Pharm Exam 3

Sumatriptan

Serotonin Agonists

Baclofen

Centrally Acting Muscle Relaxants

Oxybutynin

Anticholinergics

Bethanechol

Cholinergics

Tamsulosin

Alpha-adrenergic receptor antagonists

Alendronate

Bisphosphonates

Phenytoin

Traditional ASM Hydantoins

Carbamazepine

Traditional ASM carbamazepine

Valporic Acid

Traditional ASM Valporic Acid/Valproate

Levodopa/Carbidopa

Dopamine-replacement

Donepezili

Cholinesterase inhibitors

What does phenytoin treat?

Tonic-clonic seizures and control partial seizures

Phenytoin adverse reactions

CNS depressant

• drowsiness

Abnormal gum growth (usually in kids and teens)

Skin rash

Phenytoin nursing interventions

Don't stop abruptly, can cause seizures

Monitor for drowsiness (may indicate toxicity)

Monitor gums and skin

Monitor plasma - 10-20mcg/ml

• too high can lead to sedation or vision changes

Phenytoin teaching

Administer with food to avoid GI upset; IV slowly to prevent cardiac collapse; ensure regular dental checks and use soft toothbrushes to prevent gingivitis.

What does carbamazepine treat?

Treats tonic-clonic and partial seizures, bipolar disorder, and trigeminal neuralgia.

Carbamazepine adverse effects

Neuro: visual disturbances, headaches, ataxia, nystagmus, blurred vision; fluid retention, skin rash, photosensitivity, BMS.

Carbamazepine nursing interventions

Monitor WBC, CBC, and HLAB*1502 in Asian clients for skin reaction risk; provide sun protection.

Carbamazepine teaching

Dose gradually increased to prevent CNS effects

Give with meals to prevent GI upset

Take consistently to avoid seizures

Do not drive until effects are knows, fall precautions

Immediately contact provider is rash

Report fever, sore throat, or easy bruising (BMS)

Wear sunscreen

What does Valporic Acid treat?

All types of seizures

Controls mania with bipolar

Prevents migraines

Valporic Acid side effects

GI upset

BMS

Skin rash

Liver toxicity (common during first few months, pts less (<) 2 taking multiple drugs)

Risk for hyperammonemia, hepatitis, and pancreatitis
- monitor for S&S

Valorpic Acid nursing interventions

Monitor: obtain baseline
- platelets
- bleeding time
- ammonia
- liver functions tests

Monitor for:
- bruising
- blood in stool or urine
- signs of hyperammonemia (vomiting, confusion, decreased LOC)
- jaundice (liver toxicity)

Valorpic Acid teachings

Oral or IV
Capsules can be opened and sprinkled on food before eating
Report signs of hyperammonemia, BM, and liver toxicity

What does Oxcarbazepine (2nd/3rd gen ASM) treat?

Seizures, neuralgia, migraines - independently or adjunct therapy

Oxcarbazepine (2nd/3rd gen ASM) adverse effects

CNS effects

SJS

Hypothyroidism

decreased bone mineral density

leukopenia

Risk for hyponatremia if used with other medications that can decrease sodium (diuretics)

Oxcarbazepine (2nd/3rd gen ASM) nursing interventions

Monitor sodium, WBC, and CBC

Test Asian HLAB*1502 for skin reactions

Oxcarbazepine (2nd/3rd gen ASM) teachings

Sun protection

Birth control is using oral contraceptives

What does Levodopa/Carbidopa treat?

Parkinson’s Disease

Levodopa/Carbidopa adverse effects

N/V

Orthostatic and postural hypotension
Dark sweat and urine (harmless)

Dyskinesias are common until correct dosing is found

Levodopa/carbidopa nursing interventions

Monitor BP, assess dizziness, fall precautions

Monitor “on/off” episodes

Levodopa/carbidopa teachings

May experience dyskinesias, decreasing the dose or adding amantadine may help

May take up to 6 months to achieve full effects

AVOID high protein foods, they decrease med absorption

Hypertensive crisis may occur is taken within 2 weeks of MAOI

What does Pramipexole (direct-acting dopamine receptor agonist) treat?

Parkinson’s and restless leg syndrome

Pramipexole (direct-acting dopamine receptor agonist) adverse effects

GI symptoms

orthostatic hypotension

Dyskinesias

Drowsiness

Muscle weakness

Pramipexole (direct-acting dopamine receptor agonist) nursing interventions

Monitor for drowsiness and muscle weakness

Fall precautions

Pramipexole (direct-acting dopamine receptor agonist) teachings

Nausea will lessen over time, take with food to lessen nausea

Increase dose over time

Tape dose when stopping

Change positions slowly

Can cause change in intraocular pressure

What does Selegiline (MAO-B inhibitors) treat?

Parkinson’s disease

Selegiline (MAO-B inhibitors) adverse effects

Insomnia (give no later than noon)

Hypertensive crisis - can occur when taken with

• ephedra or tyramine

  • S&S: hypertension, n/v

Selegiline (MAO-B inhibitors) nursing interventions

Monitor for insomnia and adjust timing of med as needed

Monitor B/P

Selegiline (MAO-B inhibitors) teachings

Avoid tyramine (aged cheese and processed meats) and caffeine

Tell prescriber if you start a new medication, has many interactions

If oral tablet, inspect tongue and oral cavity for irritation

What does Donepezili treat?

Alzheimer’s diseae

Donepezili adverse effects

GI symptoms

Insomnia

Dizziness

HA

Bradycardia causing syncope or loss of consciousness

Donepezili nursing interventions

Monitor for:

• weight loss

• GI bleeding

• insomnia/dizziness

Donepezili teachings

Give with food or at bedtime to minimize nausea
Patients may forget to instructions for taking medications - make sure caregivers are present for instructions

What does memantine (NMDA receptor antagonist) treat?

Alzheimer’s disease

Memantine (NMDA receptor antagonist) adverse effects

CNS effects

• headache

• dizziness

• increased confusion

Constipation

Memantine (NMDA receptor antagonist) nursing interventions

Fall precautions

Lower doses if pt has liver or renal disorders

Antacids can lead to toxicity

Memantine (NMDA receptor antagonist) teachings

If constipation/diarrhea, adjust diet

What does Diazepam (Benzo) -lam or -pam treat?

Anxiety, skeletal muscle spasm, and spasticity, seizure disorders, emergency treatment of status epilepticus, acute alcohol withdrawal as an anesthetic agent during sedation

Diazepam (Benzo) -lam or -pam adverse effects

Dizziness

Drowsiness

Lethargy

Do not combine with alcohol

Paradoxical reaction - confusion, anxiety in older adults

OD or toxicity:

• sedation

• hypotension

• respiratory depression

• cardiac arrest

Risk of dependence

Diazepam (Benzo) -lam or -pam nursing interventions

Monitor VS: esp. IV administration

• hypotension

• tachycardia

• respiratory depression

Fall precautions

Taper dose when discontinuing

What is the antidote of diazepam?

IV flumazenil

Diazepam (Benzo) -lam or -pam teachings

Do not stop abruptly, cause withdrawal

Taper dose when discontinuing

Diazepam is available oral, rectal, IM, IV

Alprazolam is available oral only

Notify provider if paradoxical events occur

Do not take with alcohol or other CNS depressants, can potentiate the CNS depressant effect of both meds

Alprazolam can cause rebound anxiety

Take at bedtime

Busparione (non-benzo diazepine) adverse effects

Paradoxical effects

GI upset

• nausea

headache

dizziness

lightheadedness

Busparione (non-benzo diazepine) nursing interventions

Monitor adverse effects

fall precautions

give on regular basis, not PRN

it can take up to a week for effectiveness and several weeks for therapeutic level

Caution in liver or kidney insufficiency

What does busparione (non-benzo diazepine) treat?

Anxiety disorders, without risk of dependence

Busparione (non-benzo diazepine) teachings

Report paradoxical, GI, or CNS effects

Take med with food to prevent nausea

What does Amitriptyline (TCA) treat?

Improves mood; increases activity; restores appetite and sleep

Amitriptyline (TCA) adverse effects

dizziness; sedation; orthostatic hypotension; tachycardia; anticholinergic effects; increase suicide risk; stopping abruptly can cause withdrawal

Amitriptyline (TCA) nursing interventions

Fall precautions; VS; monitor for depression and SI; taper dose when discontinuing

Amitriptyline (TCA) teachings

Give at bedtime; several weeks for therapeutic effects; do not stop abruptly

What does Fluoxetine (SSRI) treat?

Major depression; bipolar disorder; panic disorder; OCD, premenstrual dysphoric disorder, and bulimia nervosa

Fluoxetine (SSRI) adverse effects

Insomnia; nervousness; sexual dysfunction; headache; weight gain; hyponatremia; increased SI; serotonin syndrome

Fluoxetine (SSRI) nursing interventions

Monitor for adverse effects; those taking diuretics and SSRI are at increased risk for hyponatremia; SSRI may decrease glucose in pts with diabetes

Fluoxetine (SSRI) teachings

4-6wks to take effectiveness; take with food to prevent nausea; take in AM to prevent insomnia; avoid ibuprofen due to risk of GI bleeding; report adverse effects

What does Venlafaxine (SNRI) treat?

Major depression, social anxiety disorder, and generalized anxiety disorder

Venlafaxine (SNRI) adverse effects

Nausea; similar to SSRI; vomiting; anorexia; headache; HTN; insomnia; nervousness;

Venlafaxine (SNRI) nursing interventions

Monitor for adverse effects; taper dose over 2-4wks to reduce withdrawal manifestations

Venlafaxine (SNRI) teachings

Take with food to minimize GI effects; report worse depression or SI; take BP regularly

What does Phenelzine (MAOI) treat?

Depression that hasn’t responded to other meds

Phenelzine (MAOI) adverse effects

Orthostatic hypotension; constipation; n/v; GI upset; SI; tyramine could cause hypertensive crisis

Phenelzine (MAOI) nursing interventions

Lowest dose and titrate up

Phenelzine (MAOI) teachings

Change positions slowly; report extreme agitation and SI

What does Bupropion HCl (atypical antidepressant) treat?

Depression; seasonal affective disorder; adjunct for smoking cessation

Bupropion HCl (atypical antidepressant) adverse effects

N/V; weight loss, risk of seizures; CNS effects; psychosis; hallucinations; delusions; SI

Bupropion HCl (atypical antidepressant) nursing interventions

Give with food to prevent nausea; weight pts; monitor for adverse effects; ONLY ANTIDEPRESSANT THAT DOES NOT CAUSE WEIGHT GAIN OR SEXUAL DYSFUNCTION

Bupropion HCl (atypical antidepressant) teachings

Swallow tablet; same time every time; give with food if GI upset

What does Chlorpromazine (conventional antipsychotics) treat?

Schizophrenia

Chlorpromazine (conventional antipsychotics) adverse effects

Extrapyramidal effects, akathisia, need for constant motion; Parkinson-like manifestation; acute dystonia, severe painful spasms of neck and body; tardive dyskinesia, writhing movements of tongue and neck; anticholinergic; tachycardia; sexual and erectile dysfunction; dysrhythmias

Chlorpromazine (conventional antipsychotics) nursing interventions

Monitor for adverse effects; pts with acute dystonia, give emergency anticholinergic, diphenhydramine IM or IV

Chlorpromazine (conventional antipsychotics) teachings

Monitor VS; give with food to prevent GI effects; swallow ER whole; report EPS

What does Risperidone (atypical antipsychotics) treat?

Schizophrenia

Risperidone (atypical antipsychotics) adverse effects

EPS; metabolic effects, diabetes, weight gain, dyslipidemia; CNS effects

Risperidone (atypical antipsychotics) nursing interventions

Fall precautions; monitor for EPS

Risperidone (atypical antipsychotics) teachings

Report EPS effects and adverse effects

What does Iatanoprost (prostaglandin analogs) treat?

Open-angle glaucoma

Iatanoprost (prostaglandin analogs) adverse effects

Blurred vision; itching; burning; stinging; prostaglandin changes to iris and eyelid

Iatanoprost (prostaglandin analogs) nursing interventions

Apply pressure to inner canthus for 60 secs after drops

Iatanoprost (prostaglandin analogs) teachings

Remove contact lenses before giving drops

What does Timolol (beta-adrenergic blockers) treat?

Glaucoma

Timolol (beta-adrenergic blockers) adverse effects

Stinging; burning; eye discomfort; systemic absorption can cause bradycardia, hypotension, and bronchospasm

Timolol (beta-adrenergic blockers)nursing interventions

Apply pressure to inner eye for 60 secs after giving drops

Timolol (beta-adrenergic blockers) teachings

Wear gloves; remove contacts; do not touch eye dropper

What does Pilocarpine (cholinergic agonists) treat?

Glaucoma

Pilocarpine (cholinergic agonists) adverse effects

Decreased near vision; frontal headache; systemic absorption can cause urinary urgency, bradycardia, and bronchoconstriction; retinal detachment; dark floaters; flashes of light; curtain over visual fields

Pilocarpine (cholinergic agonists) nursing interventions

Apply pressure to inner eye for 60 secs after giving drops to prevent systemic absorption

Pilocarpine (cholinergic agonists) teachings

Recognize signs of retinal detachment; precautions with decreased vision

What does Echothiophate (cholinesterase inhibitors) treat?

Glaucoma

Echothiophate (cholinesterase inhibitors) adverse effects

Myopia; cataract development; systemic absorption can cause urinary urgency, bradycardia, and bronchoconstriction

Echothiophate(cholinesterase inhibitors) nursing interventions

Apply pressure to inner eye for 60 secs to prevent systemic absorption

Echothiophate(cholinesterase inhibitors) teachings

Give 5 mins before any other eye drops