Pharm Exam #4

Benzodiazepines Tx?

Anxiety & Insomnia

Ex of Benzodiacepines?

Valium (diazepam), Ativan (lorazepam), Klonopin (clonazepam)

Benzodiazepines end in?

“PAM”

Side effects of Benzodiazepines?

sedation, drowsiness, dizziness, blurred vision, hypotension & bradypnea

Antidote for Benzodiazepines?

Flumazenil

Tricyclic Antidepressants Tx?

Depression

Tricyclic Antidepressants Side Effects?

dry mouth, flushing, photosensitivity, tachycardia, dysrhythmia, confusion, agitation, dilation of pupils

Risk of Tricyclic Antidepressants?

Cardiac toxicity—> all clients should have an EKG prior to Tx & throughout therapy

MAOI’s Tx?

Depression

Ex of Tricyclic Antidepressants?

Amitriptyline (Elavil), Clomipramine (Anafranil)

Ex of MAOI’s?

Marplan (Isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine)

Side effects of MAOI’s?

dry mouth, wt gain, dizziness, insomnia, CNS stimulation, delay in ejaculation

Antidote for MAOI’s?

Regitine

Risks of MAOI’s?

With use of other meds —> Hypertensive crisis (monitor BP)

S&S include: Occipital Headache, neck stiffness, palpitations, clammy skin

When taking MAOI’s avoid?

foods w tyramine:

Aged cheese, red wine, beer, sour cream, sausage, bologna, pepperoni, bananas, avocados, caffeine, soy sauce

SSRI Tx?

Depression, OCD, Panic disorder, Generalized Anxiety Disorder

Ex of SSRI’s?

Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa)

Side Effects of SSRI’s?

Nausea, dry mouth, insomnia, photosensitivity, CNS stimulation, restlessness, agitation, decreased libido

T or F SNRI’s Tx Depression?

True

Ex of SNRI’s?

Vanlafaxine (Effexor), Duloxetine (Cymbalta)

Side Effects of SNRI’s?

Constipation, insomnia, sexual dysfunction, nausea, dizziness, headache, changes in appetite

Serotonin Syndrome is due to?

Dangerously high levels of serotonin—> when 2 meds are prescribed which raise serotonin levels

S&S of Serotonin Syndrome?

Confusion, dilated pupils, unconsciousness, fever, irregular HR, muscle rigidity, tremor

Untreated Serotonin syndrome can lead to?

Rhabdomyolysis, cardiovascular collapse, coma, & death

Tx of Serotonin Syndrome?

Dantrolene and cooling blankets

Lithium Tx?

Acute Manic Episodes of Bipolar Disorder

T/F Don’t need to check Drug level of Lithium

False —> 1.0-1.5mEq/L (acute mania) & 0.6-1.2mEq (maintenance therapy)

T/F Lithium can cause renal failure if on med long term.

True it’s excreted by the kidneys

Lithium Toxicity:

Mild: Lethargy, coarse hand tremors, diminished concentration

Severe: deep tendon hyperreflexia, oliguria, anuria, tonic-clonic seizures, impaired LOC, nystagmus

Nursing interventions for lithium toxicity?

Suicide precautions, Monitor VS & LOC, cardiac status

Conventional Antipsychotics Tx?

Schizophrenia, Bipolar mania, Paranoid, Schizotypal & BPD (borderline personality disorder)

Conventional Antipsychotics Ex?

Haloperidol/Haldol

Side Effects of Conventional Antipsychotics?

Orthostatic Hypotension, Tardive Dyskinesia

T/F It’s safe to use Conventional Antipsychotics & Atypical Antipsychotics in elderly w dementia.

False —> increase risk of death

Atypical Antipsychotics Ex?

Quetiapine (Seroquel) , Risperidol (Risperidone), Olanzepine (Zyprexa), Ziprasadone(Geodon)

T/F Atypical Antipsychotics Tx Schizophrenia & Bipolar Disorder

True

Atypical Antipsychotics Side effects?

Wt gain, hyperglycemia, increased risk of developing DM, increased Cholesterol & Triglyceride levels

How to reverse EPS symptoms from Antipsychotics?

Anticholinergic drug (Benadryl or Cogentin)

What increases the risk of Lithium Toxicity?

Low salt diet —> excessive salt reduced the drug’s efficacy

Foods high in Vit C reduce absorption of what med?

Tricyclic Antidepressant

• The client’s medication sheet contains an order for sertraline hydrochloride (Zoloft). To ensure safe administration of the medication, the nurse would administer the does:

  • 1. On an empty stomach

  • 2. At the same time each morning 

  • 3. Evenly spaced around the clock

  • 4. As needed when the client complains of depression

2. Admin once every 24hrs

• A client is receiving fluphenazine (Prolixin) daily. The nurse would teach the client to do which of the following to minimize common side effects of this medication?

  • 1. Monitor temperature daily

  • 2. Use hard sour candy or sugarless gum

  • 3. Eat snack at midmorning and at bedtime

  • 4. Have the blood pressure checked once a week

2. Dry mouth is a common side effect

• A client begins to experience extrapyramidal effects from an antipsychotic medication. The nurse anticipates that the physician will prescribe which of the following to treat his condition?

  • 1. Haloperidol (Haldol)

  • 2. Benztropine (Cogentin)

  • 3. Prochlorperazine (Compazine)

  • 4. Chlorpromazine (Thorazine)

2. this med is used to Tx EPS rxns bc it is an anticholinergic drug

T/F Tums can be used in pts w/ CKD and hyperphosphatemia?

True

When compared to other antacids why can TUMS be taken in pts w CKD whereas other antacids can’t?

The magnesium content in the other drugs

Antacid Ex?

Amphojel, Mylanta, Calcium Carbonate (TUMS)

Antacids Tx?

Antiulcer/antiheartburn

When Mylanta or Amphojel are used in pts w renal failure/CKD it can cause?

Hypermagnesemia (muscle weakness/tremors)

Histamine 2 Receptor Antagonists Ex?

Famotidine (Pepcid), Ranitidine (Zantac)

Histamine 2 Receptor Antagonists Tx?

Peptic Ulcer Disease, GERD, Gastric ulcers

Histamine 2 Receptor Antagonists End in?

“DINE”

T/F Can take antacids @ the same time as Histamine 2 Receptor Antagonists

False —> decrease the absorption

T/F Histamine 2 Receptor Antagonists are not safe to use in the elderly due to causing confusion.

True

PPI’s end in?

“ZOLE”

PPI’s Ex?

Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix)

PPI’s tx?

GERD, Gastic/duodenal ulcers

Long term use of PPI’s can cause?

Increase fractures

Sucralfate is used to:

Line the stomach to protect it from further ulcer development

T/F Sucralfate can be taken with other meds?

False—> decreased absorption

1st thing to assess with Nausea & Vomiting?

Source (obstruction, Drug intolerance, Ulcer) & Tx underlying cause if possible

Phenothiazine Tx?

Postoperative nausea

Phenothiazine is contraindicated in?

Children—> fatal respiratory depression

Older adults—> Profound mental status changes (decreased LOC)

Antihistamines are used for nausea associated w?

Motion sickness

T/F Take an Antihistamine for Nausea 2hr before travel

False—> 1hr

Antihistamine for Nausea Ex?

Hydroxyzine (Vistaril) & Meclizine

Serotonin Receptor Agonist Ex?

Ondansetron (Zofran)

Serotonin Receptor Agonist (Zofran) Tx?

Post operative nausea & vomiting, prevention of chemotherapy induced nausea

When taking Serotonin Receptor Agonist (Zofran) need to assess?

If the drug is effective

Dopamine Agonist Ex?

Metoclopramide (Reglan)

Dopamine Agonist (reglan) Tx?

Gut motility stimulator (used w gastroparesis)

What to monitor when using Dopamine Agonist (reglan)?

Tardive Dyskinesia

T/F If cause of diarrhea is infectious, give antidiarrheal

False—> Do not admin if viral let virus run its course

Nursing interventions when a pt is experiencing diarrhea

replace fluids/electrolyte losses

When a pt is experiencing diarrhea monitor for:

Hypokalemia & Hypovolemia

Antidiarrheal Ex?

Diphenoxylate / atropine (Lomotil), Loperamide (Imodium) 

Side Effects of Antidiarrheals?

tachycardia, dizziness, nausea, vomiting, Headache, Flushing, hypotension, respiratory depression

Bismuth Subsalicylate is used for?

Management of diarrhea

T/F Safe to admin Bismuth Subsalicylate in children

False —> risk of Reye syndrome

Bismuth Subsalicylate turns stools temporarily what color?

Gray

Octreotide Tx diarrhea by what mechanism?

Decreasing GI motility, can also be used in the Tx of ulcers

Non-Pharm Tx for Constipation

Fluids, Fiber, Diet

Tx of constipation is contraindicated in pts w?

Physical bowel obstruction

For patients when straining is harmful (post CABG, surgery, CAD, CVA etc) use:

Stool softeners (docusate sodium)

Magnesium citrate, PEG3350 is used for:

Bowel cleanse for procedures (colonoscopy etc)

Long term laxative use in older adults or with long term disabilities Use:

Bulk forming laxatives (Metamucil) use with caution

Elimination of toxic substances Use:

Activated charcoal / sorbitol

To prevent intestinal ammonia in patients with liver failure Use:

Lactulose

For Fecal impaction use:

Fleets enema

How long does Metamucil take to Tx occasional constipation?

24-48hrs

Risk of lubricants/enema (mineral oil enema):

Bowel perforation

When taking meds for constipation monitor for?

Dehydration, tachycardia, dry mucous membranes, hypotension, & obstruction

Hydantoins (phenytoin) is what type of drug?

AED (antiepileptic drug)

When using Hydantoins (phenytoin) want to make sure that pt is receiving:

Good oral hygiene due to gingival hyperplasia

Hydantoins Ex:

Phenytoin

What type of drug is Phenobarbital?

AED (Antiepileptic drug)

Side effect of Phenobarbital?

Suicidal ideation & sedation

T/F need to monitor theraputic levels for Hydantoins (phenytoin) & Phenobarbital?

True

Benzodiazepines for seizure Tx Ex?

Diazepam, Lorazepam, Clonazepam

Benzodiazepines are given which route for prolonged seizure activity?

IV

Valproic acid/Valproate is used for?

Management of Seizure activity