final medication review | NURS212

what is the MOA, indications, contraindications, drug interactions, and adverse effects of radioactive iodine (RAI - example used in class is iodine-131)?

1. MOA: thyroid gland naturally absorbs iodine so when RAI is taken by thyroid cells, the radiation emitted either destroys overactive or abnormal thyroid tissue while mostly sparing surrounding tissues

2. indications: hyperthyroidism (especially Graves’ disease), toxic multinodular goiter, toxic adenoma, thyroid cancer (after thyroidectomy to destroy remaining thryoid tissue or metastates), patient with small thyroids glands, and poor surgical candidate

3. contraindications: pregnancy (can destroy fetal thyroid), breastfeeding, severe uncontrolled thyrotoxicosis (use caution/stabilize first), inability to follow radiation safety precautions, relative caution as active thyroid eye disease can worsen in Graves’ (remember: pregnancy, breastfeeding, vomiting, diarrhea)

4. drug interactions: antithyroid drugs (Methimazole, Propylthiouracil) may reduce effectiveness and are often held before treatment; iodine-containg medication or contrast dye can block uptake; thyroid hormone repalcement may be temporarily stopped before some cancer treatment

5. adverse effects: neck tenderness/swelling, N, V, hypothyroidism, worsening Grave’ eye disease, salivary gland inflammation, temporary infertility/menstrual changes

what are the nursing consideration for radioactive iodine?

1. review policies for storing, handling, administering, and disposing of radioactive substances

2. necessary PPE for radioactive materials

3. minimize exposure to bodily fluid and dispose of all correctly

4. verify not pregnant before therapy

5. encourage flud

6. monitor thyroid labs (TSH, T3, T4)

7. teach that hypothyroidism may occur and require lifelong Levothyroxine

what is the MOA, indications, interactions, contraindications, and adverse effects of carbidopa/levodopa (Sinmet, Parcopa, Rytary)?

dopaminergics for PD

1. MOA: taken up by dopaminergic nerve terminals and converted into dopamine for neurons → replaces low dopamine in PD so movement improves

2. indications: reduces PD symptoms caused by low dopamine → decreases rigidity, tremors, bradykinesia, improves mobility

3. interactions: Monoamine oxidase inhibitors (MAOIs) → prevents neurotransmitter breakdown + levodopa adds more dopamine = dangerous excess (HTN, tachycardia); antihypertensives → additive hypotension = dizziness/falls; iron → binds drug in gut = less absorption; dopamine receptor antagonists → blocks dopamine receptors = reduces effect; high protein meals → competes for absorption/brain transport = less effect

1. contraindications: narrow-angle glaucoma → may increase intraocular pressure and worsen vision damage

2. adverse effects: nausea, vomiting, dysrhythmias, “wearing of,” “on-off,” dyskinesia, psychosis, brown urine and sweat, increased impulsivity, melanoma, development, orthostatic hypotension

what are the nursing considerations for carbidopa/levodopa?

1. give on time; do not stop abruptly

2. monitor symptom improvement and “wearing off/on-off” episodes

3. watch for dyskinesia, hallucinations, impulsive behavior

4. monitor orthostatic hypotension, dizziness, falls

5. may take with food for nausea, but avoid high-protein meals near dose

6. dark urine/sweat may occur (harmless)

what the MOA, indications, interactions, contraindications, and adverse effects of gabapentin (Neurontin)

MOA: increases GABA-like inhibitory activity in the CNS → decreases release of excitatory neurotransmitters (such as glutamate and norepinephrine) → calms overactive nerves involved in pain and seizures

indications:

• focal seizures → stabilizes overactive neurons and helps prevent abnormal electrical firing

• neuropathic pain → damaged nerves fire excessively; reduces pain signal transmission

• restless leg syndrome (RLS) → decreases abnormal nerve excitability in the legs

interactions:

• opioids → additive CNS/respiratory depression, sedation

• antiepileptics → increased dizziness/drowsiness depending on drug combination

• antacids → decrease absorption of gabapentin (separate dosing)

contraindications:

• hypersensitivity to drug or components

adverse effects:

• dizziness, drowsiness, fatigue

• suicidal ideation (SI), mood changes, depression

• Stevens-Johnson syndrome (rare)

• anaphylaxis

• angioedema

• withdrawal symptoms; abrupt stop may increase seizure risk

• ataxia/unsteady gait

• peripheral edema (more common with pregabalin)

what are the nursing considerations for gabapentin?

• monitor seizure frequency or neuropathic pain relief

• assess dizziness, drowsiness, sedation → fall precautions

• do not stop abruptly (may cause withdrawal or seizures)

• monitor mood changes, depression, suicidal ideation

• watch for angioedema, rash, Stevens-Johnson syndrome

• avoid alcohol/CNS depressants; opioids increase sedation/respiratory risk

• separate from antacids by at least 2 hours (decreases absorption)

• adjust dose in renal impairment

• teach patient to avoid driving until effects known

what is the MOA, indication, interactions, contraindications, and adverse effect of phenelzine (Nardil)?

MOA: irreversibly inhibits the MAO-A (and MAO-B) enzyme that normally breaks down serotonin, norepinephrine, and dopamine → increases these neurotransmitters in the brain → improves mood

indications:

• major depressive disorder (especially treatment-resistant or atypical depression)

Interactions:

• other serotonergic drugs (SSRIs, SNRIs, TCAs, some opioids, linezolid, St. John’s wort) → serotonin syndrome

• sympathomimetics/decongestants → severe hypertension

• tyramine-rich foods (aged cheese, cured meats, wine) → hypertensive crisis

• CNS stimulants → excessive CNS stimulation / BP increase

• alcohol or CNS depressants → increased adverse effects

contraindications:

• severe hepatic impairment → drug metabolized by liver / hepatotoxic risk

• Pheochromocytoma → can trigger dangerous hypertension

• Congestive heart failure / significant cardiovascular disease

• hypersensitivity

• use with other antidepressants or serotonergic agents (without washout)

adverse Effects:

• hypertensive crisis

• dysrhythmias / palpitations

• CNS stimulation (insomnia, agitation, anxiety)

• hepatotoxicity

• orthostatic hypotension / dizziness

• sexual dysfunction

• headache, dry mouth, weight gain possible

what are the nursing considerations for Phenelzine (Nardil)?

• monitor mood, depression, suicidal ideation

• check BP regularly; watch for hypertensive crisis (severe headache, chest pain, stiff neck)

• teach avoid tyramine foods (aged cheese, cured meats, wine, beer)

• avoid SSRIs/SNRIs/TCAs, stimulants, decongestants, many serotonergic drugs (serotonin syndrome/HTN risk)

• change positions slowly → orthostatic hypotension/dizziness

• monitor liver function / signs of hepatotoxicity

• take earlier in day if insomnia occurs

• requires washout period when switching antidepressants

• carry medication list and inform providers before new meds/procedures

what is the MOA, indications, therapeutic effects, interactions, contraindications, and adverse effects of carbamazepine (Tegretol)?

MOA: stabilizes overactive neurons by blocking sodium channels and decreasing repetitive nerve firing in the CNS → helps prevent seizure activity. (It does not primarily work by enhancing GABA.)

indications:

• focal and generalized tonic-clonic seizures

• Trigeminal neuralgia

• bipolar disorder (mood stabilization, off-label/common use depending on setting)

therapeutic effects:

• decreases seizure frequency

• reduces abnormal nerve pain signals

• helps stabilize mood

• may cause sedation/drowsiness

interactions:

• many drug interactions because it induces liver enzymes

• oral contraceptives → reduced effectiveness

• warfarin → reduced effect

• other antiepileptics may increase/decrease levels

• grapefruit juice may increase carbamazepine levels

• alcohol/CNS depressants → more sedation

• Monoamine oxidase inhibitors (MAOIs) → avoid use together

contraindications:

• hypersensitivity to carbamazepine or Tricyclic antidepressants (TCAs) (similar structure)

• bone marrow suppression/history of serious blood disorders

• use with MAOIs (need washout period)

• caution with hyponatremia or Syndrome of inappropriate antidiuretic hormone secretion

adverse Effects:

• drowsiness, dizziness, fatigue

• headache

• nausea

• photosensitivity

• edema

• dyspnea (rare)

• urinary retention (possible)

• hyponatremia

• bone marrow suppression (aplastic anemia, agranulocytosis)

• serious rash / Stevens-Johnson syndrome (higher risk in some Asian ancestry patients)

what are the nursing considerations for carbamazepine?

• monitor seizure frequency and therapeutic response

• monitor CBC → risk of bone marrow suppression (infection, bruising, bleeding)

• monitor sodium → risk of hyponatremia / Syndrome of inappropriate antidiuretic hormone secretion

• monitor liver function tests

• watch for rash / Stevens-Johnson syndrome; stop and notify provider if severe rash develops

• assess dizziness, drowsiness, ataxia → fall precautions

• do not stop abruptly (may trigger seizures)

• avoid grapefruit juice; many drug interactions

• may reduce effectiveness of oral contraceptives

• use sunscreen / photosensitivity precautions

• take with food if GI upset occurs

what are the pertinent labs to monitor for patient taking RAI (radioactive iodine)?

1. TSH

2. T3/T4

3. Pregnancy test (must be negative before taking this medication!!!!!!)

4. thyroid uptake scan

what are the deadly/serious reaction the nurse must watch out for for patient taking RAI?

1. severe hypothyroidism after treatment

2. worsening Grave’s eye disease

3. radiation harm to fetus (must make sure the patient is not pregnant!!!)

4. thyroid storm (rare but can happen if the patient hyperthyroidism is uncontrolled)

what are the pertinent labs/assessment to monitor for patient taking carbidopa/levodopa?

1. blood pressure (more likely to cause orthostatic hypotension, and this is one of the most common symptoms of these medications)

2. mobility/gait (this is because since the medications have an on-off period, freezing, rigidity, or tremor may return abruptly, increasing the patient's fall risk | long-time use of these medications can also cause dyskinesia, which can interfere with balance

3. LFTs (AST/ALT) and renal functions as this how the drugs is processed and excreted

4. intraocular pressure as the medication can cause a rise in intraocular pressure which is why the medication is contraindications in patient with narrow-angle glaucoma

what are the deadly/serious reactions that the nurse should monitor for patient taking carbidopa/levodopa?

1. severe falls from hypotension (orthostatic hypotension is a common side effects)

2. hallucinations/psychosis (due to the increased in dopamine)

3. dyskinesia causing injury

4. making sure the patient does not have narrow-angle glaucoma as the medication can cause a sudden, dangerous rise in eye presure

what are the pertinent lab to monitor in patient taking gabapentin (Neurontin)?

1. eGFR

2. BUN

3. creatinine

This is because the drug is excreted entirely by the kidneys

what are the deadly/serious reactions that the nurse should monitor for patient taking gabapentin?

1. respiratory depression (especially when taking with opioids/CNS depressants)

2. suicidal ideation

3. severe sedation/falls

4. withdrawal seizures if abruptly stopped

what are the pertinent lab/assessment to monitor for patient taking phenelzine?

1. blood pressure (as we want to monitor for a tyramine-induced hypertensive crisis or orthostatic hypotension, which is a common symptom from increased dopamine level)

2. blood glucose (as phenelzine can increase insulin sensitivity and lower blood sugar)

3. mental status (as this medication can increase the risk of suicidal thinking and behaviors and worsening depression, anxiety, or agitation)

4. liver function test (because the medication can cause hepatotoxicity - AST/ALT)

what are the deadly/serious reaction that should be monitored for patient taking phenelzine?

1. hypertensive crisis (when eating tyramine-rich foods)

2. serotonin syndrome (agitations, confusion, rapid heart rate, muscle rigidity, shivering, sweating, dilated pupils, and diarrhea)

3. severe orthostatic hypotension/falls

4. suicidality early treatment

what are the pertinent labs to monitor for carbamazepine?

1. CBC (this is because carbamazepine can suppress bone marrow so low WBC can increase infection risk, low platelets can increase bleeding risk, and low RBC/Hgb can increase anemia and fatigue)

2. sodium (this is because this medication blocks the sodium channel, which can cause hyponatremia and can cause syndrome of inappropriate antidiuretic hormone, SIADH)

3. LFTs (AST/ALT) because carbamezepine is metabolized by the liver and may cause hepatoxicity’

4. SERUM DRUG LEVEL!!! (4-12 mcg/mL) → toxicity signs are ataxia, diplopia, dizziness, nystagmus, sedation