NCMA216 MIDTERMS

PARKINSON’S DISEASE

a condition caused by low dopamine levels in the brain- tremors, stiffness, slow movement.

LEVODOPA-CARBIDOPA (SINEMET)

Class/Type: Antiparkinsonian/ Dopamine precursor + decarboxylase inhibator

• Together, they restore movement and reduce tremors.

LEVODOPA

becomes dopamine once it reaches the brain

CARBIDOPA

prevents Levodopa from breaking down too early, so more reaches the brain.

LEVODOPA-CARBIDOPA SIDE EFFECTS

• Involuntary movements (tremor, twitching)

• Nausea, vomiting

• Orthostatic hypotension

• Hallucinations or confusion (esp. in elderly)

LEVODOPA-CARBIDOPA NURSING PRIORITIES

• Give BEFORE MEALS or with LOW-PROTEIN FOOD. (protein reduces absorption.

• Monitor BP regularly; advice slow position changes

• Observe for “wearing-off” effect- symptoms returning before next dose.

• Teach that improvement may take a few weeks.

ALPRAZOLAM (XANAX)

Class/Type: Anti-anxiety/ Benzodiazepine

Use: For anxiety. panic attacks, insomnia- part of the benzodiazepine

GABA

(a calming brain chemical)- produces relaxation and sleepiness.

ALPRAZOLAM SIDE EFFECTS

• drowsiness, dizziness

• dependence and withdrawal symptoms if stopped suddenly

• Respiratory depression (especially if taken with alcohol or opioids)

ALPRAZOLAM NURSING PRIORITIES

• Administer at bedtime or during periods of rest

• Avoid alcohol or driving- can cause heavy sedation

• Taper dose regularly; don’t stop abruptly

• Watch for signs of abuse or tolerance

IMIPRAMINE (TOFRANIL)

Class/Type: Antidepressant / Tricyclic antidepressant (TCA)

Use: Antidepressant (Tricyclic type), also used for bedwetting (enuresis) in children

Mechanism: Increases serotonin and norepinephrine, improving mood

IMIPRAMINE SIDE EFFECTS

• Dry mouth, constipation

• Blurred vision, urinary retention

• Drowsiness

• Orthostatic hypotension

• Cardiac toxicity in overdose

IMIPRAMINE NURSING PRIORITIES

• Give at bedtime (sedating)

• Encourage ORAL FLUIDS AND FIBER for constipation

• Avoid ALCOHOL and MONOAMINE OXIDASE INHIBITORS

• TAKES 2-4 WEEKS to show improvement- encourage patience

LISINOPRIL (ZESTRIL)

Class/Type: Antihypertensive / ACE Inhibitor

Use: for hypertension and heart failure

VASODILATION

lowers BP and reduces heart strain

LISINOPRIL SIDE EFFECTS

• Dry cough (most common)

• Hyperkalemia (high potassium)

• Dizziness, headache

• Angioedema (swelling of face/lips- emergency)

LISINOPRIL NURSING PRIORITIES

• Monitor BP, K LEVELS, and RENAL FUNCTION

• Avoid potassium supplements/ salt substitutes

• Teach: report persistent cough or swelling of lips/eyes immediately

DIGOXIN (LANOXIN)

Class/Type: Cardiac glycoside/ Anti- heart failure, Antiarrhythmic

Use: For heart failure and atrial fibrillation- strengthens the heart and slows its rate

Mechanism: Increases heart contraction (positive inotrope) and slows electrical conduction (negative chronotrope)

DIGOXIN SIDE EFFECTS

• Bradycardia

• Digoxin toxicity: nausea, vomiting, yellow-green vision

• Fatigue, confusion

DIGOXIN NURSING PRIORITIES

• CHECK APICAL PULSE FOR 1 FULL MINUTE before giving (hold if <60 bpm

• Monitor DIGOXIN LEVEL (0.5-2 ng/mL)

• Watch for HYPOKALEMIA, which increases toxicity risk.

• Teach patient to report vision changes or nausea immediately

FUROSEMIDE (LASIX)

Class/Type: Loop diuretic / Anti-hypertensive, anti-edema

Use: Loop Diuretic used for edema, hypertension, and heart failure

Mechanism: Promotes sodium chloride, and water loss- reduces fluid overload and BP

FUROSEMIDE SIDE EFFECTS

• Hypokalemia (low K- muscle cramps, arrhythmia)

• Dehydration

• Hypotension

• Ototoxicity if given too fast IV

FUROSEMIDE NURSING PRIORITIES

• Monitor electrolytes, I&O, BP, and weight.

• Encourage POTASSIUM-RICH FOODS (bananas, potatoes)

• Administer IN THE MORNING to avoid nocturia (urinating during night)

• Teach to rise slowly- may cause dizziness

PHENYTOIN (DILANTIN)

Class/Type: Anticonvulsant / Anti-seizure

Use: For seizure control

Mechanism: Stabilizes nerve membranes and decreases abnormal brain activity.

PHENYTOIN SIDE EFFECTS

• Gingival hyperplasia (swollen gums)

• Drowsiness

• Ataxia, nystagmus (signs of toxicity)

• Rash or Liver problems

PHENYTOIN NURSING PRIORITIES

• Maintain GOOD ORAL HYGIENE and REGULAR DENTAL CARE

• Monitor THERAPEUTIC LEVEL (10-20 ug/mL)

• DO NOT STOP SUDDENLY- can trigger seizures

• Give with FOOD OR MILK to prevent stomach upset

AMIODARONE (CARDARONE)

Class/ Type: Antiarrhythmic / Class III

Use: Antiarrhythmic- for life-threatening ventricular arrhythmias or irregular heartbeats

Mechanism: Slows heart conduction and prolongs REPOLARIZATION- keeps heart rhythm steady

AMIODARONE SIDE EFFECTS

• Photosensitivity (easily sunburned)

• Pulmonary toxicity (cough, SOB)

• Thyroid imbalance

• Liver toxicity, blue-gray skin discoloration

AMIODARONE NURSING PRIORITIES

• Monitor ECG, LIVER, THYROID, and LUNG FUNCTION

• Advise SUN PROTECTION or stay indoors during peak sun

• Report COUGH, SOB, or JAUNDICE right away

CETIRIZINE (ZYRTEC)

Class/Type: Second-Generation Antihistamine/ Anti-allergy

Use: Relief of allergy symptoms (e.g., allergic rhinitis, sneezing, watery eyes, itching)

Mechanisms:

• Blocks H1 RECEPTORS, preventing the action of histamine (a chemical that causes allergy symptoms)

• Less sedating than first-generation antihistamines (like diphenhydramine)

CETIRIZINE SIDE EFFECT

• Mild drowsiness

• Dry mouth

• Fatigue

CETIRIZINE NURSING PRIORITIES

• teach patient to AVOID ALCOHOL OR CNS DEPRESSANTS (can cause drowsiness).

• Encourage HYDRATION to prevent dry mouth

• Take ONCE DAILY AT NIGHT if it causes sleepiness

ALBUTEROL SULFATE (PROVENTIL INHALER)

Class/Type: Beta-2 Adrenergic Agonist (Bronchodilator)

Use: Asthma and acute bronchospasm relief

Mechanisms:

• Stimulates beta-2 receptors in the lungs- relaxes smooth muscle- bronchodilation

• Opens up narrowed airways for easier breathing

ALBUTEROL SULFATE SIDE EFFECTS:

• Tremors

• Palpitations

• Nervousness

• Tachycardia

ALBUTEROL NURSING PRIORITIES

• ASSESS LUNG SOUNDS AND RESPIRATORY RATE before and after use.

• TEACH PROPER INHALER USE and to rinse mouth after

• Wait 1-2 MINUTES BETWEEN PUFFS if multiple inhalations are prescribed.

• Monitor for INCREASED HEART RATE

IPRATROPIUM BROMIDE (ATROVENT)

Class/Type: Bronchodilator/ Anticholinergic (COPD)

Use: COPD Maintenance and Bronchospasm prevention.

Mechanism: 

• Blocks acetylcholine in bronchial smooth muscle- prevents constriction- bronchodilation

• Used when patients can’t tolerate beta-agonists.

IPRATROPIUM BROMIDE SIDE EFFECTS

• Dry Mouth

• Cough

• Hoarseness

• Blurred vision (if sprayed in eyes)

IPRATROPIUM BROMIDE NURSING PRIORITIES

• Encourage ADEQUATE FLUID INTAKE

• USE BRONCHODILATOR (e.g., albuterol) first, wait 5 MINUTES, then use Atrovent.

• Avoid spraying near eyes- can cause BLURRED VISION OR GLAUCOMA FLARE

OXYMETAZOLINE (AFRIN) NASAL SPRAY

Class/Type: Topical Nasal Decongestant/ Sympathomimetic

Use: SINUSITIS and nasal congestion relief

Mechanism: Causes LOCAL VASOCONSTRICTION in nasal blood vessels- reduces swelling and congestion

OXYMETAZOLINE SIDE EFFECTS

• Rebound congestion (rhinitis medicamentosa)

• Burning/ stinging in nose

• Dryness

OXYMETAZOLINE NURSING PRIORITIES

• USE ONLY FOR 3 DAYS MAX to prevent rebound congestion

• Teach roper administration (head slightly forward)

• Avoid sharing nasal spray to prevent cross-infection

EXPECTORANTS (e.g., GUAIFENESIN)

Class/Type: Mucolytic/ Helps loosen mucus

Use: Helps clear mucus in productive cough or bronchitis

Mechanism: Increases respiratory tract fluid, thinning mucus to make it easier to cough out.

EXPECTORANTS SIDE EFFECTS

• Nausea

• Vomiting

• Dizziness

EXPECTORANTS NURSING PRIORITIES

• Encourage INCREASED FLUID INTAKE

• Advise to AVOID DRIVING if drowsy

• Use only for SHORT-TERM (<1 WEEK)

ANTITUSSIVE DRUG- DEXTROMETHORPHAN (ROBITUSSIN DM)

Class/Type: Antitussive/ Cough suppressant

Use: Suppresses nonproductive cough (dry cough)

Mechanism: Acts directly on the medullary cough center in the brain to decrease cough reflex

ANTITUSSIVE DRUG SIDE EFFECT

• Drowsiness

• Nausea

• Constipation

ANTITUSSIVE NURSING PRIORITIES

• Avoid in patients with asthma or emphysema (can trap mucus)

• Avoid alcohol or sedatives

• Do not use for more than 1 week

RANITIDINE (FANTAC)

Class/Type: H2 Receptor Antagonist/ Anti-ulcer

Use: Duodenal and Gastric ulcers, GERD, and Heartburn

Mechanism: Blocks H2 receptors in stomach lining- decreases acid secretion- promotes ulcer healing

RANITIDINE SIDE EFFECTS

• Headache 

• Dizziness

• Diarrhea or Constipation

RANITIDINE NURSING PRIORITIES

• Give BEFORE MEALS OR AT BEDTIME

• Avoid smoking, alcohol, caffeine, NSAIDs (Nonsteroidal Anti-Inflammatory Drug)/ (delay healing)

• Monitor for CONFUSION IN ELDERLY and RENAL FUNCTION

OMEPRAZOLE (PRILOSEC)

Class/Type: Proton Pump Inhibitor (PPI)

Use: GERD, ulcers, and hyperacidity

Mechanism: Blocks H/K ATPase enzyme- suppresses final step of acid production- decreases stomach acid

OMEPRAZOLE SIDE EFFECTS

• Headache

• Abdominal Pain

• Diarrhea

• Long-term risk of bone fractures or B12 deficiency

OMEPRAZOLE NURSING PRIORITIES

• Administer before meals (preferably breakfast)

• Swallow capsule whole, do not crush or chew

• Monitor for GI symptoms and electrolyte imbalance

CHLORPROMAZINE (THORAZINE)

Class/Type: Phenothiazine Anti-emetic & Anti-psychotic

Use: Severe nausea and vomiting, also used for intractable hiccups or psychiatric disorders

Mechanism: Blocks dopamine receptors in the chemoreceptor trigger zone (CTZ) in the brain- suppresses vomiting reflex

CHLORPROMAZINE SIDE EFFECTS

• Sedation

• Hypotension

• Extrapyramidal symptoms (tremors, rigidity)

• Dry mouth

CHLORPROMAZINE NURSING PRIORITIES

• Monitor BP for orthostatic hypotension

• Provide safety measures for drowsiness

• Avoid driving or operating machinery

• Watch for extrapyramidal effects and report tremors or stiffness

LEVOTHYROXINE (SYNTHROID, ELTROXIN)

Class/Type: Thyroid Hormone Replacement

Use: Hypothyroidism (low thyroid hormone levels)

Mechanisms:

• Synthetic T4 (thyroxine) that increases metabolism, energy, and oxygen use.

• Restores normal thyroid levels and body functions (metabolism, heart rate, growth)

LEVOTHYROXINE SIDE EFFECTS

• Palpitations/ rapid heart rate

• Anxiety, nervousness, or irritability

• Insomnia

• Tremors

• Weight loss despite good appetite

• Heat intolerance/ sweating

• Diarrhea

LEVOTHYROXINE NURSING PRIORITIES

• Give before breakfast on an empty stomach with a full glass of water

• Monitor T3, T4, and TSH levels regularly

• Watch for chest pain or palpitations- may indicate too much dose

• Educate your patient that therapy is LIFELONG

• Avoid switching brands without medical advice

CALCITRIOL (ROCALTROL)

Class/Type: Anti-hypocalcemic Agent / Vitamin D Analog

Use: Hypocalcemia (low calcium), chronic kidney disease, or hypoparathyroidism

Mechanisms:

• Promotes calcium absorption from the intestines and reabsorption in kidneys

• Increases bone mineralization and serum calcium levels

CALCITRIOL SIDE EFFECTS

• Hypercalcemia (too much calcium): nausea

• Vomiting

• Weakness

• Confusion

• Metallic taste

CALCITRIOL NURSING PRIORITIES

• Monitor serum calcium and phosphorus levels

• Encourage adequate hydration

• Avoid calcium supplements or antacids unless prescribed (risk of hypercalcemia)

• Teach patient to report muscle pain or irregular heartbeat (signs of calcium imbalance)

GLIPIZIDE (GLUCOTROL)

Class/Type: Sulfonylurea (Oral Antidiabetic)/ Hormones

Use: Type 2 diabetes mellitus (T2DM)

Mechanism:

• Stimulates beta cells of the pancreas to release insulin

• Improves insulin sensitivity in tissues

GLIPIZIDE SIDE EFFECTS

• Hypoglycemia

• Dizziness

• Headache

• Nausea

• Weight gain

GLIPIZIDE NURSING PRIORITIES

• Give 30 minutes before meals

• Monitor blood glucose levels and for signs of hypoglycemia (sweating, hunger, tremors)

• teach the “Rule of 15” for low blood sugar: 15g sugar- wait 15 minutes- recheck

• Avoid alcohol (may cause disulfiram-like reaction: flushing, nausea)

INSULIN- NPH (INTERMEDIATE-ACTING

Class/Type: Intermediate- acting insulin

Appearance: Cloudy suspension (must be rolled before use)

Onset: 1-2 hours

Peak: 6-14 hours

Duration: 16-24 hours

Use: Type 1 Diabetes Mellitus (T1DM) or long-term glucose control in T2DM

Mechanism: Facilitates glucose uptake into cells, reducing blood sugar

INSULIN SIDE EFFECTS

• Hypoglycemia (shakiness, sweating, dizziness, confusion, headache)- most common

• Weight gain (from improved glucose use)

• Injection site reactions (redness, swelling, itching, lipodystrophy if same site is used repeatedly)

INSULIN NURSING PRIORITIES

• Roll (don’t shake) vial gently before drawing

• Administer subcutaneously, usually twice daily

• Can be mixed with regular insulin (clear-cloudy rule)

• Teach signs of hypoglycemia: sweating, tremor, confusion

• Keep snack or glucose tablets ready for emergencies

• Store unopened vials in refrigerator; opened ones at room temp for up to 1 month

GLUCAGON (GLUCAGEN)

Class/Type: Glucose-Elevating Agent

Use: Severe hypoglycemia (especially when patient is unconscious or can’t swallow)

Mechanism: Stimulates the liver to breakdown glycogen into glucose- increases blood sugar levels quickly

GLUCAGON SIDE EFFECTS

• Nausea

• Vomiting

• Rebound hyperglycemia

GLUCAGON NURSING PRIORITIES

• Administer IM, IV, or subcutaneously

• Turn patient on their side (to prevent aspiration if vomiting occurs)

• Follow with oral carbohydrates when patient awakens

• Monitor blood glucose levels closely

PREDNISONE (DELTASONE)

Class/Type: Corticosteroid/ Glucocorticoid/ Anti-inflammatory, immunosuppressant

Use: Inflammation, autoimmune diseases, asthma, allergies, or adrenal insufficiency

Mechanism: Mimics cortisol, reducing inflammation and suppressing immune response

PREDNISONE SIDE EFFECTS

• Hyperglycemia

• Immunosuppression'

• Mood Changes

• Weight gain

• Cushingoid appearance (moon face)

• Delayed wound healing

• GI upset

PREDNISONE NURSING PRIORITIES

• Give in the morning with food or milk to avoid stomach irritation

• Do not stop abruptly- must be tapered to avoid adrenal crisis

• Monitor blood sugar, BP, and signs of infection

• Advise low-sodium, high-protein, and potassium-rich diet

• Watch for muscle weakness or swelling (possible hypokalemia)