Pharm 2 EXAM 1 Review Flashcards

General Nursing Principles for Pharmacology

• Prioritize patient safety by searching for the most secure nursing intervention: always assess the client first.

• If drug toxicity is suspected, the nurse should hold the medication dose and immediately notify the primary healthcare provider.

• Always prioritize the maintenance and protection of the client's airway, breathing, and circulation (the ABCs).

• Students are expected to supplement this guide with textbooks, recorded lectures, and ATI resources for topics not exhaustive in the review.

Corrections for Potential Transcript Misspellings

• "Phenolzine" or "phenylene" should be recognized as Phenelzine (an MAOI).

• "Zopadim" refers to Zolpidem (Ambien).

• "Levoteractam" refers to Levetiracetam (Keppra).

• "Carvidopa lepidopa" or "Cinemet" refers to Carbidopa-levodopa (Sinemet).

• "Amantenine" refers to Amantadine.

• "Levidoreticularis" refers to the skin condition Livedo reticularis.

• "Pancoronia" or "paceronium" refers to Pancuronium.

• "Saxina Coley" or "Succeedocoline" refers to Succinylcholine.

• "Denezil" or "Dinepazil" refers to Donepezil.

• "Remelta yarn," "Lumetzion," or "Romeltion" refers to Ramelteon.

• "Chlorprimazine" refers to Chlorpromazine.

• "Ariprazole" refers to Aripiprazole (Abilify).

Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine

• Prototype Drug: Fluoxetine (Prozac).

• Indication: Utilized for Major Depressive Disorder (MDD).

• Serious Cardiovascular and Safety Adverse Effects: Development of cardiac arrhythmias, a prolonged $QT_c$ interval, and increased suicidality.

• Dermatological Warning: The appearance of a skin rash may serve as an early clinical indicator of serotonin syndrome; report this to the provider immediately.

• Nursing Actions for Serious Effects: Immediately hold the medication and notify the healthcare provider.

• Common and Minor Side Effects: Clients commonly experience insomnia, nausea, decreased libido (low sex drive), and dry mouth.

• Client Teaching: Educate the patient that minor side effects typically resolve with continued use, and emphasize that SSRIs require several weeks of consistent use before therapeutic benefits are felt.

Serotonin Syndrome and SNRI Safety

• Causative Medications: SSRIs such as Fluoxetine and SNRIs such as Duloxetine and Venlafaxine.

• Clinical Manifestations: Often remembered by the phrase "everything goes up," including high blood pressure (hypertension), agitation, hyperreflexia, tachycardia, muscle rigidity, tremors, and shaking. Fluctuations in heart rhythm (bradycardia) may occur depending on $QT_c$ length.

• Nursing Interventions: Act rapidly to stop the causative medication and notify the physician.

• Venlafaxine Specifics: Monitor for hypertension, hyponatremia ($low sodium$), and symptoms of angle-closure glaucoma (sudden eye pain or vision changes). Monitor mood for suicidal ideation.

Monoamine Oxidase Inhibitors (MAOIs): Phenelzine

• Indication: Used for cases of depression that are difficult to treat with other classes.

• Dietary Restrictions: Strictly avoid tyramine-containing foods, specifically aged cheeses and other tyramine products, to prevent hypertensive crisis.

• Drug-to-Drug Interactions: Do not combine with other antidepressants (such as SSRIs or SNRIs) unless specifically managed by a specialist, as MAOIs "mix with everything" dangerously.

Atypical Antidepressants (Bupropion) and TCAs (Amitriptyline)

• Bupropion Safety: This medication lowers the seizure threshold, increasing the risk of seizures.

• Contraindications/Nursing Action: Review the patient's medical history for seizures or current use of anticonvulsants like Phenytoin. Question the order if a seizure history is present.

• Amitriptyline (Tricyclic Antidepressant): Used for major depression.

• TCA Serious Adverse Effects: Cardiac irregularities, syncope (fainting), and a prolonged $QT_c$ interval require immediate medical attention.

• Minor Side Effects: Dry mouth and bradycardia (though bradycardia can be significant depending on the clinical context).

Mood Stabilizers: Lithium Carbonate

• Indication: Treatment of Bipolar Disorder.

• Clinical Indicators of Toxicity: Muscle tremors, EKG changes, profound lethargy, and slurred speech. Note that mild GI symptoms like nausea and diarrhea may occur but worsening tremors are highly concerning.

• Nursing Protocol for Toxicity: Hold the scheduled dose, notify the health care provider, and prepare to draw serum lithium levels and a Basic Metabolic Panel (BMP).

• Electrolyte Management: Sodium levels are critical; the client must maintain consistent daily intake of both sodium and water.

Antiepileptics and Bipolar Adjuncts: Valproic Acid and Lamotrigine

• Valproic Acid Toxicity: Major concern is liver toxicity and potential liver failure.

• Clinical Indicators: Right-upper quadrant (RUQ) abdominal pain, jaundice (yellowing of the skin), and yellow sclera of the eyes.

• Nursing Action: Hold the medication and notify the provider immediately upon these findings.

• Lamotrigine (Lamictal): Used for seizures and bipolar disorder.

• Serious Skin Warning: Monitor for a rash, particularly on the torso, as this may indicate Stevens-Johnson Syndrome (SJS) or a significant liver reaction. Do not ignore any new rash.

Antipsychotic Medications: Chlorpromazine, Risperidone, and Aripiprazole

• Extrapyramidal Symptoms (EPS): A major class concern featuring muscle stiffness, pseudoparkinsonism, dystonia, and tardive dyskinesia.

• Tardive Dyskinesia: Involuntary movements, specifically highlighted in the upper extremities.

• Dystonia: Involuntary muscle movements, specifically highlighted in the lower extremities. Airway-related dystonia is a medical emergency.

• Chlorpromazine: Monitor for urinary retention (inability to void), which is considered an emergency in this context. Client understanding is confirmed if they agree to report difficulty urinating.

• Risperidone Adverse Effects: Unique incidence of gynecomastia (breast development) in men. Monitor for weight gain; a gain of $2-5\,lb/week$ is a significant concern, while $5\,lb/month$ may be considered common.

• Risperidone Safety: Can affect blood pressure and heart rate; instruct clients to rise slowly from a seated or lying position to prevent orthostatic hypotension.

• Aripiprazole (Abilify): Assess for abnormal movements (EPS) and notify the provider for significant findings.

Sedatives, Barbiturates, and Sleep Medications

• General Sedative Rule: Any medication with sedative properties (Phenobarbital, Benzodiazepines, etc.) carries a primary risk of respiratory depression.

• Phenobarbital: Used for seizures and anxiety; monitor for decreased respiratory rate, blood pressure, and alertness.

• Diazepam (Benzodiazepine): "Everything goes down" including respirations, blood pressure, and alertness. Strictly avoid alcohol. Note possible $QT_c$ interactions with drugs like Ciprofloxacin.

• Zolpidem (Ambien): Take only at bedtime. Avoid alcohol and a high-fat meal may assist absorption. Monitor for morning dizziness or grogginess; advise against driving or operating machinery until alert.

• Ramelteon (Melatonin Agonist): Contraindicated or requires strict monitoring in patients with Obstructive Sleep Apnea (OSA) because sedative-hypnotics exacerbate the risk of cessation of breathing during sleep.

Antiepileptic and Neuropathic Pain Medications: Levetiracetam, Gabapentin, and Phenytoin

• Levetiracetam (Keppra): Used for seizure prevention; it is not indicated for stopping an active seizure. Report severe mood changes and do not stop abruptly.

• Gabapentin: Primarily used for neuropathic pain and adjunct therapy for anxiety. Main side effect is drowsiness. Use safety precautions for mobility.

• Phenytoin (Dilantin): Used for long-term seizure management.

• Phenytoin Interactions and Complications: Interacts with Warfarin to increase bleeding risks; monitor for GI bleeds and peptic ulcer disease. Phenytoin and Warfarin together is generally contraindicated.

• Phenytoin Oral Care: Associated with dental caries and mouth problems; stress the importance of oral hygiene and regular dental checkups.

Parkinson's Disease Medications: Carbidopa-Levodopa and Amantadine

• Carbidopa-levodopa (Sinemet): Goal is to reduce muscle rigidity, trembling, bradykinesia, and shuffling gait.

• Iron Interaction: Avoid high-iron foods like red meat and shellfish at the time of dosing, as iron binds the drug and prevents absorption.

• Clinical Monitoring: If the drug is not absorbed, Parkinson's symptoms will persist.

• Amantadine: Recognize the term "Livedo reticularis" as a key adverse effect. The transcript notes it can be described as an eye disorder, though it typically involves skin findings.

Multiple Sclerosis and Myasthenia Gravis Medications

• Baclofen (Multiple Sclerosis): Used for muscle spasticity. Functions in the CNS and causes drowsiness. Avoid over-the-counter (OTC) antihistamines due to additive sedative effects.

• Neostigmine (Myasthenia Gravis): A cholinergic medication used to increase muscle tonicity/strength.

• Therapeutic Outcome: Success is indicated by improved movement and limb strength.

• Cholinergic Crisis: An overdose of acetylcholine causing muscle weakness, excessive salivation, diarrhea, bradycardia, and hypotension. If this occurs, stop Neostigmine, notify the provider, and prepare for fluid resuscitation.

ICU Medications: Paralytics and Neuromuscular Blockers

• Pancuronium: A neuromuscular junction blocker used during mechanical ventilation. It paralyzes respiratory muscles; therefore, the nurse must monitor oxygen saturation, breath sounds, and cardiac rhythm to ensure the ventilator is effective.

• Succinylcholine: A depolarizing paralytic that causes brief muscle contraction before paralysis.

• Electrolyte Hazard: Significant shifts in potassium ($K^+$) and calcium occur. Hyperkalemia is the primary risk, which can lead to cardiac arrest.

Malignant Hyperthermia Treatment and Local Anesthetics

• Dantrolene: The direct skeletal muscle relaxant used to treat Malignant Hyperthermia.

• Malignant Hyperthermia Indicators: Temperatures exceeding $104^{\circ}F$, muscle rigidity, tachycardia, and hypertension triggered during surgery.

• Expected Outcome of Dantrolene: A decrease in body temperature and a reduction in muscle rigidity.

• Lidocaine Toxicity: Indicators include periorbital numbness (numbness around the eyes), mouth numbness, and tinnitus (ringing in the ears).

• Lidocaine Cardiac Risk: Can cause bradycardia or tachycardia, but the transcript explicitly states it does not cause hypotension as a toxicity clue.

Alzheimer's Disease and Medication Error Protocol

• Donepezil: Used for Alzheimer's to increase acetylcholine. Expected to improve memory, cognition, and physical movement.

• Medication Error Procedure: If the wrong dose or drug is administered, the nurse's first action is to assess the client for adverse reactions. After the client is safe, notify the provider and follow institutional reporting protocols.