What happens when a patient as Parkinson’s bradykinesia?
Slow speech
Difficulty chewing
Shuffling the feet when walking
What is the prototype drug of to control petit mal seizures?
Ethosuximide (Zarontin)
What is the prototype drug for Parkinson’s?
Levodopa, Carbidopa, and Entacapone (Stalevo)
What are the three drugs that make up Stelevo?
Levodopa, Carbidopa, and Entacapon
What are the signs of Stalevo toxicity?
Muscle twitching and spasmodic winking are early signs of toxicity.
What type of patients should not take Stalevo?
Narrow-angle glaucoma patients
What are some administration instruction to tell a patient on Stalevo?
Increase fluids and fiber in diet.
Take on empty stomach for better absorption
Avoid multivitamins – decrease the effects of Stalevo
Avoid foods high is Vit B6
What are some foods to avoid when on Stalevo?
Multivitamins because they decrease effect of Stalevo
Avoid goods with high Vit B6-banana, wheat germ, fortified cereals
What are two signs that the drug Stalevo is wearing off?
Twitching of the eyes
Increased tremors
What are the actions to take if you see Twitching of the eyes and Increased tremors from taking Stalevo with Parkinson’s?
Increase the dose of the medication
Change the interval between doses of the medication
Add an adjunctive therapy
What is a bad reaction to Donepezil?
Hepatotoxicity – Assess LFTs.
What are the two main goals of MS pharmacotherapy?
Modify the progression of the disease
Treat acute exacerbation
What are some positive effects of Schizophrenia?
Neologism- creating words
Hitting
Grossly disorganized thinking/thoughts
What is the prototype drug of first-gen antipsychotics?
Chlorpromazine (Thorazine)
What is the priority plan of a complication from Chlorpromazine (Thorazine)?
Agranulocytosis – If infection occurs (fever, sore throat), obtain CBC and notify provider
What would you see and do if you saw a complication of Thorazine?
Agranulocytosis
infection occurs (fever, sore throat), obtain CBC and notify provider
What should you do if WBC falls below < 3,000/µL when taking first-gen antipsychotics?
discontinue
What are some general side effects of Thorazine?
Anticholinergic effects, Sedation, Hypotension
High EPS, Low AE (extrapyramidal symptoms)
What would you do if a patient is on Thorazine and has some sedation/hypotention from anticholinergic effects??
Sit for a few minutes before taking vital signs.
Urinate prior to taking the medication.
Give sugar free candy or gum.
What would you do if a patient on first-gen antipsychotics has High EPS, Low AE?
Give benztropine (Cogentin)
Prevent EPS except TD
What are some types of high potency first gen antipsychotics?
Haloperidol (Haldol) (1 – 30 mg/d)
Fluphenazine (Prolixin) (0.5 – 40 mg/d)
Thiothixene (Navane) (2 – 30 mg/d)
Trifluoperazine (Stelazine) (1 – 40 mg/d)
Perhenazine (Trilafon) (8-60 mg/d)
Loxapine (Loxitane) (20 – 250 mg/d)
Pimozide
What is the prototype drug of Conventional (Typical)/ Nonphenothiazines?
haloperidol (Haldol) or other antipsychotics
What is the use of of Nonphenothiazines
severe mental illness
What might it mean when a patient is on nonphenothiazides and has relapse?
Relapses with the medication
If patient stops taking the medication
What does 2nd Generation treat?
Treat both negative and positive symptoms
What does 1st Generation do?
Treat just positive symptoms
What is the gold standard for atypical antipsychotics?
Clozapine (Clozaril, FazaClo)
What are some types of EPS?
Acute dystonia, tardive dyskinesia, akathisia, pseudoparkinsonism
What is tardive dyskinesia?
Unusual tongue and face mvmts
Lipe smacking and worklike motions
Puffing check
What is acute dystonia?
Dancing, twitching, tongue, and facial muscles
What is the outcome of 2nd gen antipsychotics?
Patient will not hear voices anymore and other symptoms are reduced
What are some signs of akathisia?
Can’t relax with rep and compulsions
Pseudoparkinsonism?
Tremor, muscle rigidity, stooped posture, and shuffling
What should a nurse look for when someone is on Clozapine?
Vitals
ES- report
+/- symptoms
What are some signs that patients on Clozapine have changed up their routine?
Patient exhibits positive symptoms
What are some actions the patient might have taken when taking Clozapine?
Changed fluid used to mix meds like caffeine
Changed pharmacies
Started smoking
What is the diagnosis of a depressive disorder?
a depressed affect plus five of the following symptoms for a minimum of two weeks
Difficulty sleeping or sleeping too much
Extremely tired; without energy
Abnormal eating patterns
Vague physical symptoms
What can cause a hypertensive crisis in MAOI’s?
food containing tyramine
What foods should be avoided with MAOI’s
Fermented/cured/aged/pickled/processed foods
If a patient on Nardil comes in with hypotension, what might they be doing?
Eating foods containing tyramine
What is a prototype for mood stabilizers?
Lithium (Eskalith)
What is the range for litium toxicity?
Lithium Toxicity: ≥ 1.5 – hold dose and notify provider
What is the range for litium toxicity?
Lithium Toxicity: ≥ 1.5 – hold dose and notify provider
What might it mean if a patient
has diarrhea, vomiting, stomach pain and lithium level is 2.1
?
Lithium toxicity, hold dose and notify provider
What are some things a patient should avoid when taking lithium?
Avoid increased salt/caffeine
What are some meds for glaucoma?
Glucocorticoids, antihypertensives
Antidepressants, antihistamines
What symptoms would you see with a patient who as a level of 0.5 of lithium? And what would you do?
Signs of mania and hyperactive and pressured speech, and ask for dose adjustment
What is open-angle glaucoma?
Aqueous humor builds up and there is excessive production of blockage of outflow
What is the indication of starting glaucoma pharmacotherapy treatment? (2)
When IOP is between 21 and 30 mm Hg***
When signs of optic nerve damage or visual-field changes are present regardless of IOP
For how long do you use glaucoma pharmacotherapy?
Until you die
What might you tell the patient if they are taking multiple meds for their glaucoma?
Combination therapy may be necessary to achieve goal
What are two additional expected ADR for Latanoprost (Xalatan) besides dryness, burning, and photophobia?
Thicker eyelashes and changes in color of the iris and periocular skin
What should you say to the patient who reports a darker iris when taking Latanoprost (Xalatan) for their glaucoma?
Keep taking it. It’s normal
What are some administrations teaching for Latanoprost (Xalatan)?
Remove contacts before using eyedrops and don’t reinsert until after 15 minutes
Wait 5 minutes for additional eyedrops
Don’t get pregnant
What is the prototype drug for glaucoma?
Latanoprost (Xalatan)
What should you do to administer ceruminolytics?
Assess for excess cerumen
Instil an earwax softener and irrigate with tepid water
