Pharmacology Success Mod Iii

Front 1

The nurse adm the narcotic agonist naloxon (Narcan) to a 7yr old chid who drank a large bottle of narcotic cough syrup. What intervention should the nurse be prepared to implement?

Back 1

Adm Narcan again in 30 min. (see hint)

Hint 1

Narcan has a short half-life and could wear off before the effects of the narcotic cough syrup. The nurse should observe for signs of returning respiratory depression and be ready to intervene.

Front 2

Acute tx of respiratory depression with an opioid antagonist such as ______ is required when ↓ or shallow opioid-induced respirations are life-threatening.

Back 2

Naloxone (Narcan)

Hint 2

Therapeutic: antidotes (for opioids)
Pharmacologic: opioid antagonists

Front 3

A pt has a new physician order to use a fentanyl (Sublimaze) transdermal patch for treatment of chronic pain. Which of the following instructions should the nurse provide to the pt regarding this med?

Back 3

Hold the patch in place for 10 - 20 seconds to ensure good skin contact

Hint 3

The site should be cleansed beforehand with water only and it should be applied to the upper torso. After removal, the patch should be folded in half and flushed down the toilet or placed in a sharps container

Front 4

An older adult pt receiving home health care services has been prescribed acetaminophen with codeine (Tylenol #3) for mild pain following a denture procedure. What common adverse effect would the home care nurse assess this pt at the next routine visit?

Back 4

Constipation

Hint 4

Codeine produces similar adverse effects as observed with other opioid agonists with a higher risk for constipation, particularly in older adults.

Front 5

The nurse has an order to adm an opioid analgesic to a client who was admitted via the emergency dept following a MVA. The nurse would use special care when adm this type of drug if the client has a history of ______.

Back 5

COPD

Hint 5

Opioids should also be used with extreme caution in conditions such as acute bronchial asthma or any respiratory impairment or chronic disease, increased intracranial pressure (may increase), or severe inflammatory bowel disease (risk of toxic megacolon).

Front 6

A pt with alcohol dependence tells the nurse that he has been taking an oral "antagonist" med since completing detoxification. the nurse concludes that this pt most likely has what med ordered?

Back 6

Nnaloxone (Narcan)Therapeutic: antidotes (for opioids)
Pharmacologic: opioid antagonists

Hint 6

Naloxone, anltrexone, and nalmefene are opioid antagonists that competitively displace the opioid analgesics from their receptor sites, thus reversing their effects.

Front 7

The nurse would caution the pt with osteoarthritis who is taking ibuprofen (Motrin) on a regular basis that this med could lead to what adverse effect over time?

Back 7

Gastrointestinal bleeding

Hint 7

Therapeutic: antipyretics, antirheumatics, nonopioid analgesics, nonsteroidal anti-inflammatory agents
Pharmacologic: nonopioid analgesics
Like other nonselective COX inhibiors, inbuprofen poses a risk for GI bleeding. It may also result in renal failure in pts with preexisting moderate renal impairment. Other adverse effects include edema, HTN (usually modest), and GI discomfort.

Front 8

Specific ______ that are considered inappropriate for use in older adults include propoxyphene (Darvon products), pentazocine (Talwin), and meperidine (Demerol).

Back 8

Analgesics

Hint 8

These agents are more toxic in older adults and much safer analgesics are available.

Front 9

True or False: An older adult pt requires pain med following a surgical procedure. The nurse would question an order for acetaminophen with codeine (Tylenol #3), because the order is inappropriate for use in older adults?

Back 9

False

Hint 9

Analgesics

Front 10

A pt ċ a hx of chronic pain is being transferred to the nursing unit. Assuming the appropriate medical orders are written, what three steps of pain management would you need to recall to treat pain according to its severity?

Back 10

Mild pain is rated 1-3 by pts & is generally effectively treated with nonopioid and nonpharmacologic adjuvants. Moderate pain 4-6, the previous interventions + a weak opioid combination. Severe pain 7-10, the pt would benefit from strong opioids along with nonpharmacologic adjuvants

Hint 10

Analgesics

Front 11

A pt has been admitted to the hospital with aspirin overdose. What is the recommended treatment that should be provided to this pt?

Back 11

Remove the aspirin from the body using some means, such as gastric lavage or emesis, exchange transfusion, hemodialysis, peritoneal dialysis, or (in severe cases) hemoperfusion.

Hint 11

Analgesics

Front 12

A postoperative pt has been prescribed morphine sulfate for relief of incisional pain. For what seious adverse effects of this drug would you assess this pt?

Back 12

Some serious adverse effects include seizures, tinnitus, jaundice (from hepatic toxicity), respiratory difficulty or RESPIRATORY DEPRESSION, excitability (paradoxical reaction seen mainly in children), confusion, and tachycardia.

Hint 12

Analgesics

Front 13

Physiologic responses to acute pain generated by the ______ nervous system include sweating, pallor, restlessness, agitation and /or ↑BP, P, or RR.

Back 13

sympathetic

Hint 13

Analgesics

Front 14

Each person reacts to pain on the basis of ______, ______, and ______ influences.

Back 14

physical, emotional, cultural

Hint 14

Analgesics

Front 15

______ pain, in which a dysfunction in the CNS or PNS affects nerve conduction in a negative way, often involves neural supersensitivity.

Back 15

Neuropathic

Hint 15

Analgesics

Front 16

______ pain, the presence of severe discomfort or an uncomfortable sensation, lasting from 1 sec to less than 6 mnths has a sudden onset and usually subsides with tx.

Back 16

Acute

Hint 16

Analgesics

Front 17

The physiologic effect of vivid dreams occurs in the ______ stage of anesthesia.

Back 17

Analgesia

Hint 17

Anesthetics

Front 18

The physiologic effect of numbness occurs in the ______ stage of anesthesia.

Back 18

Analgesia

Hint 18

Anesthetics

Front 19

The physiologic effect of rapid eye movement occurs in the ______ stage of anesthesia.

Back 19

Excitement

Hint 19

Anesthetics

Front 20

The physiologic effect of ↓ body temp occurs in the ______ stage of anesthesia.

Back 20

Surgical anesthesia

Hint 20

Anesthetics

Front 21

The physiologic effect of exaggerated reflexes occurs in the ______ stage of anesthesia.

Back 21

Excitement

Hint 21

Anesthetics

Front 22

The physiologic effect of laughter occurs in the ______ stage of anesthesia.

Back 22

Excitement

Hint 22

Anesthetics

Front 23

The physiologic effect of vasomotor collapse occurs in the ______ stage of anesthesia.

Back 23

Medullary paralysis (toxic stage)

Hint 23

Anesthetics

Front 24

The physiologic effect of shallow respirations occur in the ______ stage of anesthesia.

Back 24

Surgical anesthesia

Hint 24

Anesthetics

Front 25

The two major categories of anesthesia are general and ______ or ______.

Back 25

regional or local

Hint 25

Anesthetics

Front 26

The advantage of balanced anesthesia is a ↓reported incidence of postoperative ______, and ______.

Back 26

N/V, pain

Hint 26

Anesthetics

Front 27

Malignant hyperthermia is a dangerous adverse effect of ______, ______ anesthetics.

Back 27

inhaled, fat-soluble

Hint 27

Anesthetics

Front 28

______ anesthesia produces analgesia and amnesia but not muscular relaxation.

Back 28

Dissociative

Hint 28

Anesthetics

Front 29

______ ______, an anesthetic gas, is the most commonly used agent for analgesia during dental surgery, minor surgery, and obstetric procedures.

Back 29

Nitrous oxide

Hint 29

Anesthetics

Front 30

______ is the only volatile anesthetic agent that sensitizes the myocardium to the effects of catecholamines or sympathomimetic agents.

Back 30

Halothane: Interferes with the response of the cardiovascular musculature.

Hint 30

Anesthetics

Front 31

The class of drugs know as ______ are most often used for conscious sedation in which full anesthesia is not required such as during endoscopy, or as a premedication or adjunct in balanced anesthesia.

Back 31

benzodiazepines

Hint 31

Anesthetics

Front 32

______ is a rapid-acting nonbarbiturate IV anesthetic (that is often referred to as a dissociative anesthetic) and is a derivative of phencyclidine, a psychotomimetic (Tending to induce hallucinations, delusions, or other symptoms of a psychosis.) drug of abuse.

Back 32

Ketamine: A general anesthetic given IV or IM in the form of its hydrochloride that produces catatonia and profound analgesia with little relaxation of the skeletal muscles.

Hint 32

Anesthetics

Front 33

The adm of ______ ______ provides surgeons with easier access to an ↑ visualization of the surgical site and prevents inadvertent pt movement during the procedure.

Back 33

neuromuscular blockers

Hint 33

Anesthetics

Front 34

A pt who will be undergoing a surgical procedure has had a preoperative visit with the anesthesiologist. The pt asks you why anesthesia seems so complicated and why so many drugs are used. What would you consider when formulating a response?

Back 34

A combo of drugs is necessary to produce all of the desired effects sought ċ anesthesia. Analgesia, muscle relaxation, unconsciousness, and amnesic effects are not produced safely by a single anesthetic.

Hint 34

Balanced anesthesia involves the induction of anesthesia ċ a combo of drugs, each for its own specific effect, rather than ċ a single drug that has multiple effects

Front 35

A pt in the oral surgeon's ofc is having a tooth extracted using nitrous oxide for anesthesia. What adverse effects would you be concerned about on awakening of the pt and how will you promote oxygenation after the procedure?

Back 35

Nitrous oxide adm may result in postOp N/V, or delirium. At the termination of anesthesia, the rapid movement of large amts of nitrous oxide from the circulation into the lungs may dilute the oxygen in the lungs. This dilution may result in a phenomenon known as diffusion hypoxia. To prevent this, the anesthetis usually adms 100% oxygen to clear nitrous oxide from the lungs. During recovery the nurse adms humidiified oxygen by mask and encourages the pt to breathe deeply to promote ventilation.

Hint 35

Anesthetics

Front 36

A pt has a new order for a one-time dose of a benzodiazepine. What could be the possible reasons this drug would be ordered in this manner?

Back 36

Benzodiazepines are most often used for conscious seation in which full anesthesia is not required such as during endoscopy, or as a premedication or adjunct in balanced anesthesia.

Hint 36

Anesthetics

Front 37

A pt ċ PD is scheduled for surgery. Prior to receiving anesthesia ċ halothane, the pt should have Levodopa discontinued 6-8 hrs prior to surgery to reduce the risk of?

Back 37

Cardiac dysrhythmias

Hint 37

Halothane is the only volatile anesthetic agent that sensitizes the myocardium to the effects of catecholamines (epinephrine, norepinephrine, or dopamine) or sympathomimetic agents (e.g., ephedrine, metaraminol), leading to risk of serious cardiac dysrhythmias in the presecence of halothane. Levodopa, which ↑ the quantity of dopamine in the CNS, should be discontinued at least 6-8 hrs before halothane is adm.

Front 38

A nurse working in the postanesthesia care unit would assess the postOp pt who received barbiturates during anesthesia for which most common adverse effect during the recovery period?

Back 38

Shivering and trembling

Hint 38

The most common adverse effects during the recovery period are shivering and trembling. N/V, prolonged somnolence, and H/A are less commonly reported. Serious adverse effects include emergence delirium (↑excitability, confusion, and hallucinations), cardiac dysrhythmias (tachycardia, bradycardia, or myocardial depression), allergic response (bronchospasm, rash, hives, hypotension, and edema of eyelids, lips, or face), respiratory depression, and thrombophlebitis.

Front 39

A pt is about to receive an IV dose of midazolam (Versed) as part of preoperative med in the preoperative holding area. The nurse explains that an advantage to the use of this drug is?

Back 39

Amnesic effect to ↓recall of events near the time of adm.
Therapeutic: antianxiety agents, sedative/hypnotics
Pharmacologic: benzodiazepines

Hint 39

Benzodiazepines such as midazolam (versed) induce amnesia at ↑doses. This is an advantage for pts who are undergoing painful or uncomfortible procedures because it ↓recall of traumatic events while under the influence of the agent.

Front 40

A pt in the ICU is receiving propofol (Diprivan) by continuous IV drip for sedation. The nurse attributes the development of which assessment finding to adverse effects of the drug?

Back 40

Reduced respiratory rate

Hint 40

Propofol is a respiratory depressant and may produce apnea and cardiac depression depending on the dose, rate of adm, and concurrent drugs adm. Bradycardia and hypotension may also occur frequently. N/V, and involuntary muscle movement are commonly reported.

Front 41

A pt who was intubated and placed on mech ventilation is "fighting" the ventilator. Before beginning to adm scheduled meds, including vecuronium (Norcuron), the nurse would ensure that there is an order for which other type of med?

Back 41

A benzodiazepine

Hint 41

With muscle relaxation caused by vecuronium, the ventilated pt may appear comfortable and relaxed, but unless he or she is receiving other meds (eg, opioid analgesics, benzodiazepines, or other anesthetics), the pt is likely to be very anxious and uncomfortable. As such, it is critical to adm analgesics for pain and benzodiazepines or other anesthetics that affect level of consciousness and memory prior to and during treatment with neuromuscular blockers.

Front 42

A pre-Op pt reports a fam hist of malignant hyperthermia to the anesthesiologist. The nurse reading the preanesthesia report ensures that which of the following meds is readily available for use with this pt if needed?

Back 42

dantrolene sodium (Dantrium)

Hint 42

Malignant hyperthermia is a life-threatening condition with a mortality rate of 30%-40%. The OR team, within which the nurse has a key role, should have a preplanned course of action, including the availability of dantrolene sodium, a comlete change of anesthesia circuit, hyperventilation with 100% oxygen, methods to ↓ body temp rapidly, and other symptomatic treatment.

Front 43

A pt in the ER requires sutures following an injury. The nurse would remove the lidocaine solution containing epinephrine from the room to reduce the risk of its accidental use if the pt needs sutures in which of the following body areas?

Back 43

Fingertip, toes, ears, nose, and penis

Hint 43

Vasoconstrictors such as epinephrine and norepinephrine are used with the local anesthetic to ↓systemic absorption and prolong the duration of action of the anesthetic. They are not used for nerve blocks in areas with end arteries (fingers, toes, ears, nose, and penis) because ischemia may develop, resulting in gangrene. Lidocaine is considered the prototype local anesthetic.

Front 44

Sedatives and hypnotics are ______ drugs. The major difference beween them is the degree of ______ induced.

Back 44

CNS-depressant; CNS depression

Front 45

Some general pharmacologic properties of ______ include muscle relaxant, antianxiety, antiseizure, and hypnotic effects.

Back 45

benzodiazepines

Hint 45

Hypnotics

Front 46

The ______ and the ______ are the sites of cytochrome P450 metabolism for either the active drug or the metabolite dosage forms of the benzodiazepines.

Back 46

GI tract, liver

Front 47

What data would you consider it necessary to collect from a pt receiving sedatives/hypnotics during the assessment phase of the nursing process?

Back 47

A combination of drugs is necessary to produce all of the desired effects sought with anesthesia. Analgesia, muscle relaxation, unconsciousness, and amnesic effects are not produced safely by a single anesthetic Balanced anesthesia involves the induction of anesthesia with a combination of drugs, each for its own specific effect, rather than with a single drug that has multiple effects.

Front 48

The nurse interprets that a pt is experiencing a paradoxical reaction to a benzodiazepine after noting that the pt is exhibiting which manifestation?

Back 48

Hallucinations

Hint 48

Paradoxical neurologic reactions with benzodiazepines are rare but include insomnia, ↑excitability, hallucinations, and apprehension. The most common adverse effects of benzodiazepines include drowsiness, hiccups (especially with midazolam [Versed]), lassitude (weakness; exhaustion), and loss of dexterity.

Front 49

After reading the pts history and physical report, the RN concludes that a benzodiazepine has been ordered for tx of which of the following pt health problems?

Back 49

Anxiety disorder

Hint 49

The most common indications for benzodiazepines include anxiety disorders, alcohol withdrawal, preOp med, insomnia, seizure disorders, and neuromuscular disease. They are also used to induce amnesia during cardioversion and endoscopic precedures.

Front 50

Antiannxiety or anxiolytic agents are used to?

Back 50

reduce feelings of anxiety

Hint 50

Antianxiety, Sedative, and Hypnotic Drugs

Front 51

______ sleep is also referred to as paradoxical or dreaming sleep.

Back 51

REM (rapid eye movement)

Hint 51

Antianxiety, Sedative, and Hypnotic Drugs

Front 52

Insomnia is a frequent concern of ______.

Back 52

older adults

Hint 52

Antianxiety, Sedative, and Hypnotic Drugs

Front 53

______ is indicated for the tx of benzodiazepine overdose or to reverse the sedative effects of benzodiazepines following surgical or diagnostic procedures.

Back 53

Flumazenil (Romazicon)

Hint 53

Antianxiety, Sedative, and Hypnotic Drugs

Front 54

Zolpidem is used for the short-term treatment of ______.

Back 54

insomnia

Hint 54

Antianxiety, Sedative, and Hypnotic Drugs

Front 55

______ is indicated for the treatment of anxiety disorders, and is considered to be equivalent in efficacy to the benzodiazepines, with usually less sedation.

Back 55

Buspirone (BuSpar)

Hint 55

Antianxiety agents

Front 56

In addition to the standard nursing care plan for a pt receiving an antianxiety drug, what special considerations would you be aware of when the pt is a child?

Back 56

In addition to standard aspects of the nursing care plan for antianxiety drugs, the pediatric considerations should include references to the ↑ susceptibility of children to the CNS-depressant effects of benzodiazepines; danger of impaired functions ċ chronic use of clonazepam; the contraindications in children for buspirone, methyprylon, & for hyperactive or psychotic children, diazepam; the importance of following manufacturer's dosage instructions; avoiding, when possible, concurrent use of other CNS depressants; monitoring excessive sedation, lethargy, or lack of coordination; monitoring for paradoxical reactions (is when medical tx, usually a drug, has an opposite effect to an effect normally expected) ċ use of barbiturates.

Hint 56

Antianxiety, Sedative, and Hypnotic Drugs

Front 57

A young adult pt reports at a routine physical examination that she has been experiening ↑ incidences of insomnia. What nonpharmacologic approaches would you suggest to the pt to try to resolve insomnia?

Back 57

Nonpharmacologic supportive measures to induce sleep could include relaxation therapy, reductions of environmental stimuli, developing regular hs routines, and/or taking a warm decaffeinated drink.

Hint 57

Antianxiety, Sedative, and Hypnotic Drugs

Front 58

An older adult pt has a history of liver disease. The nurse anticipates what antiaxiety med would be most appropriately ordered for this pt?

Back 58

lorazepam (Ativan)

Hint 58

The long-acting benzodiazepines (BZ's) and their active metabolites are more apt to accumulate, especially in older adults, resulting in an ↑ risk for falls and hip fractures. BZs that do not undergo metabolism via conjugation and cytochrome P450 metabolism tend to have inactive metabolites and shorter durations of action (lorazepam [Ativan] and oxazepam [Serax]). These agents are often preferred in older adults and those with liver disease.

Front 59

A pt with generalized anxiety disorder also has a history of substance abuse. The nurse concludes that which of the following meds has indications for long-term use that are consistent with the needs of this pt?

Back 59

buspirone (BuSpar)Therapeutic: antianxiety agents

Hint 59

Individuals with a history of substance abuse often have concurrent anxiety, often in the context of other psychiatric conditions. For generalized anxiety disorder, many clinicians would consider the use of buspirone on a long-term basis, and a nonbenzodiazepine such as hyproxyzine for short-term management

Front 60

The nurse would monitor a pt receiving PRN doses of hydrOXYzine (Vistaril) for what adverse effects of therapy?

Back 60

Sedation
Therapeutic: antianxiety agents, antihistamines, sedative/hypnotics

Hint 60

Adverse effects include sedation, which usually disappears after a few days of therapy or when the dosage is ↓; and anticholinergic adverse effects such as dry mouth, blurred vision, and constipation.

Front 61

The nurse is assigned to the care of a pt who is scheduled to have an electroencephalogram performed. The pt tells the nurse that the physician is going to order a sedative before the procedure. The nurse anticipates that the pt is referring to what med that is optimal for this use?

Back 61

cholral hydrate (Noctec); Chloral hydrate is indicated for nocturnal sedation in all types of pts and especially for the ill, the young, & the elderly pt.

Hint 61

Chloral hydrate is indicated as a sedative and as a hypnotic. Chloral hydrate is unique among the sedatives in that it has minimal impact on electroencephalogram (EEG) readings, making it an ideal sedative for conscious sedation before EEG evaluations for seizure potential.

Front 62

The physician has written a prescription for a hypnotic med as a sleep aid for an older adult pt. In providing med teaching that enhances pt safety, the nurse recomends that the pt try to limit its use to what frequencies?

Back 62

3 to 4 times per week

Hint 62

When possible, prescribers often suggest that older adults limit their intake of hypnotics to 3 or 4 times a week, which allows pts to select the nights on which the need to take their meds. This schedule usually results in enhanced effectiveness, ↓ daytime drowsiness or sedation, and a ↓ potential for induing tolerance to the med.

Front 63

Chlorpromazine is a?

Back 63

Phenothiazine derivative

Hint 63

Psychotherapeutic drugs

Front 64

Eskalith is a?

Back 64

MAOI

Hint 64

Psychotherapeutic drugs

Front 65

Amitriptyline is a?

Back 65

tricyclic antidepressant

Hint 65

Psychotherapeutic drugs

Front 66

Isocarboxazid is a?

Back 66

tricyclic antidepressant

Hint 66

Psychotherapeutic drugs

Front 67

Prozac is a?

Back 67

tricyclic antidepressant

Hint 67

Psychotherapeutic drugs

Front 68

Nardil is a?

Back 68

MAOI

Hint 68

Psychotherapeutic drugs

Front 69

Nursing management of psychotherapeutic agents docuses on, among other things, monitoring the pts ______ and ______ responses to the meds.

Back 69

behavioral, affective

Hint 69

Psychotherapeutic drugs

Front 70

Although the exact mech of action for the typical antipsychotics is unkown, their major therapeutic effects and adverse effects result from ______ blockade in specific areas of the CNS.

Back 70

Tourette

Hint 70

Psychotherapeutic drugs

Front 71

Haloperidol is used in the tx of schizophrenia, psychosis, and for the control of tics associated with ______ syndrome.

Back 71

Antipsychotic, neuroleptic

Hint 71

Psychotherapeutic drugs

Front 72

______ or ______ drugs are agents that affect cognitive thought processes and affect dopaminergic receptors.

Back 72

Abnormal Involuntary Movement

Hint 72

Psychotherapeutic drugs

Front 73

Because symptoms of withdrawal may be pronounced for 1-3 weeks after abrupt discontinuation of antidepressants, whenever possible, they should be ______ to avoid or minimize these effects.

Back 73

tapered

Hint 73

Psychotherapeutic Drugs

Front 74

Pediatric pts with chickenpox, CNS infections, measles, dehydration, gastroenteritis, or other acute illnesses with be at special risk of developing adverse reactions to psychotherapeutic agents and possibly ______ syndrome.

Back 74

Reye

Hint 74

Psychotherapeutic Drugs

Front 75

The ______ antidepressants may cause ↑anxiety in the older pt and in those with cardiovascular disease; their use ↑ the risk of dysrhythmias, tachycardia, stroke, heart failure, and MI

Back 75

tricyclic

Hint 75

Psychotherapeutic Drugs

Front 76

Anyone considering the use of an antidepressant in a child or adolescent for any clinical use must balance the risk of increased ______ with the clinical need.

Back 76

suicidality

Hint 76

Psychotherapeutic Drugs

Front 77

A pt will begin taking a monoamine oxidase inhibitor (MAOI), What foods would you teach the pt are to be completely avoided while taking MAOI therapy?

Back 77

Aged cheeses, erring, broad beans, Chianti and sherry wines, and yeast. There are several other foods that must be restricted in the diet, which include beer, sardines, snails, anchovies, processed meats, fermentee foods, liver, canned figs, raisins, coffee, sauerkraut, licorice, ripe avocado, and soy sauce. Up to 2 oz. per day of the following foods is acceptable: sour cream, yogurt, cottage cheese, American cheese, mild Swiss cheese, wine (avoid Chianti, sherry), and chocolate.

Hint 77

Psychotherapeutic Drugs

Front 78

A pt has been taking an antipsychotic drug for approximately one week. Knowing that the drug carries a risk for the adverse effect of neuroleptic malignant syndrome, for what manifestations would you assess the pt?

Back 78

In Neuroleptic malignant Syndrome (NMS), the pt presents with very rigid muscle tone and fever secondary to severe muscle injury. There may also be altered mental status, joint pain, tachycardia, tachypnea and sweating.

Hint 78

Psychotherapeutic Drugs

Front 79

A pt will begin taking a ddrug that carries the risk of serotonin syndrome. How would you explain this to the pt when providing med teaching about possible adverse drug effects?

Back 79

Meds that affect the metabolism, synthesis, or reuptake of serotonin may result in serotonin accumulation and the serotonin syndrome (SES). This syndrome is characterized by mental status changes (confusion, restlessness, anxiety, disorientation), ataxia, myoclonus, tremors, rigidity, hypertension, and automonic dysfunction. Symptoms usually occur within 2 to 72 hours up to several weeks after beginning the adm of a serotonergic drug and it is treated by discontinuing the drug and providing supportive care.

Hint 79

Psychotherapeutic Drugs

Front 80

For which of the following pts would the long-acting haloperidol decanoate (Haldol Decanoate) by IM injection be best utilized?

Back 80

A pt who is noncompliant with oral therapy

Hint 80

Use of long-acting haloperidol decanoate (Haldol Decanoate) by IM injection results in a prolonged duration of action of approximately three weeks. This product should not be confused with the shorter-acting parenteral formulation. This formulation is often used for pts who do not adhere to conventional therapy.

Front 81

A young adult pt will be starting on antidepressant therapy with fluoxetine hydrochloride (Prozac) 20 mg daily. Which important teaching point would the nurse be sure to share with the pt?

Back 81

"Try taking your med with breakfast if you experience nausea."

Hint 81

Fluoxetine hydrochloride (Prozac), an SSRI that demonstrates significant an adverse effect of GI disturbances. To reduce nausea, the pt should be advised to take the med with meals.

Front 82

A female pt seems to be fidgety with motor restlessness, and jiggles her legs when asked to sit down. What med does the nurse anticipate will be ordered to reduce these manifestations?

Back 82

benztropine (Cogentin)

Hint 82

By blocking dopamine, antipsycotic meds produce extrapyramidal side effects, such as restless fidgeting or pacing, motor restlessness and not being able to sit still or lie down quietly. The therapeutic tx is the adm of anticholinergic agents such as benztropine (Cogentin), trihexyphenidyl (Artane), or procyclidine (Kemadrin). Diphenhydramine (Benadryl), an antihistamine, also may be adm.

Front 83

An older adult pt being treated with clozapine (Clozaril) for the last 6 months calls the nurse to cancel a pt appointment because of flu symptoms including sore throat, fever, and tiredness. Which of the following is the best reply by the nurse?

Back 83

"It is important to go to the lab and get your blood work done. I'll call ahead so they will know you're coming. Then come in to the clinic to be seen."

Hint 83

Although agranulocytosis occurs in only about 1% to 2% of pts taking clozapine, this risk is greater than the risk with standard antipsychotic agents. After the first 6 months, blood counts are drawn biweekly, so the nurse would want to obtain one to determine whether the pt is experiencing agranulocytosis or flu. The nurse would provide specific instructions but avoid alarming the pt.

Front 84

The nurse is assessing a pt who recently started taking an antipsychotic med. What adverse effects could the nurse expect to observe?

Back 84

Constipation, decreased sweating, and blurred vision

Hint 84

The most common adverse effects of antipsychotic medication include the following: dry mouth, blurred vision, nasal stuffiness, weight gain, difficulty urinating, infection, decreased sweating, increased sensitivity to sunlight, yellowing of the eyes (especially the whites of the eyes), breast enlargement/lactation, skin rash, anhedonia, itchy skin, and constipation

Front 85

A pt taking antidepressant med says to the nurse. "I've been getting dizzy since I started this drug. Do you think I should stop taking it?" Which response by the nurse is most appropriate?

Back 85

"Try to change positions slowly and dangle your feet at the side of the bed before getting up. At what time of the day do you take this med?

Hint 85

Antidepressant meds can cause orthostatic or postural hypotension, and the nurse will teach the pt to change positions slowly, and to dangle the feet at the bedside before getting out of bed in the morning. The pt may also take the dose at bedtimme to minimize these effects.

Front 86

A pt with bipolar disorder is beginning therapy with lithium carbonate (Eskalith). Which of the following would be priority points of pt edu related to use of the med?

Back 86

Maintain a fluid intake of 2.5 - 3L daily

Hint 86

An adequate fluid intake of 2.5 - 3L qday and sufficient sodium intake are needed to maintain therapeutic drug levels. A normal diet with sufficien sodium intake is also important because sodium depleted states (eg, decreased sodium intake, sweating, vomiting, diarrhea) all result in increased reabsorption of lithium in the kidney and ccan lead to rapidly escalating lithium levels and toxicity. Coffee, tea, and cola intake should be limited because of the diuretic effect, and exercise, saunas, and exposure to hot weather should be avoided. Lithium levels are drawn every 3 months or so after the initial stabilization period, during which they are measured every 1-2 weeks