NUR 2474 Exam 1 Review Latest Update 2023/2024 Graded A+

NUR 2474 Exam 1 Review 2023/2024 Please review general tips from Quiz review document (test taking strategies, select all that apply questions, etc.). The test will utilize Respondus browser and monitor (using webcam). No notes or textbook allowed on the test. Calculator will be enabled in the browser. General tips for studying: 1. Memorize names of medication categories from the presentation (SSRI’s, benzodiazepines, first/second generation antipsychotics, etc.) used to treat common neuro conditions (PD, Alzheimer’s disease, BPD, ADHD, etc.) 2. Memorize key drugs from categories above (there are many questions with specific drug names) 3. Use generic names 4. When reviewing particular drugs note category, indications, common side effects, toxicity signs (if applicable) Topics to review: 1. Lithium therapy (blood testing, therapeutic levels, toxicity levels, side effects, toxic effects) a. Blood level drug testing should occur early in therapy every 2-3 days, until a therapeutic dose has been established, then long term for every 3 to 6 months while using the drug. b. Therapeutic Level= 0.8-1.4 c. Toxic Level= Greater than 1.5 d. SE at therapeutic level: GI effects, tremors, polyuria, renal toxicity, goiter, hypothyroidism, teratogenesis. e. Toxic SE: will be much worse and possibly life threatening i.e. tremor that becomes larger with muscle incoordination. 2. BPD patients on Lithium and adjunct meds for mania/depression a. The bipolar patient will have periods of mania, depression, and psychosis, and will need a mood stabilizer lithium to control their mood, an antidepressant (SSRI), and an antipsychotic (2nd gen-olanzapine, risperidone) to control the psychosis. 3. Benzodiazepines and alcohol withdrawal a. The benzo will help one withdraw from alcohol by decreasing the withdrawal manifestations and intensity, while making one sleepy and having CNS depression. Plus, it is easy to give IM and will work quickly. 4. Alprazolam therapy and anxiety a. Alprazolam is a benzo that is used to treat anxiety. b. It works by reducing anxiety by inhibiting the GABA in the CNS, depressing the CNS. c. SE: CNS depression, anterograde amnesia (patient cannot remember much), sleep driving (not safe), paradoxical effects (still anxious, stays up, rowdy), respiratory depression. d. Interacts w/ CNS depressant medications (additive effects), and ETOH. 5. Treatment of anxiety patients with sedative/hypnotics a. Can use benzo’s (pam/lam), atypical anxiolytic buspirone, SSRIs paroxetine/fluoxetine, TCAs, MAOIs, trazodone. b. Sedative hypnotics can cause the patient to have sedation, sleepiness, CNS depression, anterograde amnesia (patient cannot remember much), sleep driving (not safe), paradoxical effects (still anxious, stays up, rowdy), respiratory depression. c. They must always be taped by the HCP, not the patient. d. Teach no ETOH use, no sleep driving. e. Withdrawal can occur- PO= drowsiness, lethargy, confusion, IV= hypotension, respiratory arrest, cardiac arrest. Methylphenidate (Ritalin) therapy in children 6. a. Methylphenidate is used to increase attention and focus in children (NOTHING DEALING W/ BEAHVIORS) b. Use of methylphenidate with kids can decrease their appetite and cause insomnia if given late in the day. c. 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. 7. Donepezil (Aricept) therapy in pt’s with Alzheimer’s disease a. Patients who have Alzheimer’s have treatment available to slow the decline of the disease, but does not cure the disease. b. Donepezil works to slow the progression of the disease by causing reversible inhibition of cholinesterase and the cholinergic receptors. 8. Review therapy discontinuation for depression a. If an antidepressant is stopped abruptly (cold turkey), the patient can go into withdrawal syndrome (s/s HA, Nausea, visual disturbances, sweating, dizziness, tremors). b. We must gradually taper the drug over weeks slowly and call the HCP to have them guide the patient through the process. c. DO NOT let patient discontinue antidepressants themselves! 9. Sertraline (Zoloft) and nursing infants a. Sertraline is a SSRI, and when this drug is used with a patient who is pregnant or nursing infants, the infant can have neonatal abstinence syndrome occur. b. It is safe to use but may cause this. c. 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. 10. Duloxetine (Cymbalta) and alcohol abuse a. Duloxetine is a SNRI and when used with ETOH, it can interact with the medication and make the patient very sick. b. The patient must avoid ETOH while taking any of these medications. 11. Diazepam (Valium) for status epilepticus (seizures) a. Diazepam, a benzo, can be used in first line to stop a seizure or a patient in status epilepticus by a IM injection. 12. Side effects vs adverse effects vs allergies a. Side Effects: unavoidable secondary drug effects produced at therapeutic doses. May be unwanted, but unavoidable and expected. b. Adverse Effects: undesired and unexpected severe responses to a medication. They do have the potential to cause harm. c. Allergies: an immune response to a medication that causes a reaction that can be mild to life threatening. i. S/S: itchy, rash, hives, wheezes, SOB, swelling of face, lips and throat. 1. If we see these, we will stop the medication, call the doctor, D/C lines, check for antidotes, and give emergency care based on ABC’s. ii. Anaphylaxis can be life threatening and can kill someone. These s/s are increasingly intensified. iii. When administering any medications, the RN should ask about patient allergies to medications and what happens when they take them. 1. Ex: if a patient says they get N/V with a certain abx where it is expected, we will still give the med, but also may give an antiemetic. These are not s/s of allergic reaction, and we must educate the patient on it. 2. Ex: if a patient says they get hives when they take a certain abx, we will not give the medication and call the doctor for the next steps. 13. Intended effect, teratogenic effect, paradoxical effect a. Intended Effects: effects that we want to see and that are therapeutic when using the drug. i. Ex: with an antidepressant, we want to see a mood change, because that is the intended use of the drug. b. Teratogenic Effect: a drug induced birth defect that can cause harm to the fetus. i. Why we do not allow pregnant moms or those lactating to not take certain medications so they do not harm their child. 1. Ex: antiepileptic medications- carbamazepine. c. Paradoxical Effect: The opposite of the intended drug response. 1. Ex: Benzo’s may be used for sedation and insomnia treatment, but