NUR 2474 Rasmussen Pharmacology Exam 1 2023 with 100% correct questions and answers

dopaminergic agent levodopa/carbidopa anticholinergic agent benzotrophine cholinesterase inhibitor donepezil Immunomodulators interferon beta traditional anti epileptic drugs phenytoin, carbamazepine, valproic acid atypical anti epileptic drugs oxcarbazepine lamotrigdine barbiturates Phenobarbital muscle spams drugs baclofen dantrolene 1st generation antipsychotics low potency: chlorpromazine high potency: haloperidol 2nd generation antipsychotic clozapine risperdone olanzapine SSRIs fluoxetine sertraline paroxetine SNRI venlafaxine duloxetine TCA amitriptyline MAOI phenelzine atypical antidepressant Bupropion, trazodone OTC herbal for depression ST. Johns Wort mood stabilizer lithium benzodiazepines lorazepam, diazepam alprazolam benzodiazepine like drugs zolpidem insomnia drugs used trazodone doxepin OTC drug for insomnia melatonin Atypical Anxiolytic Buspirone amphetamines amphetamine, lisdexamfetamine methamphetamine methylxanthines methylphenidate when should we complete blood testing with use of lithium? early in therapy- every 2-3 days, until a therapeutic dose has been established, then long term-every 3 to 6 months therapeutic level of lithium 0.8-1.4 mEq/L toxic level of lithium greater than 1.5 mEq/L when can we start to see side effects of lithium? when the drug is at a therapeutic level. they are expected. what are the side effects of lithium (therapeutic level)? GI effects, tremors, polyuria, renal toxicity, goiter, hypothyroidism, teratogenesis. what will happen to side effects when one has a toxic level of lithium? the effects will be much worse and possibly life threatening i.e. tremor that becomes larger with muscle incoordination what medications can we use to treat the cyclic effects of bipolar (mood-depression- psychosis)? mood stabilizer (lithium)= control mood antidepressant (SSRI,TCA,MAOI)= control depression antipsychotic (Ist/2nd generation)= control the psychosis how does a benzodiazepine help with ETOH withdrawal? it will decrease the withdrawal manifestations and intensity, while making one sleepy and having CNS depression. plus, it is easy to give IM and will work quickly. what is a popular benzodiazepine that is used to treat anxiety? alprazolam (think A-anxiety) how does alprazolam work to reduce anxiety? it inhibits GABA in the CNS, depressing the CNS. what are the side effects of alprazolam use? a. CNS depression, anterograde amnesia (patient cannot remember much), sleep driving (not safe), paradoxical effects (still anxious, stays up, rowdy), respiratory depression. what drugs does alprazolam interact with? CNS depressant medications (additive effects), ETOH what are various treatments and drugs used to treat anxiety patients? benzo's (pam/lam), atypical anxiolytic buspirone, SSRIs paroxetine/fluoxetine, TCAs, MAOIs, trazodone. explain what a sedative hypnotic does cause the patient to have sedation, sleepiness, CNS depression, anterograde amnesia (patient cannot remember much), sleep driving (not safe),respiratory depression what things should we teach the patient using a drug to treat anxiety? drug should be tapered only by the HCP, not patient no ETOH use what withdrawal effects may look like what does anxiety medication PO withdraw look like? drowsiness, lethargy, confusion what does anxiety medication IV withdraw look like? hypotension, respiratory arrest, cardiac arrest. explain what methylphenidate does increases attention and focus in children (NOTHING DEALING W/ BEHAVIORS) other effects of methylphenidate use in children decreased appetite insomnia if given late in the day what things should we always do when giving methylphenidate to a child with ADHD? ALWAYS: give the drug in the morning, after breakfast, and give the last dose before 4pm, or else the child will not sleep at night which 3 drugs are controlled substances and highly abused? amphetamines, barbiturates, methylphenidate what is the purpose of drug treatment with Alzheimer Disease patients? there is treatment to help slow down the progression of the disease, but to not cure it how does donepezil works? it slow the progression of Alzheimers disease by causing reversible inhibition of cholinesterase and the cholinergic receptors. what should we do when discontinuing an antidepressant (or any medication)? if antidepressant is stopped cold turkey, withdrawal syndrome can occur. we must gradually taper the drug slowly and have the HCP taper it. do not let patient taper drug by themselves. what are signs and symptoms of withdrawal syndrome? HA, Nausea, visual disturbances, sweating, dizziness, tremors what is the relationship between sertraline and nursing infants? when this drug is used with a patient who is pregnant or nursing infants, the infant can have neonatal abstinence syndrome occur what should we educate pregnant or nursing moms about when using sertraline? We must educate the patient on potentially using other medications during this time period, as it can cause potential birth defects and the baby to become sick. explain the relationship between fluoxetine and alcohol abuse when this drug is used with alcohol abuse, it can interact with the medication and make the patient very sick.. what should we teach the patient regarding alcohol use the patient must avoid alcohol while taking most medications what is the first line medication used to stop a seizure? diazepam (benzo) by IM explain side effect unavoidable secondary drug effects produced at therapeutic doses. May be unwanted, but unavoidable and expected. explain adverse effect undesired and unexpected severe responses to a medication. They do have the potential to cause harm. explain allergies/anaphylaxis an immune response to a medication that causes a reaction that can be mild to life threatening. what are s/s of allergic reactions? i. itchy, rash, hives, wheezes, SOB, swelling of face, lips and throat. what should we do if we a patient actively in allergic reaction? stop the medication, call the doctor, D/C lines, check for antidotes, and give emergency care based on ABC's. what should we do before giving any medication? ask about patient allergies to medications and what happens when they take them. remember if they report they get any s/s of allergic run with medication use, we must hold med and call dr. explain intended drug effects effects that we want to see and that are therapeutic when using the drug. Ex: with an antidepressant, we want to see a mood change, because that is the intended use of the drug. explain teratogenic effect a drug induced birth defect that can cause harm to the fetus. Why we do not allow pregnant moms or those lactating to not take certain medications so they do not harm their child. explain paradoxical effect The opposite of the intended drug response. example of paradoxical response Benzo's may be used for sedation and insomnia treatment, but may instead cause them to stay up, have excitement, and to be rowdy. The opposite. explain tolerance occurs when there is a long term reduced responsiveness to a medication over time, causing the medication to not produce a therapeutic effect. Will need to increase the dose to get the same effect. Will be higher dose but the effects will be seen. will take longer to wean also explain dependence the patient gets used to the drug and cannot stop using it. When they do stop the med cold turkey they can have withdrawal symptoms. Why we have to wean and taper the drug. explain addiction occurs when the patient abuses the drug and uses it for pleasure instead as prescribed. why may we give a atypical antipsychotic medication (2nd generation)? when one cannot handle the EPS that the 1stgeneration drugs produce. which patient populations should we not use a atypical antipsychotic with? those with diabetes, those with high cholesterol what can the atypical antipsychotics cause? drug onset diabetes, drug onset high cholesterol, weight gain why should not we use an atypical antipsychotic with a patient with dementia? It will not work to control the disease and will exaggerate the psychosis. They will need a cholinesterase inhibitor how can we give antipsychotic medications? Depot IM injection or PO what can atypical antipsychotics be used to treat? schizophrenia, bipolar and depression what does phenytoin treat? epilepsy, partial and tonic clonic seizures what is the interactions between phenytoin and pregnancy? can be teratogenic and cause fetal deformities. Can also interfere with clotting factors of newborns, causing bleeding Can also interfere and decrease effectiveness of oral contraceptive use what should we teach pregnant moms to do when taking phenytoin? Will need to teach the patient importance of taking folic acid while use of the drug and importance of taking the vitamin K shot before delivery of the baby, potential to switch oral contraceptive use to another way to increase effect of the anti-epileptic what is there therapeutic level of phenytoin? 10-20 what is the therapeutic level of carbamazepine? 5-12 what can we use carbamazepine to treat? epilepsy, bipolar, and trigeminal neuralgias why is a therapeutic level important with some medications? if the drug is not in a certain range, it can be toxic. broad therapeutic range= good drug to use, narrow range= not so good. must draw blood levels if in a narrow therapeutic range medication. what medications cause EPS? antipsychotic drugs- 1st generation what are the early EPS? acute dystonia, oculogyric crisis, opisthotonus, joints dislocation, impaired breathing, akathisia, parkinsonism what are the late EPS? tardive dyskinesia explain acute dystonia slow muscle movement and spasticity explain oculogyric crisis upward deviation of the eyes explain opisthotonus back spasticity explain joint dislocation from the muscle spasms, can be painful explain impaired breathing the diaphragm cannot work correctly due to slowing of movement explain akathisia compulsive, restless movement, need to be in motion with anxiety. explain Parkinsonism drug induced Parkinson's: bradykinesia, mask like face, tremor, rigidity, shuffling gait, drooling, cog wheeling, stooped posture how do we treat early EPS? anticholinergics, bentos, beta blocker explain tardive dyskinesia choreoathetoid movements of the tongue and face, lip smacking movement, fly catching tongue, slow worm like tongue movement, involuntary movements of limbs, tones, hips and fingers. how do you treat late EPS? no treatment, but you can prevent it. D/C all medications and switch to 2nd generation antipsychotic what do TCAs treat? major depression how do TCAs work blocks serotonin and NE reuptake what are the side effects of TCAs sedation, orthostatic hypotension, anticholinergic what is the most dangerous effect of TCAs cardiac toxicity S/S of cardiac toxicity in TCAs dysrhythmias, tachycardia, heart blocks, v tach, v fib how do we treat cardiac toxicity in TCAs? no antidote, treat with gastric lavage, activated charcoal, IV HCO3 What do neuroleptics do? it blocks dopamine. only increase the effects of Parkinson's disease, as they will induce Parkinson's symptoms with EPS, it is an additive relationship. what is the issue with using a neuroleptic with a patient with Parkinson's disease? will worsen the Parkinson's disease symptoms. would be appropriate to use a 2nd generation antipsychotic a neuroleptic is the same as an__________ antipsychotic explain the concept of half life and how to solve them The amount of time ½ of the drug is taken out of the system. To solve: divide by 1/2 he medication dosage by each half life. Ex: if a drug has 4 half lives, you divide the medication 4 times by 1/2 what can occur when one begins to not use an antipsychotic medication because of the parkinsons symptoms ? the Parkinson's symptoms will go away, but because you stop the antipsychotic, the psychotic symptoms will come back. what do MAOIs interact heavily with? tyramine what happens if a person using an MAOI eats a food that is high in tyramine? hypertensive crisis explain the s/s of hypertensive crisis severe HA, tachycardia, hypertension, N,V, confusion, sweating, stroke, death what is important to do when we start a patient on MAOI educate our patients to avoid ALL tyramine rich food examples of tyramine rich foods are_______________ aged meats and cheese, smoked fish and meats, avocado, figs, banana, beer, wine. what medications can cause neuroleptic malignant syndrome 1stgeneration antipsychotics- chlorpromazine and haloperidol s/s of neuroleptic malignant syndrome lead pipe muscle rigidity, sudden high fever, sweating, autonomic, instability, dysrhythmia, BP fluctuations, altered LOC, seizures, coma. Death w/ cardiac or respiratory failure how do we treat neuroleptic malignant syndrome? supportive, withdraw antipsychotic med, give dantroline and bromocriptine what are some of the patient teaching points for medication therapy? take as prescribed only, take on the correct schedule, report severe s/s to HCP, attend all follow ups and lab appts, family members should assist with adherence if possible, teach to never stop a drug cold turkey and the HCP should be the only person weaning pt off drug. what does levodopa and carbidopa do? works to increase the amount of dopamine that can be used for reuptake in the brain. It is a dopaminergic agent in which once it is converted, the drug will then act as a dopamine supply and will be taken up. what is the purpose of carbidopa use? helps to enhance the effects of levodopa and decrease GI discomfort. has no other effects. side effects of levodopa/carbidopa N, V, CV postural hypotension, increase intake of salt and water, psychotic s/s when too much in brain, mood changes- more anxious and agitated, memory and cognitive impairment, risky behaviors, dyskinesia, darken sweat and urine, malignant melanoma what things should we teach our patient about when taking levodopa/carbidopa? give additional carbidopa to alleviate GI effects, change position slowly, fall precautions needed, increase fluids, decrease amount if psychotic symptoms apparent, assist with relaxation, teach about the darkened urine and importance of skin checks, will need to spread out protein rich meals due to interaction. interactions with levodopa/carbidopa protein, vitamin B6 What is levodopa/carbidopa used to treat? Parkinsons disease what are some of the effects of the cholinesterase inhibitors? increase in salivation, lacrimation, urination, diarrhea, gi effect, emesis, muscus (SLUDGEM) what are some of the effects of the anticholinergic drugs can't see, can't spit, can't pee, can't poop what do cholinesterase inhibitors interact with? patients who have asthma- drug use can cause bronchoconstriction, will be worse with patients who have asthma what is interferon beta used for? MS exacerbations how does interferon beta work? a. Suppresses wbc and leukocytes in the immune system. what are side effects form the use of interferon beta flu like symptoms- fever, chills, HA, body aches. Hepatotoxicity, myelosuppression, injection site reactions, depression, suicidal thoughts. what are some things we should teach while using interferon beta? they may have flu like symptoms but not the flu- if they have them can use ibuprofen or acetaminophen, rotate injection sites, if pain itchy or redness, they can take diphenhydramine what is oxcarbazepine used for? anti seizures what can oxcarbazepine cause that is significant? hyponatremia what is the importance about the interaction between oxcarbazepine and diuretics? the patient will lose more sodium and water, dropping their sodium level even more than the drug will (additive effect). what is lamotrigdine used for? anti seizures and bipolar disorder. what are the side effects of lamotrigdine? dizziness, double and blurry vision, N,V, Steven Johnson's syndrome, aseptic meningitis, risk for suicide explain what Stevens Johnson's syndrome is? full body rash caused by the medication, can be fatal if not treated. what is an important assessment we must do when the patient use lamotrigdine? skin assessment what is baclofen used for? treats muscles spasms associated with MS, SCI, CP- it suppresses the resistance to passive movement what are side effects of baclofen? CNS depressant effection, GI efect, urinary retention is there an antidote to baclofen use? no what should we do when discontinuing baclofen? withdraw the medication over 1-2 weeks, if too fast, the patient is at risk for rhabdomyolysis lisdexafetamine is an ______________ amphetamine what is lisdexafetamine used for? ADHD and increased focus and attention (stimulant) What are adverse effects associated with lisdexafetamine use? CNS stimulation, weight loss, CV effects, psychosis what are toxic effects of lisdexafetamine use? dizziness, confusion, hallucination, delusions, palpitations, CV issues, fatal can cause convulsions, coma, and hemorrhage is lisdexafetamine a high abused drug? yes- all amphetamines can be highly abused. what should we do before giving lisdexafetamine? asses for history for drug abuse antidote to benzodiazepines Flumazenil antidote to opioids Naloxone antidote to neuromuscular blockers neostigmine antidote to cholinesterase inhibitors atropine explain the nursing process of assessment regarding med administration what data you collect based on what you see or what the patient reports (ex: they are in pain, they have a fever, etc) explain the nursing process of analysis regarding med administration where you decide to give or not to give the medication based on your assessment. explain the nursing process of planning regarding med administration how you will be giving it (PO/IV/IM/SC), what med you will give, any allergies, etc