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ear drops - ** VERIFIED ANSWERS ** โโ INSTILL AT ROOM TEMP/ child- down and back/ adult- up and back eye drops - ** VERIFIED ANSWERS ** โโ important to instill the eye drop medication into the conjunctival sac (not the eyeball/cornea). inner to outer enema - ** VERIFIED ANSWERS ** โโ patient lays on left side pharmacokinetic - ** VERIFIED ANSWERS ** โโ what happens in the body once med is administered -Absorption -Distribution/ Binding -Metabolism -Renal Excretion first-pass effect - ** VERIFIED ANSWERS ** โโ A swallowed pill that goes into the liver through the portal vein where some of the drug becomes inactive protein binding - ** VERIFIED ANSWERS ** โโ protein (usually albumin) binds to medication to help chemicals move through. When the medication is bound to the protein it is not available to perform its action in the body True or False - ** VERIFIED ANSWERS ** โโ True
free drug - ** VERIFIED ANSWERS ** โโ The amount that is left not bound called the__________________and it performs the pharmacologic response pharmacodynamics phase - ** VERIFIED ANSWERS ** โโ refers to the effects drugs will have on a patient and the mechanism of their actions. How do antacids affect drug absorption? - ** VERIFIED ANSWERS ** โโ Antacids increase the PH (alkaline) of gastric juices which causes a decrease in the disintegration process Most drugs (excluding enteric coated or XR) need an acidic environment to break down. Lipid soluble drugs are not able to pass the membrane without a protein/ enzyme carrier. True or false - ** VERIFIED ANSWERS ** โโ False In the GI tract the lining is made up of a mucous membrane composed of lipids and proteins which allows lipid soluble drugs to easily pass through. If the drug is water soluble it will need a protein or enzyme carrier to pass through Benzodiazepine - ** VERIFIED ANSWERS ** โโ Alprazolam, Midazolam, Lorazepam,Diazepam NMS or Neuroleptic Malignant Syndrome - ** VERIFIED ANSWERS ** โโ Delirium with fever, catalepsy, and muscle rigidity, and blood pressure instability What 2 types of medication can cause Neuroleptic Malignant Syndrome? - ** VERIFIED ANSWERS ** โโ antipsychotics and antiemetics can cause this life threatening condition Local anesthetic - ** VERIFIED ANSWERS ** โโ Lidocaine
MAOI - ** VERIFIED ANSWERS ** โโ phenelzine sulfate atypical antipsychotic - ** VERIFIED ANSWERS ** โโ aripiprazole tricyclic (TCA) - ** VERIFIED ANSWERS ** โโ amitriptyline serotonin and norephinephrine reuptake inhibitor - ** VERIFIED ANSWERS ** โโ venlafaxine mood stabalizer - ** VERIFIED ANSWERS ** โโ lithium What are Phenobarbitol used for? - ** VERIFIED ANSWERS ** โโ Treats seizures, status epilepticus What are 2 main side effects of Phenobarbitol - ** VERIFIED ANSWERS ** โโ respiratory depression / sedation nice to know: depression, bradycardia, hypotension, dizziness, confusion, drowsiness, headache, impaired judgment, nightmares, constipation, ED. What does Alprozolam interact with? - ** VERIFIED ANSWERS ** โโ Grape fruit / juice While taking benzodiazepines, the patient should avoid drinking alcohol & green tea True or false - ** VERIFIED ANSWERS ** โโ True zolpidem - ** VERIFIED ANSWERS ** โโ nonbenzodiazepine Ambien, Ambien CR
Who am I? Nonbenzodiazepine Treats insomnia, take 15-30 min before bed Avoid alcohol, OTC sleep meds Used short term, can build tolerance - ** VERIFIED ANSWERS ** โโ zolpidem What is happening during absorption - ** VERIFIED ANSWERS ** โโ drug gets into bloodstream What is the primary site for metabolism? - ** VERIFIED ANSWERS ** โโ liver What affects absorption? - ** VERIFIED ANSWERS ** โโ High fat foods Decreased gastric emptying Exercise GI acidity Who am I? When drug can accumulate in body Decreases plasma protein levels need to watch drug combination Portion bound to protein is inactive Free drug can reach site of action - ** VERIFIED ANSWERS ** โโ High protein bound drug The time it takes for the drug to start working ____________ - ** VERIFIED ANSWERS ** โโ onset The highest concentration in the blood ________________ - ** VERIFIED ANSWERS ** โโ peak
- No caffeine, alcohol, nicotine, heavy meals within 6 hours of bed
- warm bath
- warm milk
- relaxing music General anesthesia includes 2 different methods of administering medication. What are the methods and preferred meds to use? - ** VERIFIED ANSWERS ** โโ 1. inhalation - nitrous oxide
- IV - midazolam and propofol What are 3 adverse effects you should watch for in a patient taking zolpidem? - ** VERIFIED ANSWERS ** โโ 1. anterograde amnesia
- hangover effect
- suicide ideations What medication is used for dental procedures, thoracentesis, lumbar puncture - ** VERIFIED ANSWERS ** โโ Lidocaine What are 2 adverse reactions to a spinal epidural? - ** VERIFIED ANSWERS ** โโ Hypotension and Respiratory depression. Who am I? Use: anti inflammatory, pain, mildly works on fever Cox 1 and Cox 2 inhibitor Adverse - GI ulcers, bleeding, peripheral edema Stop before surgery Don't take with aspirin or alcohol - ** VERIFIED ANSWERS ** โโ Ibuprofen (NSAID) Who am I? Used for inflammation, pain, fever, antiplatelet
Not given to children Adverse - GI ulcers, bleeding Take with food, no alcohol or warfarin Stop before surgery - ** VERIFIED ANSWERS ** โโ Asprin (A salicylate) Who am I? Not given to patients with heart disease No GI symptoms Many drug interactions Not given with Ginko Biloba Use - pain, inflammation - ** VERIFIED ANSWERS ** โโ celecoxib NSAID Cox 2 inhibitor Who am I? Reduces uric acid levels Assess kidney/liver function Decrease purine foods Can have GI side effects - ** VERIFIED ANSWERS ** โโ allopurinol What is allopurinol used for? - ** VERIFIED ANSWERS ** โโ gout What does COX1 do? - ** VERIFIED ANSWERS ** โโ Protects stomach lining and regulates platelets What does COX 2 do? - ** VERIFIED ANSWERS ** โโ Triggers inflammation and pain What are the nursing responsibilities when a patient is taking Allopurinol? - ** VERIFIED ANSWERS ** โโ Always increase fluid intake
miosis, urinary retention, constipation, sedation - ** VERIFIED ANSWERS ** โโ Morphine What can pinpoint pupils indicate? - ** VERIFIED ANSWERS ** โโ overdose What is the antidote for opioids? - ** VERIFIED ANSWERS ** โโ Naloxone What are some nursing responsibilities when a patient is receiving morphine? - ** VERIFIED ANSWERS ** โโ Assess VS for baseline Assess pain level before and after admin Fall precautions What are the adverse effects of morphine? - ** VERIFIED ANSWERS ** โโ Respiratory depression, decreased HR, itching, euphoria, and blurred vision What is Sumitriptan used for? - ** VERIFIED ANSWERS ** โโ Used in the treatment of migraines - however contraindicated in coronary artery disease and hypertension When do you teach the patient to take their sumitriptan? - ** VERIFIED ANSWERS ** โโ Take with the first sign of symptoms or aura. Which medication could have these adverse effects? decreased or increased heart rate hearing loss seizures blurred vision thromboembolism - ** VERIFIED ANSWERS ** โโ Sumitriptan When would you avoid giving acetaminophen to a patient? - ** VERIFIED ANSWERS ** โโ If patient has reduced liver function or if you know patient has a history of alcoholism
What medication would require these nursing interventions: Seizure precautions Monitor lab for therapeutic level (10-20) & CBC Advise patient to wear medic alert bracelet, don't stop abruptly, attend dental check ups - ** VERIFIED ANSWERS ** โโ Phenytion What side effects do you expect to see in a patient taking Phenytoin? - ** VERIFIED ANSWERS ** โโ 1. Gingival hyperplasia
- headaches
- hyperglycemia (Watch blood glucose)
- dizziness/ drowsiness
- discolored urine (pink-red, brown color) What are 3 adverse reactions you could possibly see in a patient receiving Phenytoin? - ** VERIFIED ANSWERS ** โโ 1. Thrombocytopenia
- Leukoctyopenia
- Steven Johnson's syndrome What is something the nurse would want to be sure to teach a patient on Phenytoin? - ** VERIFIED ANSWERS ** โโ Increase calcium, folic acid and vitamin d intake. (specifically calcium) Use back up birth control Gingival Hyperplasia is very common What medication requires these Nursing interventions/ patient teaching? Take in the AM, with a good breakfast Avoid caffeine Monitor VS, sleep, weight Report palpitations, tachycardia - ** VERIFIED ANSWERS ** โโ Methylphenidate
What disease would the nurse confirm the patient DOES NOT HAVE before administering Lorazepam? - ** VERIFIED ANSWERS ** โโ Glaucoma Who am i? For major depression Watch for orthostatic hypotension, anticholinergic effects Can lead to EPS - ** VERIFIED ANSWERS ** โโ amitriptyline (TCA) Who am I? Monitor for orthostatic hypotension, drowsiness, memory impairment, fatigue, suicide ideation Don't stop abruptly Assess for EPS - ** VERIFIED ANSWERS ** โโ Aripiprazole Atypical antipsychotic What is Aripiprazole used for? - ** VERIFIED ANSWERS ** โโ schizophrenia, bipolar disorder What should the nurse monitor in a patient taking amitriptyline? - ** VERIFIED ANSWERS ** โโ Monitor CBC. Watching for blood dyscrasias Monitoring for s/s of EPS Fall risk- so slow position changes due to orthostatic hyertension Who am I? SSRI Anticholinergic symptoms, suicide ideation Takes weeks to work Take at bedtime Not taken with other CNS depressants - ** VERIFIED ANSWERS ** โโ fluoxetine
What are 4 reasons a patient would be taking fluoxetine? - ** VERIFIED ANSWERS ** โโ depression, OCD, PTSD, bulimia What food would fluoxetine interact with? - ** VERIFIED ANSWERS ** โโ grapefruit juice If the patient has _______________, they should not be prescribed fluoxetine. - ** VERIFIED ANSWERS ** โโ glaucoma (increased pressure due to SSRI) Who am I? used for major depression, anxiety, panic disorder Don't stop abruptly Adverse - suicide ideation, Steven Johnson syndrome, NMS Don't take with herbals, interacts with prescribed meds - ** VERIFIED ANSWERS ** โโ Venlafaxine SNRI Who am I? Diet restrictions - no tyramine or meds with phenylephrine Last resort Not given with TCAs - ** VERIFIED ANSWERS ** โโ Phenelzine sulfate MAOI What types of foods contain tyramine? - ** VERIFIED ANSWERS ** โโ aged cheese, yogurt, coffee, chocolate, raisins, bananas, liver, pickled foods, yeast, wine, & beer What can tyramine cause in someone taking MAOI's? - ** VERIFIED ANSWERS ** โโ hypertensive crisis
What are some nursing considerations while patient is taking lithium for bipolar disorder? - ** VERIFIED ANSWERS ** โโ 1. Monitor lithium levels. range 0.8-1. mEq/L
- Monitor sodium, can decrease sodium
- Monitor hydration status (I/O's, BUN, Creatinine, daily weight)
- Increase fluids What OTC medication should some on on lithium avoid? - ** VERIFIED ANSWERS ** โโ NSAIDs What type of antidepressant is considered first line therapy for depression? - ** VERIFIED ANSWERS ** โโ SSRI Any drug that stimulates the CNS can cause a hypertensive crisis when taking a MAOI True or False - ** VERIFIED ANSWERS ** โโ True Lithium has a narrow therapeutic range. (0.8-1.2) If patient's lithium levels are above 1.5, patient can become ___________ and show these symptoms: vomit, diarrhea, blurred vision, tremor, confusion - ** VERIFIED ANSWERS ** โโ toxic The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine. The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect? - ** VERIFIED ANSWERS ** โโ Acute dystonia A patient has been taking aripiprazole for 2 weeks. The client reports drowsiness and headache. What will the nurse do? - ** VERIFIED ANSWERS ** โโ Explain to the patient that these are common side effects of the medication. Pick the incorrect statements about antiepileptic drug (AED) therapy
- AED therapy can be stopped when seizures are stopped.
- AED therapy is usually lifelong.
- Consistent dosing is the key to controlling seizures.
- A dose may be skipped if the patient is experiencing adverse effects.
- Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity. - ** VERIFIED ANSWERS ** โโ 1 & 4 The nurse is reviewing the medications for a patient recently diagnosed with ADHD and prescribed methylphenidate. Which previous medical condition in the patient's history should the nurse report to the prescriber? - ** VERIFIED ANSWERS ** โโ Seizure disorder The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor (MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich - ** VERIFIED ANSWERS ** โโ c. Salami and Swiss cheese sandwich You need to recognize these s/s. If a patient is showing the following, what is the patient most likely experiencing. "Lethal" Loss of consciousness (coma) Eye pupils pinpoint and then progress to dilation and fixed as it progresses and body shuts down Tachycardia (weak) Have cold and sweating skin Absent reflexes Low and shallow respirations - ** VERIFIED ANSWERS ** โโ Drug overdose Patient is experiencing withdraw symptoms. What would the nurse likely see? - ** VERIFIED ANSWERS ** โโ "CRAVES" (mild to severe) Convulsions
