If a female tells the nurse that she is using BCPs while taking an antibiotic, what situation should the nurse advise the patient concerning?
Drug-drug interaction (antibiotic cancels out BCPs-pregnancy could occur)
Prior to administering an antibiotic, a nurse should perform what on/for the patient?
The nurse's pre-antibiotic assessment should include... History of ______ _____________ __________ (physical exam, vital signs, lab reports, pregnancy test if needed) _________-_________ interactions (drug history) _________ and ___________
History of drug allergies Baseline Drug-drug interactions Culture and sensitivity
Aspect of initial assessment that determines causative pathogen of infection
Aspect of initial assessment that determines which antibiotics are effective against a causative pathogen
Most common drug (antibiotic) allergy
If penicillin is given parenterally at clinics/ER, the patient should be observed _______ minutes before leaving even if the patient has received penicillin before w/o reaction.
Administration of antibiotics such as penicillin with acidic fruit juices results in what?
Neutralization of the antibiotic (alkaline)
Natural, inexpensive penicillin; only works on Gram-positive infections
Penicillins (2) developed for Gram-positive and some Gram-negative infections; one of the more broad-spectrum prototypes
Extended-spectrum penicillin used against Psuedomonas
Antiobiotic widely prescribed for Gram-negative infections (structurally similar to penicillins)
How many generations of cephalosporins exist?
1st generation of cephalosporins: __________ (Keflex)
2nd generation of cephalosporins: __________ (Ceclor)
3rd generation of cephalosporins: __________ (Rocephin)
4th generation of cephalosporins: __________ (Maxipime)
Cephalosporins are more effective against gram-_________ and (aerobic/anaerobic) bacteria
Cephalosporins have a broader __________, longer __________, and better permeability to _______-_________ fluid with each new generation of the antibiotic.
Broader spectrum Longer duration Better permeability to cerebrospinal fluid
Cephalosporins interfere w/ the bacterial ______ _______, making them bacteriocidal.
Bacterial cell wall
Cephalosporins have an antabuse-like interaction w/ _________ for up to 72 hours, causing impaired consciousness.
Alcohol (avoid alcohol intake while taking cephalosporins)
Broad-spectrum antibiotic used against both Gram-positive/Gram-negative infections
Tetracyclines inhibit bacterial __________ synthesis by binding to the _____ ribosomal unit, thereby interfering attachment of _______ to ______ and terminating growing amino acid chains.
Inhibit bacterial protein synthesis; bind to 30s ribosomal unit; interfere with attachment of tRNA to mRNA
Does tetracyclines' interference with bacterial protein synthesis render them bacteriocidal or bacteriostatic?
Tetracyclines bear a strong affinity for ________ to form insoluble complexes.
Prototype tetracyclines (2)
Broad-spectrum antibiotic that can be either bacteriostatic or bacteriocidal
Macrolides inhibit bacterial _________ synthesis.
What drug is administered when a patient expresses an allergic reaction to penicillins?
Macrolides (broad spectrum)
Macrolides are most effective against Gram-_________ infections.
When administered macrolides, patients should be encouraged to take the antibiotic (before eating/after eating).
Before eating (empty stomach)
The ______ coating of macrolides prevents GI irritation.
___________-resistant strains are rather common, due to the drug's frequent use in the place of penicillin.
Antibiotic most often used to treat tuberculosis (TB) and often administered parenterally alongside other drugs
Aminoglycosides are bacteriocidal by inhibiting bacteria _______ synthesis. (Bonus: gram-positive or gram-negative bacteria?)
Protein synthesis (Gram-negative)
When administered aminoglycosides, patients should be warned concerning what adverse effects? (2)
Two (2) reasons for ineffective antifungal drug therapy
Incomplete full course Reinfection
Systemic fungal infections might be deadly in...
List four immuno-compromised people: ______________ syndrome Taking ________ therapy Taking _________________ to fight __________ rejection Debilitated, _____________ or otherwise poor health
Immunodeficiency syndrome (AIDS) Taking cancer therapy Taking immunosuppressants to fight transplant rejection Debilitated, malnourished or otherwise poor health
Systemic antifungal agents (2)
Amphotericin & Fluconazole bind to __________ in fungal cell membranes, causing __________.
Intensive and extended fungal treatment causes what side effects? (12) _______ and chills ______tension and ______cardia _____/______ pain & _____ache GI issues (2) Three types of toxicity
Fever and chills Hypotension and tachycardia Muscle, joint pain, headache Nausea and vomiting Renal, neuro- and hepatic toxicity
Protozoa - Malaria: Female Anopheles mosquito is the carrier of several species of ____________.
Plasmodium is responsible for:
Malaria is caused by infected ___________ __________.
Prototype antimalaria: _________ (Aralen)
Patient teaching (Antimalaria): Don't stop until medication is ______ Watch for _______ deficits Take with _____ to avoid GI upset Possible __________ of symptoms Start therapy ___ weeks before exposure and continue ___ weeks after prophylaxis
Don't stop medicine until gone Watch for hearing deficits (ototoxicity) Take with food to avoid GI upset Possible recurrence of symptoms Start therapy 2 weeks before exposure and continue 8 weeks after for prophylaxis.
Vaccines and Immune System (active): ________ immunity: body produces its own antibodies __________: induced or immunization ________-lasting, often _______-long
Natural: body produces its own antibodies Vaccination: induced or immunization Long lasting, often life-long immunity
Vaccines and Immune System (passive): Transfer __________ antibodies from one to another _________: Mother to child via placenta Pharmacotherapy: ___________, antivenins (venemous bites/stings), _____ (transfusion of whole blood) (Lifelong/temporary) immunity
Transfer performed antibodies from one to another. Natural: mother-to-child via placenta Pharmacotherapy: Immunoglobulin, antivenins, sera Temporary immunity
Side/adverse effects of Vaccines: Minor anticipated side effects (2)
Fever Localized inflammatory reactions (soreness, erythema and increased warmth at injection area)
Side/adverse effects of Vaccines: Serious adverse reactions (uncommon) (4)
Fever > 103 F Dyspnea CNS effects (convulsions, encephalitis) Anaphylactic reactions (e.g. if vaccine made with eggs with patient's allergic history to eggs)
Nursing concerns when administering vaccines (3)
Timing (schedule established by CDC) Dose Route of administration
Nursing concerns when administering vaccines (Precautions and contraindications): _______________ patients (transplants, chemo, long-term steroid users, etc) __________ women _________ event reporting
Immunosuppressed patients (transplanted, chemotherapy, long term steroid users etc.) Pregnant women Adverse event reporting
Nursing concerns when administering vaccines (Treatment of minor illnesses): __________ to ease fever, discomfort, and localized symptoms ______ compresses to site
Acetaminophen to ease fever, discomfort and localized symptoms (never give aspirin to a child or adolescent because of possibility of developing Reye's syndrome) Warm compresses to site (heating pad or towel in a very warm water rung dry)
Immunomodulators (2): __________ (enhance immune system's ability to fight infection/disease) __________ (suppress immune system's ability to fight infection/disease)
Immunostimulants (enhance immune system's ability to fight infection/disease-usually used to treat patients w/cancer) Immunosuppressants (suppress immune system's ability to fight infection/disease-usually used to prevent transplant rejection/dampen hyperactive immune responses [Lupus, rheumatoid arthritis])
Immunosuppressants: Immunosuppressant responsible for prophylaxis of transplant rejection ___________ (Sandimmune)
Immunosuppressants: Immunosuppressant responsible for treating autoimmune conditions and malignancies _____________ (Orthoclone, OTK3)
Muromonab-CD3 (Orthoclone, OTK3)
Immunosuppressants: Immunosuppressant responsible for treating arthritis
Immunosuppressants: 3 important facts: Decrease __________ response Very high risk of _________ ____________-decreased WBC count
Decrease immune response Very high risk of infection Leukopenia - deceased white blood cell count (normal WBC is 5,000-10,000)
Immunosuppressants (nursing interventions): Careful _______-_________ techniques Avoid ________ medical procedures Avoid _________, ______ temperature and _______ suppositories Frequent/meticulous _________ care Bathe with ______________ soap Avoid ________ ____________ and ___________ should be changed daily/whenever soiled Protect skin from _________ and _________ Wear ________
Careful hand washing techniques. Avoid invasive medical procedures. Avoid tampons, rectal temperature and rectal suppositories. Frequent and meticulous mouth care. Bath with antibacterial soap. Avoid crowds. Dressing and bandages should be changed daily and whenever soiled. Protect skin from abrasions and lacerations. Wear shoes.
Corticosteroids: Long term management of ________ _______ but significant _______ effects. (Ex. Rheumatoid arthritis, chronic lung disease)
Chronic disease Adverse effects
Corticosteroids: Short term therapy of severe ____________ (acute exacerbations) Traumatic injury such as ______ trauma or _______ injuries
Severe inflammation Head trauma or spinal cord injuries
Corticosteroids: Affect many aspects of immune system (MOA): Reduce circulating ____________ Deplete body of ___________ and ____________ Move ___________ from bone marrow to circulation Block production of ________________ and ____________ Ls
Reduce circulating lymphocytes Deplete body of monocytes and macrophages. Move neutrophils from bone marrow to circulation. Block production of prostaglandins and interleukin Ls
Corticosteroids: Contra. and precautions: Never administer corticosteroids when patients has known ________ infections.
Corticosteroids (contraindications and precautions): Never administer corticosteroids to a patients with known ______ infection Do not administer _____ virus (vaccines) to clients taking steroids (due to suppressed immune response).
Known fungal infection Live virus (vaccines)
Corticosteroids (contraindications & precautions): When given to clients with a history of tuberculosis, may _________ disease.
Chemotherapy agents (adverse effects): Loss of hair from hair follicles
Chemotherapy agents (leukopenia/neutropenia): Lowest point of WBC level (Bonus: what does this pose the highest risk for?)
Nadir (Highest risk of infection)
Chemotherapy-induced anemia (nursing care): Minimize __________ expenditures Watch for signs of ________ deficit (fatigue, dizziness, SOB) Instruct patient to select foods high in _______ & _______ Provide (large/small) meals with (maximal/minimal) chewing effort Assist in _______, _________ or other physical activity Optimize nursing interventions & activities to allow for more _______
Minimize energy expenditures Watch for signs of oxygen deficit Instruct patient to select foods high in protein & calories Provide small meals with minimal chewing effort Assist in turning, ambulating, or other physical activity Optimize nursing interventions & activities to allow for more rest
Chemotherapy-induced anorexia (nursing care): Assess for decreased _______, ________ to food, and _____ loss Encourage ______, ______ meals with best-tolerated foods Emphasize high-_______, high-________ foods Avoid _______ or ______ foods Try to find new favorite foods after ______ alteration Cold, soft foods may be soothing in the event of _______
Assess for decreased appetite, aversion to food, and weight loss Encourage small, frequent meals with best-tolerated foods Emphasize high-protein, high-calorie foods Avoid fatty or greasy foods Try to find new favorite foods after taste alteration Cold, soft foods may be soothing in the event of stomatitis
Chemotherapy-induced alopecia (nursing care): Discuss alopecia with patient & family (before/after) it occurs Encourage a very (long/short) haircut Instruct client on attaining head ________, such as wigs or turbans Wash hair gently with a _____-balanced shampoo Handle hair as (much/little) as necessary Avoid ________, hairspray, electric ______, and hot air ______/combs Instruct patient that hair loss is (always/seldom) permanent and that it will regrow within __-__ months after the beginning of chemo treatment
Discuss alopecia with patient & family before it occurs Encourage a very short haircut Instruct client on attaining head covers, such as wigs or turbans Wash hair gently with a pH-balanced shampoo Handle hair as little as necessary Avoid bleaches, hairspray, electric curlers, and hot air dryers/combs Instruct patient that hair loss is seldom permanent and that it will regrow within 6-9 months after the beginning of chemo treatment
Chemotherapy (nursing concerns): Obtain baseline _______ assessment and ________ Check prescriber's order and verify ______ and patient's _________ Monitor for ________ to chemotherapies Verify patient's _______ and administer pre-___________ Wear ______ and _______ to protect self from contamination Assess ________ site for sensation to pain, _________, and __________ Determine drug _______ with tissue damage
Obtain baseline physical assessment and vital signs Check prescriber's order and verify dosage & patient's body surface area Monitor for adverse effects to chemotherapies Verify patient's ID and administer pre-medication Wear gloves & gown to protect self from contamination Assess IV infusion site for sensation to pain, burning, and stinging Determine drug vesicant with tissue damage
Chemotherapy: Leakage of agents into tissues around IV site
Chemotherapy: Vesicants can cause permanent ______, ______, and ______ damage
Vesicants can cause permanent nerve, tendon, and muscle damage
Chemotherapy: Which category of drugs are utilized to reduce adverse effects?
Colony stimulating factors (CSFs)
Chemotherapy: CSFs regulate growth, differentiation, and function of what type of cells? CSFs decrease the duration of what two conditions induced by chemotherapy?
Aluminum hydroxide antacids adverse effects: Constipation and ______phosphatemia
Some antacid combinations have the tendency to cause (respiratory/metabolic) (alkalosis/acidosis)
Anticholinergic/antihistamine agents also given as antiemetic agents: _________ (Antivert) _________ (Hyoscine) patch
Meclizine (Antivert) Scopolamine (Hyoscine) patch
Antipsychotic/antidopaminergic agents also given as antiemetics: _____________ (Reglan) _____________ (Phenergan)
Metoclopramide (Reglan) Promethazine (Phenergan)
Benzodiazepine agent also given as antiemetic agent: _________ (Ativan)
Cannabinoids are given as antiemetic agents in the active ingredient form of _________
Corticosteroid agent also given as an antiemetic agent: ___________ (Decadron)
Serotonin (5-HT3) antagonist agent also given as an antiemetic agent: _____________ (Zofran)
Antiemetics (nursing concerns): Assess 3 statuses (what are they?) Place on ____-lying position with altered ____ to prevent aspiration Withhold ____ and _____ until nausea subsides (and then start slowly) Monitor for ___________ symptoms (EPS) in elderly, emaciated patients, and children Instruct not to ______ or other hazardous activities Avoid ______
Nutritional, fluid, and electrolyte status Side-lying position with altered LOC WIthhold foods and fluids Monitor for Extrapyramidal symptoms Instruct not to drive Avoid alcohol
Agents that increase the frequency and quality of bowel movements
Bulk-forming laxative prototype: __________ (Metamucil) (Bonus: also given as _______/______ of constipation)
Psyllium mucilloid (Metamucil) (Prevention/treatment of constipation)
Bulk-forming laxatives MOA: Attracting _____ and thus increasing fecal bulk
Attracting water and thus increasing fecal bulk
Bulk-forming laxatives nursing concerns: Take __-__ hours to work Take with plenty of ______
Take 24-48 hours to work Take with plenty of water
Stool softener/surfactant MOA: Cause more ____ and ____ to be absorbed into stools
Cause more water and fat to be absorbed into stools
Stool softeners/surfactants are often used for __________, not treatment, of constipation (surgery, injury, and MI)
Prevention, not treatment
Stool softener/surfactant adverse effects (2)
Abdominal cramping Diarrhea
Stool softener/surfactant nursing concerns: Take __-__ hours to work
24-48 hours to work
Laxatives (nursing concerns): Complete ______ and _______ _______ movement and ___ functioning Dietary and lifestyle _______ for optimal GI function Avoid long-term use of laxatives to prevent _________ Determine _________ before administration
Complete history and assessment Bowel movement and GI functioning Dietary and lifestyle education for optimal GI function Avoid long-term use of laxatives to prevent dependence Determine etiology before administration
Therapeutic index of Digoxin, cardiac glycosides Is this narrow or broad?
0.5-2.5 ng/mL (narrow)
Cardiac glycosides (adverse effects): CV: ____ block, dysrhythmias GI: __________ and NV Vision: colored vision (________) and _____ vision
CV: AV block, dysrhythmias GI: anorexia and NV Vision: colored vision (yellow) and halo vision
With which two categories of patients should precaution be taken when administering cardiac glycosides?
Older patients Renal-impaired patients
Nursing concerns (digoxin toxicity): ___________ digoxin (D/C) Determine serum _______ levels and __________ Supportive therapy for _____ symptoms Monitor and treat ___________ Digoxin immune FAB (__________) for severe overdose
Discontinue digoxin Determine serum digoxin levels and blood electrolytes Supportive therapy for GI symptoms Monitor and treat arrythmias Digoxin immune FAB (Digiband) for severe overdose
A series of large doses of digoxin, given to quickly reach therapeutic level (Bonus: By way of what administration?)
Condition characterized by severe chest pain often radiating to left shoulder, arm, or jaw (brought on by physical exertion or emotional stress)
Angina pectoris drugs improve blood supply by dilating ______ to reduce (pre/afterload) Lower oxygen demand by slowing _______ rate, reducing _________ and lowering ________ _______ to reduce (pre/afterload)
Osmotic diuretics adverse effect: Rebound increase in ____ and ______ (leakage of fluid)
Rebound increase in ICP (intracranial pressure) and extravasation
A substance to prevent or delay coagulation of the blood, or inhibit enlargement of blood clots
A substance to prevent platelet plugs from forming and benefit in defending the body against heart attacks and strokes
A substance to dissolve clots
A substance to promote coagulation
Parenteral anticoagulant prototype
Heparin is given first as a ____ dose and then ________ infusion
First as a loading dose and then continuous infusion
Parenteral anticoagulants MOA: Activation of _____________, which inhibits thrombin and (to lesser extent) factor Xa Prevents new _________ formation and growth of existing _________ but does not dissolve _______)
Activation of antithrombin III, which inhibits thrombin and (to lesser extent) factor Xa Prevents new thrombus formation and growth of existing thrombi but does not dissolve thrombus)
Pertinent lab value for administration of parenteral anticoagulants (how often?)
Antidote for parenteral anticoagulant (heparin) overdose
What route and location are preferred for heparin?
SubQ Preferably into abdomen (rotate site)
What must you NEVER do when adminstering heparin?
Aspirate the syringe
Oral anticoagulant prototype
Warfarin MOA: Inhibits two enzymes involved in formation of activated ________ Inhibits synthesis of new ______ _______ (prevents new thrombus formation but does not dissolve the thrombus)
Formation of activated vitamin K Inihibits synthesis of clotting factors
Pertinent oral anticoagulant (Warfarin) lab test(s) (how often before discharge? afterward?)
PT/INR Every day before discharge Weekly to biweekly afterward
Vitamin K (Aqua-MEPHYTON)
Warfarin indication: Used in IV _______ until therapeutic (lab test) achieved, and then Coumadin is administered only
Used in IV heparin
Anticoagulant safety concerns: Bruising from ________ Monitor for _______ bleeding (gums, urine, stool) Use soft ________ No ____ drugs without physician approval No ____ or _______s For warfarin, avoid cabbage, cauliflower, kale, _______, some ________, egg yolks, liver, and ______
Bruising from venipuncture Monitor for subclinical bleeding (gums, urine, stool) Use soft toothbrush No OTC drugs w/o physician's approval No ASA or NSAIDs Avoid cabbage cauliflower, kale, spinach, some cheeses, egg yolks, liver, and tomatoes
Antiplatelet agents prototype
Acetylsalycylic acid (ASA)
Antiplatelet agents MOA: Reducing platelet __________ through reversibly inhibiting platelet ______ (low-dose) and _______ (high-dose)
Reducing platelet aggregation through irreversibly inhibiting platelet COX-1 and COX-2
Antiplatelet agents indication: Prevention of _______ and ______ (low dose, 81 mg/day), acute ___ (medium dose, 162-325 mg/day)
Prevention of heart attack and stroke Prevention of acute MI
Antiplatelet agents safety concerns: Subclinical bleeding such as _______ and _______ GI ________ or irritation
Subclinical bleeding such as petechiae or acchymosis GI hemorrhage or irritation
Pinpoint, unraised, round, red spots under the skin (caused by bleeding)
Extravasation of blood underneath the skin (a bruise)
Thrombolytic agent prototype: _______ (Activase)
Altepase (Activase) MOA: converts _______ to ______, which then dissolves _____ clots degrades ________ factors V & VIII lowers circulating amount of _______ and ______
Converts plasminogen to plasmin, which then dissolves fibrin clots Degrades procoagulant factors V & VIII Lowers circulating amount of fibrinogen and plasminogen
Altepase (Activase) indications: generally used when life is jeoparized by presence of a(n) ___________
Presence of an intravascular clot
Thrombolytic agents (safety concerns): Excessive ________ IV given in critical care units with close monitor of __________
Excessive bleeding IV given in critical care units with close monitor of hemodynamics
Neutral fats stored in adipose tissue as an energy resource
Substances manufactured in the liver to make estrogen
Lipoprotein type responsible for delivery of most cholesterol to blood vessel periphery, contributing to plaque buildup (Hint: "bad" cholesterol)
Low-density lipoproteins (LDLs)
Lipoprotein type responsible for transport of cholesterol back to the liver
Bile-sequestering agents MOA: Bind to ______ Form (soluble/insoluble) complexes containing cholesterol (excreted in _____) Lower (HDL/LDL) cholesterol level by increasing (HDL/LDL) receptors on hepatocytes
Bind to bile acids Form insoluble complexes containing cholesterol (excreted in feces) Lower LDL cholesterol level by increasing LDL receptors on hepatocytes
Bile-sequestering agents interactions: Which two medications?
HPT/lipid/cholesterol reducing agents (adverse effects): Three (3) GI effects _____rrhea
Constipation Bloating Belching Steatorrhea
Condition in which the body cannot absorb fat, causing a buildup of fat in the stool (loose, greasy, foul-smelling bowel movements)
HPT/lipid/cholesterol reducing agents (nursing concerns): Increased ______, ______- and ______-intake Monitor for ______ and ______ (low Vitamin K) Other medications should be taken __ hour(s) before or __ hours(s) after administration Teaching plans for nutrition of ____-soluble vitamins (3) and supplement use
Increase exercise, water- and fiber-intake Monitor for bruising and bleeding Other medications should be taken 1 hour before or 4 hours after administration Teaching plans for nutrition of fat-soluble vitamins (A, E, & K) and supplement use
Nonselective adrenergic agonist prototypes: __________ (Adrenalin) __________ (Efedron) (Bonus: which is an OTC bronchodilator?)
Etiologies of diabetes insipidus (4) (Hint: think about it...) (Bonus: which etiology is most rare?)
Head injury Brain injury Brain tumor Hereditary (rare)
What are the (2) characterized symptoms of DI?
Excessive thirst Urination
Dilated veins in the wall of the lower esophagus
(Bleeding) esophageal varices
What condition brings about bleeding esophageal varices? (Hint: condition with a comorbidity)
Chronic liver disease with portal hypertension
While it's nice to prevent nocturnal enuresis with ADH, there are sadly some contraindications and cautions. In fact, there are 4 of them. What are they? (Hint: they are ALL cardiac-related, and think about what ADH does to your blood volume.)
Metformin (Glucophage) (ODD) MOA: Reduce blood glucose by reducing __________, thereby suppressing ______ production of glucose Decrease __________ reabsorption of glucose and increase _______ uptake of glucose
Reduce blood glucose by reducing gluconeogenesis, thereby suppressing hepatic production of glucose Decrease intestinal reabsorption of glucose and increase cellular uptake of glucose
Which oral diabetic drug is most commonly prescribed?
Meglitinide (ODD) prototype: __________ (Prandin)
Meglitinide (ODD) MOA: Lowers glucose by stimulating insulin release from _________
Lowers glucose by stimulating insulin release from pancreatic beta cells
Thiazolidinedione (ODD) prototype: ___________ (Avandia) (Note: if anyone knows how to properly pronounce this drug name, by all means, please share.)
Rosiglitazone (Avandia) (This one, too. Good grief.)
Rosiglitazone (Avandia) (ODD) MOA: Lowers blood glucose by increasing _______ sensitivity to insulin
Lowers blood glucose by increasing cellular sensitivity to insulin
Acarbose (Precose) (ODD) MOA: Lowers glucose by interfering with ________ absorption from what organ system?
Lowers glucose by interfering with carbohydrate absorption from GI tract
New incretin agents (ODD) prototype: __________ (Januvia)
Sitagliptin (Januvia) (ODD) MOA: Inhibits dipeptidyl peptidase-IV (DPP-IV), thereby reducing destruction of ________, which increase levels of _______ hormones
Inhibits dipeptidyl peptidase-IV (DPP-IV), thereby reducing destruction of incretins, which increse levels of incretin hormones
ODD adverse affects (5)
Hypoglycemia NV Heartburn Diarrhea
ODD nursing concerns: Take medications preferably ___ minutes prior to breakfast and at the same time each day If a dose is missed, take it __________ and (do/do not) double-up if close to next dose Teach signs & symptoms of hypoglycemia and instruct patient to consume _______ or _______ once hypoglycemia has occurred (and notify health providers) Avoid other medications like _______ and _______ Encourage routine ______, proper _____, and proper ________
Take medications preferably 30 minutes prior to breakfast and at the same time each day If a dose is missed, take it as soon as remembered but DO NOT double-up if close to the next dose Teach signs & symptoms of hypoglycemia and instruct patient to consume juice or candy once hypoglycemia has occurred (and notify health providers) Avoid other medications like aspirin and EtOH Encourage routine follow-ups, proper diet, and proper exercise
There is a link between what two psycho/neuro conditions?
Insomnia & anxiety
What is another name for anxiety & insomnia agents?
Depressants (Note: a good way to remember 'depressants' is to remember their slang name: 'downers')
How are depressants classified if they are administered for anxiety? What about for insomnia?
Benzodiazepines MOA: Potentiate ______ Depress ______ at different levels
Potentiate GABA (like anesthesia) Depress CNS at different levels
What are the three (3) levels at which benzodiazepines depress the CNS?
Relaxation Sleep Coma
Benzodiazepines indications: Routine management of ________ Reduction of _______ prior to medical/surgical procedures Reduction of _______ (same answer as above) in patients with what life support device?
Routine management of anxiety Reduction of anxiety prior to surgical/medical procedures Reduction of anxiety in patients with ventilators
What four (4) conditions can benzodiazepines also be used for besides anxiety (off-label)?
Insomnia Seizures Alcohol withdrawal Status epilepticus
CNS: drowsiness, lethargy, dizziness, hang-over, reduced REM sleep GI: NVD CV and respiratory depression
How often should patients be assessed when administered phenobarbital IV?
Patients taking barbiturates should be monitored for signs of what hematologic condition?
Anti-seizure agents suppress _______ discharges to prevent abnormal foci from forming or spreading
Suppress neuron discharges
Anti-seizure agents control ________ movement and ________ balance
Electrolyte movement Neurotransmitter balance
Barbiturates are the traditional drugs for which type of seizure? (Note: barbiturates have been replaced my newer & safer drugs)
Which drugs are important for use against status epilepticus?
Which anti-seizure agents are effective in the management of most types of seizures, but have MANY adverse effects?
Hydantoin prototype: _________ (Dilantin)
Phenytoin (Dilantin) MOA: Delays influx of _______ ions in neurons, and slows propagation and spread of abnormal _________ Does NOT elevate the ___________
Delays influx of sodium ions in neurons, and slows propagation and spread of abnormal discharges Does NOT elevate the seizure threshold
Hydantoins adverse effects (remember, there are many): Lethargy, _____ache, ________, dizziness _________ (EOM), confusion, _______, coma, and paradoxical ________ (When do these specific adverse effects occur?)
A progressive, neurodegenerative disorder characterized by abnormal motor movement
Parkinson Disease is caused by abnormal amounts of _______ in the brain (Bonus: what specific part of the brain?)
Abnormal amounts of dopamine in the brain (Substantia nigra)
Cardinal signs of Parkinson Disease (4)
Tremors (shaking of the hands and head while at rest) Muscle rigidity (resistance to passive movement of arms and legs, mask-like facial expression) Bradykinesia (slowness of voluntary movement, speech) Postural instability (stumbling, stooped over)
Which class of drugs is most effective against Parkinson Disease?
Dopaminergic agents MOA: Metabolic ________ of dopamine Dopamine in the brain is increased after metabolized through ___________ to dopamine
Metabolic precursor to dopamine Dopamine in the brain is increased after metabolized through decarboxylation to dopamine
Dopaminergic agents may be given in combination with what other drug? (Hint: _________ [Sinemet])
Nurses should monitor ________ as a serious adverse effect of dopaminergic agents
The goal of dopaminergic administration is to achieve the _________ effective dose
Lowest effective dose
Nursing concerns for anti-Parkinson Disease agents (1/2): Assess for ____ reponses/characteristics of __________ Inspect the oral cavity after drug administration in patients with __________ Teach patient to watch for full effects in __-__ weeks
Assess for CNS responses/characteristic of Parkinsonism Inspect the oral cavity after drug administration in patients with dysphagia Teach patient to watch for full effects in 1-4 weeks
Nursing concerns for anti-Parkinson agents (2/2): Avoid terminating medication _______ Monitor for safety with ________ and ______ Caution for adverse effects, including _____ changes
Avoid terminating medication abruptly Monitor for safety with ambulation and ADLs Caution for adverse effects, including CNS changes
Phenelzine (Nardil) MOA: Binds irreversibly to ______ Intensifies actions of endogenous neurotransmitters (4)?
Binds irreversibly to monoamine oxidase (MAO) Intensify actions of endogenous epinephrine, norepinephrine, serotonin, and dopamine
What is the most common side effects of MAO inhibitors?
Patients taking MAO inhibitors should avoid food containing _________?
Foods containing tyramine
Class of second-generation antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Which anti-depressants are effective with low incidence of serious side effects?
SSRI prototype: __________ (Prozac)
SSRIs MOA: Block uptake of serotonin at (brain structure) Enhance action of _________
Block uptake of serotonin at neuronal presynaptic membrane Enhance action of serotonin
SSRIs adverse effects: GI _______ _______ _______ dysfunction
GI upset Anorexia Sexual dysfunction
The full therapeutic effects of SSRIs appear in __-__ weeks
Patients taking SSRIs should avoid foods containing ________ for interaction
Foods containing tyramine
Treatment of bipolar disorders focuses on impaired levels of all three _________ in (body system)
Impaired levels of all three neurotransmitters in the limbic system
Bipolar disorders agent prototype (conventional therapy for treatment): _________ (Lithobid)
Lithium carbonate (Lithobid)
Lithium carbonate (Lithobid) MOA: Likely acts by changing _________ balance in specific brain regions Increases the synthesis of _______
Likely acts by changing neurotransmitter balance in specific brain regions Increases the synthesis of serotonin
Lithium bicarbonate (Lithobid) is used with __________ or an antipsychotic for acute mania phase
Used with benzodiazepines
Lithium carbonate (Lithobid) is used with a(n) ____________ for the depressive phase
Used with an antidepressant
Anti-depressants nursing concerns: Obtain baseline functions of what three (3) organs? Take drug with ______ or ______ to reduce GI upset Monitor serum levels every __-__ days initially and then every __-__ months thereafter (lithium toxicity) Assess daily for weight, _____, and changes in skin ______ (signs of lithium toxicity) Instruct patient to take __-__ glasses of fluids daily (to maintain hydration) Warn for switching _________ brands
Obtain baseline functions of thyroid, kidney, and cardiac system Take drug with meals or milk to reduce GI upset Monitor serum levels every 1-3 days initially and then 2-3 months thereafter (lithium toxicity) Assess daily for weight, edema, and changes in skin turgor (signs of lithium toxicity) Instruct patient to take 8-12 glasses of fluids daily to maintain hydration Warn for switching different brands
The primary goal of anti-psychotic drugs is to manage symptoms to function ______ and perform ______
Manage symptoms to function independently and perform ADLs
Management of psychotic disorders is challenging due to patients viewing their behavior as ______ as well as undesired ________