Pharmacology Exam 4 Review

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?

1. Dopamine

2. Serotonin

3. Norepinephrine

What are the 7 common disorders of the CNS system?

1. anxiety

2. depression

3. bipolar

4. schizophrenia

5. attention-deficit/hyperactivity disorder (ADHD)

6. seizures

7. Parkinson’s disease

What are the two most common medications used for CNS depressants (anxiety)?

1. Lorazepam (Ativan)

2. 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?

1. anxiety

2. obsessive compulsive disorder (OCD)

3. 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?

1. tricyclic antidepressants (TCA’s)

2. selective serotonin reuptake inhibitors (SSRI)

3. Serotonin norepinephrine reuptake inhibitors (SNRI’s)

4. 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?

1. paroxetine

2. sertraline

3. 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?

1. venlafaxine

2. 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?

1. Haloperidol (Haldol)

2. 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?

1. acetaminophen (Tylenol)

2. 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?

1. 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?

1. Baclofen

2. Cyclobenzaprine

3. Tizanidine

What is Cyclobenzaprine (Flexeril)?

Skeletal muscle relaxant

What is cyclobenzaprine used for?

acute muscle spasms