Chamberlain College of Nursing : NR565 Week 4 Midterm Exam Study Guide.VERIFIED DOCUMENT. MUST HAVE!

NR565 Week 4 Study Guide Week 4 is the midterm (no quiz) and includes all material from Weeks 1-4; Be sure to also review the Weeks 1, 2 & 3 study guides to prepare for the exam Many questions will are written to assess your clinical application of the material from the textbook, in real-world scenarios Chapter 15: Drugs Affecting the Central Nervous System Anorexiants: Precautions and contraindications  Tolerance/Dependence (physical & psychological) o Use cautiously in pts w/ history of drug/alcohol abuse (cross tolerance)  Actively drinking taking anorexiants may have depression, paranoia, psychosis  Contraindicated in pts who abuse cocaine, meth (Adrenergic stimulation)  Use maximum of 6 months  Diabetics may experience altered insulin/ hypoglycemic oral concentrations  Lorcaserin (serotonergic anorexiant drug)- may experience serotonin syndrome or neuroleptic malignant syndrome o Category X pregnancy drug Anticonvulsants: Hydantoins  Metabolism and excretion Hydantoins Metabolized by liver, excreted by kidneys  MOAs, indications Hydantoins (Phenytoin) MOA- inhibit and stabilize electrical discharges in the motor cortex of the brain by affecting the influx of sodium ions into the neuron during depolarization and repolarization, slowing the propagation and spread of abnormal discharges. Indications- First line treatment of choice for tonic-clonic and partial complex seizures— least sedating drugs to treat seizure disorders  Absolute contraindications Sinus bradycardia, SA Block, 2ond/3rd degree AV block, Stokes-Adams syndromes Ethotoin- Hepatic/hematological disorders  Precautions Pregnancy category D Newborns exposed to phenytoin – mom gets Vit K and baby at birth Liver/Kidney disease (Careful) Rebound status epilepticus if d/c’d abruptly  Monitoring Patients should be assessed for phenytoin hypersensitivity syndrome (fever, skin rash, lymphadenopathy), which usually occurs at 3 to 8 weeks. Baseline complete blood count, urinalysis, and liver function tests should be assessed prior to onset of treatment, with frequent reassessment during the first few months of treatment. Plasma levels should be monitored, especially when drugs that increase plasma hydantoin, such as ibuprofen, are used. Suicide Risk Assessment  Adverse drug reactions e CNS effects such as agitation, ataxia, confusion, dizziness, drowsiness, headache, and nystagmus; cardiovascular effects such as hypotension, tachycardia, atrial and ventricular conduction depression, and ventricular fibrillation; gastrointestinal (GI) effects such as nausea, vomiting, anorexia, altered taste, constipation, dry mouth, and gingival hyperplasia; and genitourinary effects such as urinary retention and reddish-brown discoloration of the urine. Serious dermatologic reactions, including Stevens–Johnson syndrome and toxic epidermal necrolysis may occur. Other possible adverse effects include skin rashes (scarlatiniform or morbilliform), hyperglycemia, tinnitus, gynecomastia, coarsening of facial features and enlargement of the lips, hematopoietic changes, photophobia, and polyarthropathy.  Drug interactions (including oral contraceptives) Concurrent administration causes the decreased effect of carbamazepine, estrogens, corticosteroids, haloperidol, methadone, levodopa, sulfonylureas, oral contraceptives, and cardiac glycosides Will make oral contraceptives less effective  Black box warnings Phenytoin has a Black-Box Warning that IV administration should not exceed 50 mg/minute in adults and 1 to 3 mg/kg/minute in pediatric patients owing to risk of cardiovascular reactions associated with a too rapid rate of administration. Iminostilbenes