Nurs 493 Pharmacology 2023 with verified questions and answers

Beta2-Adrenergic Agonist albuterol Terbutaline (Brethine) Beta2-Adrenergic Agonist Action -act by selectingly activating the beta2-receptors in the bronchial smooth muscle, resulting in bronchodilation -as a result of this: bronchospasm is relieved, histamine release is inhibited, ciliary motility is increased Terbutaline -long term control of asthma -monitor HR -to decrease HR, give beta blocker Benzodiazepine: CCCOLD -Chlordiazepoxide (Librium) -Clorazepate (Thanxene) -Clonazepam (Klonopin) -Oxazepam (Serax) -Lorazepam (Ativan) -Diazepam (Valium) Benzodiazepine Action -enhances the inhibitory effects of gamma-aminobutyric acid in the CNS. -Relief of anxiety occurs rapidly following adminstration Benzodiazepine Uses -Generalized anxiety disorder (GAD) and panic disorder -Other uses: -seizure disorder -insomnia -muscle spasm -alcohol withdrawal (for prevention and treatment of acute manifestations) -induction of anesthesia -amnesic prior to surgery or procedures Benzodiazepine Adverse Effects -Anterograde amnesia (difficulty recalling events that occur after dosing) -Long term use: can lose memory Selective Serotonin Reuptake Inhibitors (SSRI) -Fluoxetine (Prozac) SSRI Action -selectively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons -it doesn't clock uptake of dopamine or NE -produces CNS stimulation, which can cause insomnia -has long effective half-life. A time frame of up to 2-3 weeks is necessary to produce therapeutic medication levels -when antidepressant starts to work, pt is more likely to commit suicide SSRI: Serotonin Syndrome -agitation -confusion -disorientation -difficulty concentrating -anxiety -hallucinations -hyperreflexia -incoordination -tremors -fever -diaphoresis -usually begins 2-72 hrs after initiation of treatment -resolves when medication is discontinued -notify provider and withhold medication SSRI Interactions -use of MAOI antidepressants or TCAs can cause serotonin syndrome Tricyclic Antidepressants (TCAs) -Amitriptyline (Elavil) -Imipramine (Tofranil) -Doxepin (Sinequan) -Nortriptyline (Avently) -Amoxapine (Asendin) -Trimipramine (Surmontil) TCA Action -block reuptake of NE and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters TCA Adverse Reactions -Don't give to pts with seizures because these medications decrease seizure threshold -Orthostatic hypotension: change positions slowly, monitor BP and HR before administration and 1 hr after. -If a significant decrease in BP and HR and/or increase in HR is noted, do not administer medication and notify provider Monoamine Oxidase Inhibitors (MAOIs) -phenelzine (Nardil) -Isocarboxazid (Marplan) -Tranylcypromine (Parnate) -Selegiline (Emsam): transdermal MAOI Action -block MAO in the brain, thereby increasing the amount of NE, dopamine, and serotonin available for transmission of impulses -an increased amount of these neurotransmitters at nerve endings intensives responses and relieves depression -MOST DANGEROUS MAOI Adverse Effects -Orthostatic hypotension: monitor BP and HR -Hypertensive crisis resulting from the intake of dietary tyramine Hypertensive Crisis -tyramine rich foods can lead to hypertensive crisis -clients will most likely experience headache, nausea, increased HR, increased BP Tyramine-rich foods -ages cheeses -pepperoni -salami -avocados -figs -bananas -smoked fish -protein dietary supplements -soups -soy sauce -some beers -red wine Valproic Acid (Depakote) -mood stabilizing antiepilectic drugs (AEDs) -Action: help treat and manage bipolar disorders by various mechanisms. Slowing the entrance of sodium and calcium back into the neuron and, thus, extending the time it takes for the nerve to return to its active state. Potentiating the inhibitory effects of GABA. Inhibiting glutamic acid (glutamate) which in turn suppresses CNS excitation. Valproic Acid (Depakote) -need good oral/skin care -be careful during seizure -have seizure precautions Hypoglycemia -need seizure precautions Head injury -need seizure precautions Seizure Precautions -pad bed -bed low -near nursing station Typical antipsychotics -Haloperidol (Haldol) Typical antipsychotics Adverse Effects: EPS EPS: -Acute dystonia: severe spasms of tongue, neck, face, or back -Parkinsonism: clinical findings include bradykinesia, rigidity, shuffling gait, drooling, and tremors -Akathisia: the client is unable to stand still or sit, and is continually pacing and agitated -Tardive Dyskinesia (TD): involuntary movements of the tongue and face, such as lip-smacking, which cause speech and/or eating disturbances. May also include involuntary movements of arms, legs, or trunk Typical antipsychotic Adverse Effects -Neuroleptic Malignant Syndrome: sudden high-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and change in LOC developing into coma Anticholinergic effects -dry mouth -blurred vision -photophobia -urinary hesitancy/retention -constipation -tachycardia Fluoxetine (Prozac) -used for panic disorder and OCD -need to avoid taking NSAIDs Carbamazepine -interferes with the effectiveness of oral contraceptives OTC nasal decongestants -constrict blood vessels -increase BP Tamoxifen adverse effects -menstrual irregularities -hot flashing -bruising -used for treatment of breast cancer Allergic reaction findings -uticaria -dyspnea -hypotension -give parenteral epi Enalapril (ACE I) -watch for hyperkalemia -retention of K in kidneys methotrexate -immunosuppressant -can cause bone suppresion -monitor for infection: fever or sore throat trimethoprim/sulfamethoxazole (Bactrim) -report to provider: vesicular, crusty rash -stevens-johnsons syndrome digoxin toxicity -yellow tinged vision oxybutynin -anticholinergic medication -dry mouth -blurred vision -photophobia fluconazole -antifungal medication -treats oropharyngeal and systemic candidiasis sucralfate -mucosal protectant -forms a protective barrier over ulcers neostigmine -myasthenia gravis -adverse s/e: nausea salicylate poisoning -hyperventilation haloperidol -EPS -akathisia benzodiazepine toxicity -antidote: flumazenil -diazepam oprelvekin -thrombopoietic growth factor -platelet count phenytoin -can cause gingival hyperplasia salmeterol -long acting bronchodilator -prevents bronchospasms and improves breathing epoetin alfa -increases hemocrit -if happens too rapidly, can lead to hypertension and seizures baclofen -decreases severity of muscle spasms, allowing for improved muscle function -decrease in flexor and extensor spasticity magnesium toxicity -CNS depression statins -mild injury, causing muscle weakness or aches, and this occasionally progresses to myostitis CK levels rise in response to enzymes released with muscle injury verapamil -can cause orthostatic hypotension and dizziness -change positions slowly Indomethacin -nonsteroidal antiflammatory medication -reduces pain and inflammation acetazolamide -adverse s/e: paresthesia metronidazole -avoid drinking beer -will cause disulfiram like reaction: severe vomiting, hypotension, weakness clindamycin -cause cause C-diff associated diarrhea -watery diarrhea furosemide adverse s/e: -dizziness -hypokalemia -urinary frequency chlordiazepoxide -prevent delirium tremens of acute alcohol withdrawal doxycycline -tetracycline antibiotic -adverse effect on developing bones and teeth heparin -stop heparin infusion if platelet count is 96,000/mm3 -may indicate heparin induced thrombocytopenia -stop the infusion glucocorticoids -adverse s/e: osteoporosis -do bone density scans benztropine -anticholinergic agent -can cause tachycardia due to parasympathetic blockade of heart metoclopramide -effects on CNS -sedation Valproic acid -cause cause liver failure -monitor for jaundice Phenytoin -decreases the effectiveness of ethinyl estradiol/desogesterel (cyclessa) or other oral contraceptives by stimulating hepatic medication metabolizing enzymes Statins -report muscle pain to the provider -do not take the med with grapefruit juice -minimize intake of alcoholic beverages -expect therapy with this medication to be lifelong Bupropion -is a stimulant -can cause insomnia risedronate -should be taken on an empty stomach -at least 30 min before the first food or drink of the day -tranylcypromine -common s/e is orthostatic hypotension exenatide -greatest risk is pancreatitis -abdominal pain can be an indication of pancreatitis zidovudine -can cause severe asthma -monitor hemoglobin timolol -is a beta blocker -can worsen the client's bradycardia DTap -start at 2 months of age