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The nurse is giving instructions to a patient receiving Phenytoin (Dilantin). The nurse concludes that the patient has a sufficient knowledge if the patient states that:
a. Serum phenytoin levels should be taken before giving the medication
b. Alcohol is permitted in while taking this medication
c. Wearing a medical alert tag is not required
d. I can take the medicine with milk
Serum phenytoin levels should be taken before giving the medication
A patient treated in the emergency room is complaining of right upper quadrant abdominal pain, nausea, and vomiting. The patient has been taking a long-term use of acetaminophen and an overdose is suspected. Which medication should be readily available?
a. Valproic acid
b. Acetylcysteine
c. Naltrexone
d. Urea
Acetylcysteine
General anesthesia is a combination of medications that allow the patient to be relaxed and nearly pain free during a medical procedure? True of False?
False
Use of medications used for attention deficit disorders in children can result in:
a. Growth suppression
b. Spinal Cord injuries
c. Hair loss
d. Growth spurt
a. Growth suppression
Respiratory rate is the priority vital sign for the patient taking Morphine for chronic pain? True or False?
True
Which of the following drugs would be most appropriate for the emergency treatment of a seizure?
a. Beta blockers
b. Benzodiazepines
c. Antibiotics
d. Opiods
Benzodiazepines
A nurse is caring for a patient with an overdose of aspirin. Which of the following can be an early sign of aspirin toxicity?
a. Confusion
b. Tinnitus
c. Unsteady gait
d. Drowsiness
Tinnitus
Which medication is commonly used to treat a patient diagnosed with attention deficit disorder?
a. methylphenidate (Ritalin)
b. Phendimetrazine (Adipost)
c. diethylpropion (Nobesine)
d. caffeine
methylphenidate (Ritalin)
Lithium levels may become toxic in the presence of:
a. Dehydration
b. Use of some NSAID's
c. Pregnancy
d. Use of thiazides
Dehydration
Which of the following is an antidote to opioid overdose?
a. Flumazenil
b. Glucagon
c. Naloxone
d. Acetylcysteine
Naloxone
What is the CNS system made up of?
Brain and Spinal Cord
Dopamine and Acetylcholine
Which psychiatric medications affect the three major neurotransmitters in the body?
Dopamine
Serotonin
Norepinephrine
What are the 7 common disorders of the CNS system?
anxiety
depression
bipolar
schizophrenia
attention-deficit/hyperactivity disorder (ADHD)
seizures
Parkinson’s disease
What are the two most common medications used for CNS depressants (anxiety)?
Lorazepam (Ativan)
Buspirone (Buspar)
What are some of the signs and symptoms of Anxiety?
aches
pain
stomach aches
headaches
heart racing/pounding
trembling
sweating
difficulty concentrating
increased agitation
crying
sleep problems
How long does it take for anxiety medications to be fully effective?
3-4 weeks
What are benzodiazepines used for?
anxiety
seizures
muscle spasms
alcohol withdrawal
induction & maintenance of anesthesia
How can you identify benzodiazepines?
-pam, -lam
What are the major side effects of benzodiazepines?
sedation
respiratory depression
amnesia
dependency
withdrawal
What should you NOT do when taking benzodiazepines?
do NOT abruptly discontinue
What happens if you abruptly stop taking benzodiazepines?
You begin to have withdrawal symptoms such as anxiety, increase HR, fever, sweating, nausea, muscle cramps, and insomnia.
What should you avoid doing when taking benzodiazepines?
avoid operating machinery or driving because of sedation effect
What’s the antidote for benzodiazepines?
flumazenil (Romazicon)
What’s the phrase used to remember the use and effects of benzodiazepines?
Pam takes lorazepam for her anxiety. She doesn’t drive her Benz anymore because benzos cause sedation.
What class does buspirone (Buspar) belong to?
anti anxiety, non-benzodiazepine
What 3 disorders is buspirone used for?
anxiety
obsessive compulsive disorder (OCD)
post-traumatic stress disorder (PTSD)
What’s an administration consideration for buspirone?
it will take several weeks before patients feels the effects
What are the 4 common antidepressants?
tricyclic antidepressants (TCA’s)
selective serotonin reuptake inhibitors (SSRI)
Serotonin norepinephrine reuptake inhibitors (SNRI’s)
Monoamine oxidase inhibitors (MAOI’s)
What are the signs and symptoms of depression?
persistent sad, anxious, or “empty” mood
difficulty concentrating, remembering, making decisions, sleeping, early-morning awakenings, oversleeping
thoughts of death/suicide or suicide attempts
What are the risk factors of someone who is going through depression?
they are at high risk for committing suicide if a patient can identify a concrete plan and has the means to carry out the plan. (May need to be hospitalized for closer monitoring)
What 3 medications are associated with SSRI’s?
paroxetine
sertraline
fluoxentine
Which 5 disorders are SSRI’s used to treat?
anxiety
depression
obsessive compulsive disorder (OCD)
bulimia
post-traumatic stress disorder (PTSD)
What’s a major side effect of SSRI’s?
Serotonin Syndrome
What are SSRI’s contraindicated with and why?
Contraindicated with MAOI’s due to the risk of serotonin syndrome
What is serotonin syndrome?
a condition resulting from accumulating of high levels of serotonin in the body
What are some signs and symptoms of serotonin syndrome?
diaphoresis
agitation
tachycardia
mydriasis
autonomic instability & hypertensive
diarrhea & hyperactive bowel sounds
clonus
tremor
hyperreflexia
What happens when the serotonin syndrome becomes severe?
neuroleptic malignant syndrome
What two medications correlate with SNRI?
venlafaxine
duloxetine
What are SNRI’s used for?
major depressive disorder
anxiety
neuropathic pain
What is the black box warning for SNRI’s?
monitor for increased risk of suicidality
What is a major side effect of SNRI’s?
serotonin syndrome signs and symptoms: agitation, hallucinations, fever, diaphoresis, tremor
What teaching should be given to family members of the patient taking SNRI’s?
family should monitor for suicidal ideation
What significant disadvantage comes with MAOI’s?
is their potential to cause hypertensive crisis when taken with stimulating medications for foods containing tyramine
What’s an administration consideration for MAOI’s?
they interact with many other medications so avoid administering with other medications
What teaching should be given when taking MAOI’s?
limit intake of tyramine-rich foods
tyramine can lead to a hypertensive crisis for up to 2 weeks after therapy
Discontinue 2 weeks before starting any other meds
What are tyramine-rich foods?
cheese
alcohol
banana
avocados
red wine
salami/pepperoni
chocolate
What are the signs and symptoms of hypertensive crisis?
severe hypertension with evidence of organ dysfunction
bp >180/120
palpitations
neck stiffness or soreness
n/v
sweating
dilated pupils
photophobia
SOB
confusion
tachycardia/bradycardia
seizures
intracranial bleeding
What medication is correlated under Anti-mania?
Lithium
What is bipolar?
serious mood swings
pt experiences extreme highs and lows with mood
What are some bipolar signs and symptoms?
manic episode:
rapid speech
hyperactivity
reduced need for sleep
flight of ideas
grandiosity
poor judgement
aggression/hostility
risk sexual behavior
neglect basic self-care
decreased impulse control
What are some treatment and therapies for bipolar?
medications, psychotherapy, or combination of the two
What class does Lithium belong to?
mood stabilizer, anti-mania
What is the use for Lithium?
treatment of bipolar disorder
What is a major side effect of Lithium?
black box warning: lithium toxicity
What is the lab value to indicate lithium toxicity?
>= 1.5 mEq/L
What is Lithium contraindicated with?
renal and cardiovascular disease & dehydration
What teaching should be given to the patient in regards to lithium?
can cause mild nausea & abdominal bloating
What’s the Lithium therapeutic range?
0.8 to 1.2 mEq/L
What are the early S/S for Lithium?
diarrhea, vomiting, drowsiness, muscular weakness & lack of coordination
What are the S/S of lithium at higher levels?
coarse tremors, confusion, hypotension, seizures, & tinnitus
What two medications belong to anti-psychotics?
Haloperidol (Haldol)
Risperidone (Perseris)
What are the positive and negative symptoms of Schizophrenia?
positive: altered perceptions, abnormal thinking, and odd behaviors
negative: loss of motivation, disinterest, lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, difficulty functioning normally
What is Haloperidol primarily indicated for?
schizophrenia and Tourette’s disorder
What is a major side effect of haloperidol?
Tardive dyskinesia
What is tardive dyskinesia?
involuntary contraction of the oral and facial muscles and wavelike movements of the extremities
What 5 medications are anticonvulsants?
phenobarbital (Luminal)
phenytoin (Dilantin)
levetiracetam (Keppra)
gabapentin (Neurontin)
lorazepam (Ativan)
What are seizures?
abnormal electrical signals in the brain being fired from neurons: general or focal
What’s a partial seizure?
focal onset on one side of the brain
What’s a generalized seizure?
bilateral onset on both side of the brain and are typified by petit Mal seizures
What is status epileptics?
state of repeated or continuous seizures
What is the most common treatment for seizures?
anticonvulsants or antiseizure drugs
What class does Phenytoin belong to?
anticonvulsant, hydantoins
What are the side effects of phenytoin?
gums (gingival hyperplasia): enlarged & bleed
Should be not given to pregnant women
What is the teaching for phenytoin?
pt needs good oral hygiene
therapeutic levels are 10-20 mcg/mL
abrupt withdrawal causes status epileptics
What medications are CNS stimulants"?
Methylphenidate (Methylin, Ritalin)
Amphetamine mixtures (adderall)
What is Methylphenidate used for?
Example of a CNS stimulant that is often used to treat ADHD
What teaching should be given in regards to Methylphenidate?
Monitor growth and weight in children: causes growth suppression
What 3 medications are Antiparkinson?
Carbidopa/levodopa
Selegiline
amantadine
What happens with Parkinson’s disease?
believed to be related to an imbalance of dopamine and acetylcholine. Drug therapies are aimed at restoring the balance of dopamine and/or acetylcholine
What is important to remember when administering opioid medications?
These medications are controlled substances with special regulations regarding storage, auditing counts, and disposal or wasting of medication.
What is one adverse effect of opioid analgesics?
respiratory depression
Whats a common side effect of opioid analgesic medications?
constipation or nausea
What are 2 non-opioid analgesics?
acetaminophen (Tylenol)
Nonsteriodal Anti-inflammatory Drugs (NSAIDS)
What are the side effects of acetaminophen?
skin reddening
blisters
rash
hepatotoxicity (monitor liver function) (jaundice)
What’s the antidote for acetaminophen?
administer acetylcysteine
What can occur when taking NSAID’s?
there is decreased protection of the stomach lining and gastric irritation and bleeding may occur
What is a side effect of aspirin?
stomach bleeding warning
has had history of stomach ulcers or bleeding problems
What is a contraindication of aspirin?
if the pt has a bleeding disorder such as hemophilia or a recent history of bleeding in the stomach
What is a black box warning for aspirin?
children or teens should not take aspirin to treat chicken pox or flu-like symptoms because of the risk of Reyes syndrome
What teaching should be given in regards to aspirin?
report tinnitus
what is ibuprofen used for?
to treat mild to moderate pain and fever, inflammatory disorders including rheumatoid arthritis and osteoarthritis and pain associated with dysmenorrhea
What medications are opioid analgesics and antagonists?
morphine and Naloxone (narcan)
What are the signs and symptoms of over sedation when taking opioids?
drowsy
lethargic
respiratory rate = <12 breathes per minute
low bp
What are the side effects of morphine?
respiratory depression (primary risk)
What is the antidote of morphine?
Naloxone
What class is naloxone?
opioid reversal agent - opioid antagonist
What is Naloxone used for?
complete or partial reversal of opioid depression
What 3 medications are adjuvant analgesics AKA muscle relaxants?
Baclofen
Cyclobenzaprine
Tizanidine
What is Cyclobenzaprine (Flexeril)?
Skeletal muscle relaxant
What is cyclobenzaprine used for?
acute muscle spasms