NURS-340: Pharmacology 1 (Exam 3)

What is the mechanism of action of baclofen?

It enhances GABA activity in the spinal cord → suppresses hyperactive reflexes

What is baclofen used for?

Muscle spasms, multiple sclerosis (MS), and cerebral palsy (CP)

What are common side effects of baclofen?

Drowsiness, dizziness, weakness, and fatigue

What is the mechanism of action of phenytoin?

It blocks voltage-gated sodium channels → prevents repetitive firing of action potentials → stabilizes neuronal membranes and reduces abnormal electrical activity in the brain

What is phenytoin commonly used to treat?

Tonic-clonic seziures

What are major side effects of phenytoin?

CNS depression, drowsiness, gingival hyperplasia, and Stevens-Johnson syndrome (conduct regular skin checks)

What are priority nursing implications for phenytoin?

Monitor LOC, seizure control, gait stability, and serum drug levels

What patient teaching is essential for phenytoin?

Do not stop abruptly, maintain oral hygiene, and schedule regular dental visits

What is the mechanism of action of carbamazepine?

It blocks sodium channels → decreases neuronal firing in hyperactive brain regions

What is carbamazepine used for?

Seizures

What are major side effects of carbamazepine?

Visual disturbances, nystagmus (involuntary, rapid eye movements), ataxia, headache, photosensitivity, fluid retention, bone marrow suppression, epidermal necrolysis, and Stevens-Johnson syndrome

What labs must be monitored with carbamazepine?

WBC count and drug levels

What safety teaching is important for carbamazepine?

Do not stop abruptly, report rash immediately, and avoid sunlight exposure and sick people

What is the mechanism of action of valproic acid?

It increases GABA levels and blocks sodium and calcium channels

What is valproic acid used for?

Seizures

What are major adverse effects of valproic acid?

Hepatotoxicity, thrombocytopenia (increased risk for bleeding), GI upset, and hyperammonemia

Which patients are at highest risk for valproic acid hepatotoxicity?

Children under age 2 on multiple AEDs

What labs should be monitored with valproic acid?

LFTs, CBC, coagulation studies, and ammonia levels

What teaching is essential with valproic acid?

Avoid alcohol and report jaundice or bleeding immediately

What is the mechanism of action of gabapentin?

It binds calcium channel subunits → decreases excitatory neurotransmitter release → stabilizes nerve activity

What are common uses of gabapentin?

Seizures, neuropathy, bipolar disorder, restless leg syndrome, hot flashes, fibromyalgia, anxiety, and postoperative pain

What are major adverse effects of gabapentin?

Sedation, vertigo, hypertension, edema, joint/muscle pain, fractures, and decreased WBCs

What interactions should nurses monitor for when administering gabapentin?

CNS depressants, opioids, antihistamines, sedatives, hypnotics, and antacids

What is the mechanism of action of lamotrigine?

It inhibits voltage-gated sodium channels → stabilizes neuronal membranes

What is lamotrigine primarily used for?

Simple/complex partial seizures and focal-onset tonic-clonic seziures

What else can lamotrigine be used to treat?

Migraines (with aura), anxiety, depression, panic disorder, and binge eating disorder

What are major adverse effects of lamotrigine?

Chest/back pain, weight changes, dizziness, ataxia, diplopia, Stevens-Johnson syndrome, and blood disorders

What patient teaching is critical with lamotrigine?

Report rash immediately

What is the mechanism of action of lidocaine?

It blocks voltage-gated sodium channels → prevents depolarization and nerve impulse conduction

What is lidocaine used for?

Local anesthesia for procedures and localized pain control

What are major adverse effects of lidocaine toxicity?

CNS stimulation (restlessness, tremors, seizures, irritability, confusion) followed by CNS depression and respiratory depression

What cardiovascular effect may occur with lidocaine?

Hypotension (with spinal anesthesia)

What is an important administration precaution to take with lidocaine?

Avoid use with epinephrine in appendages (risk of ischemia)

What is the mechanism of action of midazolam?

It enhances GABA-A receptor activity → neuronal inhibition

What is midazolam used for?

Conscious sedation for procedures (endoscopy, colonoscopy)

What is a hallmark side effect of midazolam?

Retrograde amnesia

What life-threatening adverse effects must be monitored with midazolam?

Cardiac/respiratory arrest

What reversal agent must be available with midazolam?

Flumazenil

What is the mechanism of action of flumazenil?

It competitively blocks benzodiazepine binding at GABA-A receptors

What is flumazenil used for?

Reversal of benzodiazepine sedation

What are major adverse effects of flumazenil?

Elevated vitals, anxiety, panic attacks, nausea, and vomiting

What serious complication can occur after flumazenil administration?

Seizures

Why must patients be monitored after flumazenil administration?

It has a shorter half-life than benzodiazepines → risk of rebound respiratory depression

What is the mechanism of action of fentanyl?

It binds to mu-opioid receptors → activates G-protein coupled receptor pathways → inhibits pain signal transmission

What is fentanyl commonly used for?

Surgery, ICU sedation, cancer pain, and palliative care

What are major adverse effects of fentanyl?

Sedation, respiratory depression, nausea, and circulatory collapse

What reversal medication must be available when administering fentanyl?

Naloxone

What monitoring priority exists when administering fentanyl?

Respiratory rate (<12/min is critical)

What is the mechanism of action of Adderall?

It increases release of dopamine and norepinephrine and blocks reuptake

What conditions does Adderall treat?

ADD and ADHD

What are major adverse effects of Adderall?

Insomnia, nervousness, hypertension, tachycardia, palpitations, growth suppression, weight loss, and abuse/withdrawl (looks like depression)

When should Adderall be administered?

In the morning (to prevent insomnia)

What is the mechanism of action of methylphenidate?

It blocks reuptake of dopamine and norepinephrine in the CNS

What is methylphenidate used to treat?

ADHD and narcolepsy

What common adverse effects occur with methylphenidate?

Insomnia, appetite suppression, psychosis, dysrhythmias, tachycardia, and seizures

What teaching should be provided with methylphenidate?

Take after meals to reduce appetite suppression

What is the mechanism of action of modafinil?

It promotes wakefulness by increasing hypothalamic stimulation (dopamine activity)

What is modafinil used for?

Narcolepsy, shift-work sleepiness, and obstructive sleep apnea

What major adverse effects may occur with modafinil?

Headache, tachycardia, hypertension, Stevens-Johnson syndrome, nausea, and vomiting

What is the mechanism of action of levodopa?

It converts to dopamine in the brain

What is the mechanism of action of carbidopa?

It prevents peripheral breakdown of levodopa by decarboxylase

What are levodopa and carbidopa used for?

Parkinson’s disease symptom relief (tremor, rigidity, bradykinesia)

What major adverse effects may occur with levodopa and carbidopa?

Nausea, vomiting, orthostatic hypotension, darkening of bodily fluids (urine, sweat), and dyskinesias (involuntary, erratic muscle movements)

What teaching should be provided with levodopa and carbidopa?

Change positions slowly; discoloration of bodily fluids is expected

What is the mechanism of action of pramipexole?

It directly stimulates dopamine receptors in the brain, bypassing the need for dopamine synthesis

What is pramipexole used for?

Parkinson’s disease and restless leg syndrome

What common adverse effects occur with pramipexole?

GI upset, orthostatic hypotension, dyskinesias
(involuntary, erratic muscle movements), drowsiness, narcolepsy, and muscle weakness

What is the mechanism of action of selegiline?

It selectively inhibits MAO-B → prevents dopamine breakdown

What is selegiline used for?

Parkinson’s disease adjunct therapy (mood stabilizer)

What serious interaction risk exists with selegiline?

Hypertensive crisis with tyramine- and ephedrine-containing foods

What other adverse effects may occur with selegiline?

Insomnia and mouth irritation

What is the mechanism of action of donepezil?

It inhibits acetylcholinesterase → increases acetylcholine in the brain → enhances cholinergic transmission, improving memory and cognition

What is donepezil used to treat?

Early Alzheimer’s disease

What are major adverse effects of donepezil?

GI upset, headache, insomnia, dizziness, bradycardia, syncope (fainting), and loss of consciousness

Who should receive donepezil education instead of the patient?

Caregiver (memory impairment prevents retention)

What is the mechanism of action of memantine?

It is an NMDA receptor antagonist → prevents excessive calcium influx into neurons → reduces excitotoxic glutamate activity

What is memantine used for?

Moderate to severe Alzheimer’s disease

What are common adverse effects of memantine?

Dizziness, headache, confusion, and constipation

What is a key nursing implication for memantine?

Monitor cognition and functional status over time

What is the mechanism of action of sumatriptan?

It is a selective serotonin (5-HT1B/1D) receptor agonist → causes cranial vasoconstriction and inhibition of neuropeptide release and pain transmission

What is sumatriptan used for?

Migraines

What major adverse effects may occur with sumatriptan?

Vasoconstriction in the lungs/heart, nose bleeds, and feeling “heaviness” (implement fall risk precautions)

What are major contraindications of sumatriptan?

History of heart attack, hypertension, or COPD

What should patients report immediately after taking sumatriptan?

Chest pain or tightness