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104 Cards in this Set
- Front
- Back
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Patients with severe depression may be prescribed a combination of Fluoxetine, Prozak, and St. John's Wart.
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False
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Patients receiving Wellbutrin and Zyban for either depression or smoking cessation need to be taught the generic name Bupropion in order to prevent accidental overdose.
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True
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A person's feelings in response to environmental input whether positive or negative is referred to as their......
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affect
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Overwhelming feelings of sadness, despair and hopelessness are common descriptions in pt.'s suffering...
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depression
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Dopamine and norepinephrine are examples of------(what) found in the brain
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neurotransmitters or Biogenic Amine
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A medication that treats depression by inhibiting the reuptake of 5HT and norepinephrine-into the nerves are classified as ......
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TCAs -imipramine (Tofranil)
Tricyclic Antidepressants |
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Special dietary modifications are required to prevent toxicity when patient's are prescribed
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MAOI's
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What do antitussives do?
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Block the cough reflex
(Dextromethorphan) |
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What do scientists theorize that depression results from?
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A deficiency of biogenic amines in key areas of the brain; these biogenic amines include norepinephrin (NE), dopamine, and serotonin (5HT)
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What do antitussives do?
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Block the cough reflex
(Dextromethorphan) |
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What do decongestants do?
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Decrease the blood flow to the UPPER respiratory tract and decrease the overproduction of secretions.
(Ephedrine, Flunisolide) |
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What do antihistamines do?
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Block the release or action of histamine, which increases secretions and narrows airways.
(Diphenhydramine) |
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What do Expectorants do?
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Increase productive cough to clear airways.
(Guaifenesin) |
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What do Mucolytics do?
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Increase or liquefy respiratory secretions to aid clearing of airways.
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If a pt. has COPD, what do we as nurse's need to be very careful of?
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Adminestering oxygen. No more than 2 lm
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Your pt.has had a dry, non productive cough for 2 days with pneumonia, What do you expect the Dr. to order?
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An antitussive. (Dextromethorphan)
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Would you give antitussives to a pt. following surgery?
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No, because we need them to cough following surgery. Antitussives stop the cough.
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What are the adverse effects of antitussives?
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Drying effect on the mucous membranes.
CNS effects, drowsiness and sedation GI upset CODEIN |
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Your pt. has discomfort due to nasal congestion accompanied by the common cold, sinusitis, and allergic rhinitis! What do you expect the Dr. to order?
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A topical nasal decongestant
(Ephedrine) |
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What does a topical nasal decongestant such as Ephedrine do?
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It is a vasoconstrictor, therefore; it decreases blood flow to to the nasal mucosa. (It will be absorbed into the blood stream)
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What is one major problem a pt. can have that is taking topical nasal congestants?
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They cause rebound congestion. More than 3 days of use and your mucous membranes become dependant....recommend nasal spray.
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When are topical nasal decongestants contraindicated?
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In a pt. w/ lesions or erosion in the mucous membranes.
Can cause burning and stinging |
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If your pt. is taking an oral decongestant such as Pseudophedrine what is important to know?
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Oral decongestants are contraindicated in a pt. with hypertension...monitor ingredients to prevent overdose.
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Your pt. has been diagnosed with seasonal allergic rhinitis, as well as has inflammation after the removal of some nasal polyps. The Dr. has prescribed a topical Nasal Steroid Decongestant to manage the infection. What teaching is important?
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When a pt. is taking a topical nasal steroid decongestant such as Flunisolide; it can take several weeks to become effective. It also effects the immune system.
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Antihistamine can be prescribed for:
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mild allergic reactions, they can have anticholinergic effects such as
U can't see U can't pee U can't spit U can't shit. An example of this is Benadryl. Traditional antihistamines are available in generic form. Containdicated in pregnancy and lactation. Can cause drowsiness and sedation. Watch for the pt. he may have dry mouth, urinary issues, or constipation. |
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Your pt. is experiencing a dry non-productive cough in the presence of mucous. What can help?
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An expectorant such as Guaifenesin
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What is a second generation non-drowsy antihistamine?
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Claritin
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Your respiratory pt. is having difficulty coughing up thick, tenacious secretions. What do you think will be ordered?
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A Mucolytic (Acetylcysteine)
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What can be prescribed for Tylenol poisoning?
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A Mucolytic
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What are some preventive and treatment measures for COPD?
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#1.) STOP SMOKING!
Reduce environmental exposure to irritants Filter allergens from the air Avoid exposure to known irritants and allergens Open the conducting airways through muscular bronchodilation Decrease the effects of inflammation on the airway lining. |
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What is Adult Respiratory Distress Syndrome? (ARDS)
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Is caused by major trauma such as cardiovascular collapse, major burns, severe depressurization. It is a progressive loss of lung compliance and increasing hypoxia. The pt. will usually end up on a ventilator.
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Chronic Obstructive Pulmonary Disease (COPD)
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Emphysema, Bronchitis, and Asthma are all examples of COPD.
It is a permanent, chronic obstruction of the airways. Often caused by cigarette smoking. Can be 1st or 2nd hand smoke. |
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What is the indication for Xanthines (theophylline) ?
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Symptomatic relief or prevention of bronchial asthma and for reversal of bronchospasm associated with COPD. Narrow therapeutic margin. DO NOT SMOKE w/ Theophylline.
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Xanthines also are used to treat who?
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Premies. Apnea and bradycardia, very narrow therapeutic levels....watch levels closely.
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Sympathomimetics do what?
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Dilation of the bronchi w/ increased rate and depth of respiration. It mimics the sympathetic nervous system.
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Anticholinergic Bronchodilators when inhaled in the aerosol version have what?
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A cross-sensitivity to peanuts.
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Would you suggest inhaled steroids in a pt. having an asthma attack?
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No. These take time to work. More for prevention of asthma.
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Leukotriene receptor antagonists (singulair) effect metabolism and are contraindicated in pt.'s with what?
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hepatic and renal problems.
Contraindiated :aspirin |
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What do lung surfactants do?
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Change alveoli pressure by enlarging the alveoli allowing for a good air exchange. Used w/ premies. No contraindications: used in emergencies.
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How long do mast cell stabilizers take to work?
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about a week.. used for exercise induced asthma.
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What is affective disorder?
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A person's mood goes far beyond the normal "ups and downs."
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What is depression?
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Severe and long-lasting feelings of sadness beyond the precipitaing event
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Signs and symptoms of depression:
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low energy level
sleep disturbances lack of appetite limited libido inability to perform activities of daily living Overwhelming feelings of sadness, despair, hopelessness, and disorganization. (Depression often goes undiagnosed) |
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What are the Neurotransmitters?
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Norepinephrine and epinephrine
Dopamine (associated w/ rewards, things that make you feel good.) Serotonin (important in arousal and sleep and in preventing depression and promoting motivation (emotions and mood) |
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What is the Biogenic Amine Theory of Depression?
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Depression results from a deficiency of norepinephrine (NE), dopamine, or serotonin (5HT)
*Monoamine oxidase (MAO) may break them down to be recycled or restored in the neuron. *Rapid fire of neurons may lead to their depletion *The number or sensitivity of postsynaptic receptors may increase, depleting neurotransmitter levels. |
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ACTIONS OF ANTIDEPRESSANT THERAPY:
What do MAOI's do? |
MAOI's irreversibly inhibit the effects of MAO, leading to increased NE and Serotonin (5HT) in the synaptic cleft.
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What do Tricyclics do?
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Block the reuptake by the releasing nerve, leading to increased (NE and 5HT) levels in the synaptic cleft, leading to an accumulation of neurotransmitters in the synaptic cleft.
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What do SSRI's do? (2nd generation antidepressants)
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Block the reuptake of 5HT, with little effect on NE.
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Tricyclic Antidepressants (Oldest)
Indications: |
Relief of symptoms of depression
Used for pt.'s w/ sleep disorders Treatment for enuresis Chronic pain; neuropathic pain. |
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When are Tricyclics contraindicated?
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In pt.'s with a recent MI, or heart problems. Always with pregnancy, lactation, or allergy.
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Why are adolescents and teenagers at an increased risk when taking tricyclics?
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Black Box Warning:
increased risk of suicide. Adverse Reactions: Sedation, sleep disturbances, fatigue, hallucinations, dry mouth, constipation |
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Can a pt. take oral anticoagulants, MAOIs, fluoxetine, or rantidine while taking tricyclics?
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NO
Drug to drug interactions |
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Your pt. is 6 years old with enuresis. What might the Dr. prescribe?
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Tofranil (Impramine)
Tricyclics |
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What might a Dr. prescribe Tricyclics for other than enureis and depression?
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Depression r/t alcohol and cocaine withdrawal.
Also watch for signs of orthostatic hypotension and anticholinergic effects. Pt,. should wear sunglasses, sip on h20, viod before taking the med, etc. |
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Monoamine Oxidase Inhibitors (MAOIs)
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Usually used w/ pt.'s who are unresponsive or unable to take other anti depressants.
Black Box Warning also, small doses in people w/ liver problems. Do not take with tyramine (aged cheese, pickled poultry, wine, beer, brewer's yeast, etc. they increase blood pressure. |
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What is the newest group of antidepressant drugs?
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SSRI's.
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Why do Dr. prefer to prescribe SSRI's?
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They do not have the many adverse effects associated with TCA's and MAOIs.
Rememeber: they can take up to 4-6 weeks to be therapeutic. USED w/ posttraumatic stress disorders, social phobias, social anxiety disorders, panic attacks, bulimia, depression. |
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What is beginning to show with SSRI's?
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congenital abnormailities.
Also has increased suicide risk, but not a black box warning. |
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Can SSRI's be given w/ St. John's wart, TCAs or MAOIs?
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NO!
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Watch for sexual dysfunction when taking....
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SSRIs
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Helps stop smoking:
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Wellbutrin, Zyban, Bupropion
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Should children ever be given MAOIs?
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no, because of the potential for drug-food interactions and the serious adverse effects.
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Are TCA's given to children?
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Older than 6
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Adults should have medical causes for their depression ruled out before therapy is begun. Which disorders can lead to the signs and symptoms of depression?
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Thyroid disease, hormonal imbalance, and cardiovascular disorders.
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Parkinson's disease diagnosis
2 of 4 cardinal symptoms: |
1.)resting tremor
2.)bradykinesia 3.)cogwheel rigidty 4.)postural instability |
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Is Parkinson's symmetrical?
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No, they are often one handed resting tremors.
Slow-movement mask-like expressions less blinking astute posture, balance problems**hunched forward. Lack of coordination Drooling and affected speech. Dysphasia (difficulty swallowing) **SAFETY ISSUES. |
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What are some of the theories about the cause of Parkinson's disease?
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Viral infection
Blows to the head Brain infection Atherosclerosis Exposure to certain drugs Environmental factors Genetic (week indication) |
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As Parkinson's progressess about 30% of the pt.'s may also develop:
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dementia or depression
Disease is most common in men and less in African-Americans. |
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Parkinson's is a progressive chroninc neurologic disorder and can develop in people of any age but, is most common in:
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people who are past middle age and entering their 60's. No cure, and therapy is aimed at management of signs and symptoms.
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What is happening in the brain?
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Dopamine is getting wiped out. When you have less dopamine, you end up with more Acetylcholine . So we either need to prescribe more dopamine or a drug that limits acetylcholine.
All of these drugs must be taken daily. |
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What do we need to encourage pt.'s with Parkinson's disease?
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To be as active as possible
Perform exercises Attend to their own care as long as possible Caregivers should: Monitor adverse effects Provide encouragement and support |
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Most pt.'s start with Dopamine. But when we have a pt. taking Anticholinergics what do we need to teach?
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Everything slooows down! Slower digestion, difficulty urinating, eyes dry up, etc. But it helps w/ the rigidty or frozen-like.
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When are anticholinergics contraindicated in our pt.'s w/ Parkinson's?
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Narrow angle glaucoma, GI obtruction, prostate hypertrophy, and myasthenia gravis.
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What type of diet would you recommend to a pt. on anticholinergics?
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high fiber
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Adverse reactions of anticholinergics?
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Disorientation
Confusion Agitation Delirium Nausea, vomiting, and paralytic ileus CNS!!!! |
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Drug-to-drug interactions
Anticholinergics |
Tricyclic antidepressants (because they too dry everything out
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Why are anticholinergics so hard on old people?
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Elderly pt's already are suffering w/ GI issues, etc. tough drugs for old people.
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Nursing considerations for anticholinergics....
Assessment baseline H&P, liver and renal function tests. Nursing diagnosis-r/t: GI, GU, and CNS effects. |
CNS, watch for depression and dementia issues.
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What is the main treatment for Parkinson's?
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Dopaminergics-Levadopa
Not good w/ St.John's Wort or Vit. B-6 Mainstay of treatment |
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What is the precursor of dopamine that crosses the blood-brain, barrier, where it is converted to dopamine?
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Dopaminergics-Levadopa
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What drug is almost always given in combination with carbidopa as a fixed-combination drug (Sinemet)
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Dopaminergics-Levadopa
The dosage is less mixed with carbidopa to make it better and pass the blood, brain-barrier. |
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If a pt. has a suspicious skin lesion when given Dopaminergics what could this mean?
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They are at an increased risk for melanoma.
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When taking Dopaminergics can a pt. just switch to another drug?
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No, they need to space it out.
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Are high protein meals recommended when taking Dopaminergics?
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No, high protein meals decrease absorption, causing less therapeutic effects.
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What are some safety mechanisims we as nurse's can put into place for pt.'s with epilepsy?
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Pad the rails, suctioning, document as much as possible about the incidence to help determine the type of seizures.
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Epilepsy
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Chronic, recurrent pattern of seizures.
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What are the factors affecting the type of seizure?
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Location of the cells that initiate the electrical discharge.
Neural pathways that are stimulated by the initial volley of electrical impulses. |
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What is a generalized seizure?
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They begin in one area of the brain and rapidly spread throughout both hemispheres of the brain.
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What is a partial seizure?
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Begin and remain in one area of the brain.
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What is a tonic-clonic seizure?
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grand mal....most worrisome
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What are absence seizures?
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petit mal seizure
Could be a child suddenly blank staring |
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What is a febril seizure?
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r/t spikes in temp. quickly, a child at risk goes from 99-105 in 1 hr.
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What is a status epilepticus seizure?
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Cannot break the seizure-a seizure attack, very life-threatening
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What is a simple partial seizure?
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Occur in a single area of the brain and may involve a single muscle movement or sensory alteration.
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What is a complex partial seizure?
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Involve complex sensory changes
Motor changes may include involuntary urination, chewing motions, diarrhea. Pt. may have altered consciousness. |
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What is important with dosing in regards to children taking anti epileptic agents?
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Children need higher doses.
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Drugs for treating Tonic-clonic seizures. (Phenytoin) What is the therapeutic effect?
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In status epilepticus-acute end to seizures or long term prevention; prevents surgery after neurosurgery.
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What is the standard dose for Phenytoin (Dilantin)?
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10-20mcg/ml
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What are the nursing considerations for Dilantin?
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Watch for bone marrow suppression, signs of bleeding, H&H.
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All seizure meds. have what adverse effects?
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Confusion, lethargy, fatigue, Decreased BP, heart arrhythmias, decreased libido.
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When are Hydantoins contraindicated?
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Hepatic or renal impairment at increased risk of toxicity.
Adverse reaction:Nystagmus:eyes darting back and forth, slurred speach, dizziness, fatigue, headache, dermatitis, and GINGIVAL HYPERPLASIA. Watch for urine that turns brown. Steven Johnson's Syndrome. |
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Nursing considerations for Hydantoins:
Assessment: |
description of seizures, screen for contraindications, s/s pregnancy. CPE for baseline including labs-liver and renal function.
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Nursing Diagnosis:
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r/t effects on the CNS, GI, GU, and skin.
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What drug is a hydantoin and may be the drug of choice for patients who are not willing to tolerate sedation and drowsiness because of their treatment?
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Phenytoin
Rationale:Various drugs are used to treat generalized seizures, including hydantoins and barbiturates. |
