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73 Cards in this Set
- Front
- Back
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Before starting a child on any CNS stimulant, what should the nurse do?
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Establish a baseline for the child (height, weight and VS)
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A patient is prescribed a CNS stimulant, What sould the nurse include in her teaching regarding this medication?
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Take the medication early in the day to avoid sleep interference
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How does a CNS stimulant work in a child?
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Results in a mild stimulation in the CNS that results in changing the childs behavior
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Your patient is taking Valproic acid (Depakote). What labs should the nurse monitor?
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Liver enzymes
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What medications should be given as first line treatment for pain in trigeminal neuralgia?
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Ideally, a non-narcotic should be given for the pain, such as, Gabapentin and Tegretol. If these don't relieve the pain, a narcotic such as morphine needs to be given.
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What is the therapeutic range for dilantin?
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10-20 mcg/mL
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What should the nurse do if the patient is to receive Dilantin, but their Dilantintherapeutic level is 26?
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This is over the 10-20 range. The nurse needs to hold the drug and call the physician.
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What is a side effect of Dilantin?
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Gingival hyperplasia
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What are some nursing considerations regarding gingival hyperplasia?
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he patient will need to adjust their mouth care routine. Use a soft-bristled toothbrush; gauze sponge; mouthwash
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What is Fosphenytoin (Cerebyx)?
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: Precursor to Dilantin. Metabolizes to Dilantin. Given by IV or IM injection. When being given by IM, the dose needs to be divided into 2 doses.
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What should the nurse teach the patient about Fosphenytoin?
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The patient needs to maintain adequate nutritional intake; no OTC medications; wear a medic-alert bracelet.
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A patient with seizure disorder and type 2 diabetes mellitus is receiving Dilantin. Why would you be concerned about this?
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Dilantin increases glucose levels. This needs to be monitored very closely since this patient already has high glucose levels.
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What should you teach your patient that is taking Tegretol?
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Tegretol can cause liver dysfunction. Monitor for unusual bleeding, dark urine, and clay colored stools
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Why would a patient that has suffered a stroke be receiving Dilantin?
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: Dilantin is to control seizure disorder. A stroke can cause seizures, due to the brain damage caused by the stroke. Dilantin is given to prevent this.
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What is a side effect of Dilantin that Is related to the cardiac system?
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Dysrhythmia – depresses the myocardium
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True or false- Does the patient that is taking Dilantin have to take the medication for the rest of their life?
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True
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Your patient is taking Dilantin. What must the nurse include in her patient teaching regarding this medication?
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Dilantin may cause reddish-brown urine. This is normal.
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A nurse has a patient that has tube feedings and is also taking Dilantin. What must the nurse be aware of in this situation?
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Dilantin is less effective in the presence of enteral tube feedings. It may interfere with the absorption of the drug. According to drug book- stop the enteral tube feedings 2 hours before and 2 hours after drug use. Power point says we may need to increase the dose of Dilantin.
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What is the drug of choice for status epilepticus?
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Ativan (lorazepam)
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A patient with Trigeminal Neuralgia is taking Tegretol to reduce pain. How would you monitor the effectiveness of the drug?
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The patient will have pain relief
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After giving Ativan for status epilepticus, What should the nurse monitor?
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Respiratory depression
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Your patient is taking Dilantin daily. What adverse reactions are you going to monitor for?
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Gingival hyperplasia; drowsiness and sedation; increase of glucose levels; blood dyscrasia; monitor for sore throat
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Your patient is taking Ethosuximide (Zarontin). What labs should the nurse monitor?
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CBC, liver function test (LFT), and therapeutic levels
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What is the therapeutic range for Zarontin?
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40-100 mcg/mL
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Your patient has Parkinson’s disease and has been taking Sinemet. How would you evaluate the effectiveness of the drug?
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The patient should be able to ambulate more effectively. No ataxia.
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What is the patho of Sinemet?
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Contains Levodopa and Carbidopa. Carbidopa delays the breakdown of Levodopa so it works longer.
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What should you include in your patient teaching about Sinemet?
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This medication manages symptoms. Does not cure, not permanent
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Your patient with Parkinson’s disease is taking L-dopa. What should you include in your patient teaching?
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Get up slowly (orthostatic hypotension); on and off phenomenon; sweat and urine may be darker
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True or false- You would administer Cogentin to your patient that has glaucoma.
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False. Cogentin should not be administered to patients with glaucoma
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What is a side effect of Mirapex that a patient should be warned about?
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Daytime sleepiness
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What should a patient with Parkinson’s disease that is taking Sinemet or Selegeline not take?
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Should not take Demerol or Haldol.
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What is the action of Neostigmine?
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Blocks the action of anticholinesterase drugs
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Your patient is taking Mestinon. What is an assessment finding that it may be excessive for the patient?
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Rigidity and spasms; increased salivation; clenching of the jaw
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Can pregnant women take Ergotamine?
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NO. Ergotamine is a pregnancy category X. It is contraindicated in pregnancy. Can cause uterine contractions/ abortion.
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: Your patient has a diagnoses of increased ICP and it taking Osmitrol. How would you evaluate if the medication is working?
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Assess neurological status (the answer is not I&O)
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A patient has cerebral edema following a stroke. Why would we be administering Osmitrol to this patient?
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To decrease ICP
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Plavix
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Antiplatelet
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Mannitol
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Osmotic diuretic
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Procardia
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Calcium channel blocker
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Decadron
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Corticosteroid
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Therapeutic levels of Tegretol?
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3-14 mcg/mL
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Therapeutic levels of Klonopin?
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20-80 mg/mL
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Therapeutic levels of Zarontin?
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40-100 mcg/mL
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Therapeutic levels of Luminal?
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15-40 mcg/mL
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Analeptic
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Stimulate the respiratory center of the brain and cardiovascular system. Nuvigil; Provigil
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Amphetamines
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Treats ADHD. Adderall; Ritalin
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What are amphetamines contraindicated in?
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Glaucoma patients
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What should be monitored for with the patient taking Strattera?
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Monitor for suicide ideation
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What are CNS stimulants used for?
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ADHD, drug induced respiratory depression, narcolepsy, sleep apnea, exogenous obesity
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Adverse reactions of CNS stimulants?
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Excessive CNS stimulation, hyperactivity, tachycardia, palpitations, insomnia
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Anticonvulsants
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Drugs used to manage seizure disorders. Depress abnormal nerve impulse discharges in the CNS
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Adverse reactions of anticonvulsants?
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Somnolence, nystagmus, gingival hyperplasia
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Tegretol should not be taken within 14 days of what?
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MAOI antidepressant
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What can Hydantoins cause?
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Hypotension, drowsiness, sedation, gingival hyperplasia (Dilantin only), blood dyscrasias, elevated glucose
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How should dilantin be taken if given orally?
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with a meal
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What is IV Dilantin diluted in?
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NS because dextrose causes the medication to crystallize.
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What can rapid IV administration of Dilantin cause?
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DYSRHYTHMIAS and hypotension
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What can Dilantin decrease the effectiveness of?
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Some birth control pills
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Why must you use extreme caution when administering a barbituate and Valproic acid or Depakote?
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May cause phenobarbital toxicity
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What can Valproic acid and Depakote cause?
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Blood dyscrasias, hepatotoxicity
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What labs need to be monitored in a patient taking Valproic acid or Depakote?
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CBC and liver enzymes
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What can benzodiazepines cause?
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Sedation, drowsiness, blood dyscrasias
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What can Symmetrel (antiparkinsonism drug) cause?
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Lightheadedness, dizziness, orthostatic hypotension (check B/P and P)
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What can Levodopa and Sinemet cause?
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Dizziness, dark sweat or urine
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What can anticholinergics cause?
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Dry mouth, blurred vision, dizziness, orthostatic hypotension, urinary retention
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What are anticholinergics contraindicated in?
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Glaucoma, prostatic hypertrophy, myasthenia gravis
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What is Tolcapone (antiparkinsonism drug) associated with?
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Liver damage and liver failure
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When giving Apokyn (antiparkinsonism drug) what else needs to be initiated?
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Antiemetic therapy must be initiated with this drug due to vomiting. May cause profound hypotension and N/V
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What does Palodel (antiparkinsonism drug) reduce the effectiveness of?
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Oral contraceptives
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What are S/S of liver dysfunction?
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Persistent nausea, fatigue, lethargy, anorexia, jaundice, dark urine, clay colored stools, unusual bleeding, pruritus, and RUQ tenderness
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What vitamin should the patient taking levodopa avoid?
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B6 (pyridoxine). Interferes with the action if Levodopa. (found in whole grains, fortified cereals, liver, and green vegetables)
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What are cholinergic drugs contraindicated in?
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Asthma, PUD, CAD, hyperthyroidism
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What is Urecholine contraindicated in?
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Mechanical obstruction of the GI or GU tracts
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