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Pharm test review 9/17
Terms in this set (90)
A patient had been admitted to the ER because of benzodiazepine overdose. He is very drowsy but still responsive. Which of the following immediate interventions will the nurse prepare?
Administration of flumazenil
An older adult has been given a benzodiazepine for sleep induction, but the night nurse noted that the patient was awake most of the night. The nurse documents that the patient has had which type of medication reaction?
(opposite of what it should be)
The nurse is preparing to administer zaleplon (Sonata) for sleep. Which intervention applies to administration of this hypnotic, a nonbenzo?
Take just before bedtime
The nurse will monitor the patient who is taking a muscle relaxant for which adverse effect?
A hospitalized patient is complaining of having difficult sleeping. Which action will the nurse take first to address the problem?
Provide an environment that is restful with reduction in noise.
a class of stimulant drugs that includes amphetamine sulfate and all of its drug derivatives
CNS stimulants that have generalized effects on the brainstem and spinal cord producing an increase in responsiveness to external stimuli.
drugs used to control or suppress appetite
a syndrome characterized by difficulty in maintaining concentration
a condition characterized by abrupt attacks of muscular weakness and hypotonia triggered by an emotional stimulus
Drugs that narrow or constrict blood vessels in the brain and provide relief of pain for certain migraine headaches.
a syndrome characterized by sudden sleep attacks
a class of CNS stimulants used to treat migraine headaches.
Serotonin receptor agonists
CSN stimulants whose actions resemble or mimic those of the sympathetic nervous system?
Caffeine containing beverages and drugs?
No Doz Maximum strength
Coffee, Tea, Soft drinks, Cocoa, Red bull, Propel
Changes in mental status
Changes in mood
Tachycardia- anything over a 100
Loss of appetite
Altered sleep patterns
What are some Patient Teaching Tips?
Serotonin agonists (aka Triptans) are taken on prn bases at the onset of a migraine- do the imatrex
Give medications exactly as prescribed.
Alcohol, OTC cold products, cough syrups that contain alcohol, nicotine, and caffeine-containing food items should be avoided.
Keep a journal of daily activities and responses.
Avoid any abrupt or sudden withdrawal of medications
What is important to know with herbal medication?
Allergies the patient has
Drugs currently taken to watch drug interactions
A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see which adverse effect?
The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate?
Imbalanced nutrition, less than body requirements
A patient has a new prescription for sumatriptan (Imitrex). The nurse providing patient teaching on self-administration will include which information?
Take the medication before the headache worsens
The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy?
The medication order reads: "Atomoxetine (Strattera) 1.2 mg/kg/day in 2 divided doses." The child weighs 66 lbs. How much will be given each dose?
For CNS stimulates: decreased cardiac output, related to adverse effects of CNS stimulates. Palpations/tachycardia
imbalanced nutrition, less then body requirements, related to adverse effects of CNS stimulates. Amphitaments and anorexias.
chronic pain related to the experience of or a history of migraine headaches
disturbed sleep patterns related to the action and adverse effects/actions of CNS stimulates
related to, secondary to, evidence by, history of
how to state the nursing diagnosis
What are the 3 Times to verify Medication?
1st- when preparing medication for administration when referencing the MAR
2nd- after all medication is gathered together
3rd- before giving the patient medication (in front of them)
What is drug adsorption for parenteral route like?
What is the order for fastest to least fastest for drug absorption?
Why is IV the fastest absorption?
allows for direct control of the amount in the blood. 100% bioavailability
What methods are good for prolonged absorption?
Intramuscular and Subcutaneous injections
Buccal medication that is sublingual is administered where?
under the tongue, because it is vascular and goes to the direct blood supply
Inhalation medication does what?
Rapid absorption, directly to the lung tissue. used for asthma, allergies, and pulmonary diseases.
Topical medication route does what?
delivers medication directly. slower for onset and prolonged in their duration of action. Avoid first-pass effects of the liver. used for local effects, not systematic.
Oral medication route does what?
easier, more convenient, and safer than injection
reversible in some cases
inactivation of some drugs due to stomach acid and pH.
what absorbs the medication fastest?
IV, instant bloodstream access. bioavailability due to no first pass metabolism.
Sublingual and buccal routes surpass what?
the liver, yet are systemically bioavailable.
The three main routes drug absorption occurs?
1) enteral (stomach, small, large intestine)
2) Parenteral (any route besides the GI)- normal injections
Intravenous injections delivers the drug directly into the?
Intramuscular drugs and subcutaneous are absorbed more?
Slowly compared to intravenous
what are first pass routes?
Movement of a drug from it's site of administration into the bloodstream for distribution to the tissues?
Transport of the drug by the blood-stream to its site of action?
Biochemical alteration of a drug into an inactive metabolite, more soluble compound, less active metabolite? The liver is most responsible.
Elimination of drugs from the body? The kidney is most responsible. Liver and bowel is also used.
time required for one half of the drug given to be removed from the body? Measures rate at which the drug is eliminated from the body.
physiologic reactions of the body to the drug
Time required for the drug to elicit a therapeutic response?
onset of action
Time required for a drug to reach its maximum therapeutic response
length of time that the drug concentration is sufficient (without more doses) to elicit a therapeutic response?
Duration of action
highest blood level?
lowest blood level?
If a peak level is too high, what can happen?
If trough level is too low, what can happen?
may not be at therapeutic levels to produce a response.
Any errors at any point in patient care that cause or have the potential to cause patient harm?
Potentially toxic nature, requires special care when prescribing, dispensing, or administering?
List some High-Alert medications:
• Magnesium Sulfate
• Potassium Chloride and Phospates
• Sodium chloride, Hypertonic
The major categories of medication errors? (4)
1) no error, but could have led to an error
2) error that causes no harm
3) medication error that causes harm
4) error that results in death
How can you prevent medication errors? (5)
1) multiple check and balances
2) prescriber should write legible orders with correct information
3) pharmacists or drug literature should be referenced if there is a concern
4) Check medications 3 times before giving drugs
5) 6 rights of med admin should be used
The HIPPA guidelines has certain liabilities that nurses must follow such as?
Assurance of privacy
of patient information
Failure to assess/evaluate
Failure to ensure safety
Ethical nursing practice is based on fundamental principles such as?
The ANA code of ethics ensures that?
the nurse is acting on behalf of the patient and with the patient's best interests at heart
What is within the nurse's realm?
To provide information and to assist the patient in making decisions regarding health care.
Nurse has the right to?
refuse to participate in any treatment or aspect of the patient's care that violates the nurse's personal ethical principles. CANT DESERT THE PATIENT
The ANA code of ethics for nurses requires the nurse to?
Provide nonjudgemental nursing care from the start of the patient's treatment until the time of the patient's discharge.
Another ethical consideration is the use of placebos, what is the recommendation by the American Pain Society and the agency for health care policy?
Do not use placebos. if prescribed, ask why it is being used? and inform the patients of their rights.
effect the CNS by reducing nervousness, excitability, irritability without causing sleep?
effect the CNS by causing sleep and have more potent effect?
sedative-hypnotics Can be classified as three main groups?
barbiturates, benzodiazepines, miscellaneous drugs
Sleep has two cycles:
REM- rapid eye movement
non-REM: non-rapid eye movement
sedative hypnotics can act as?
both a sedative or hypnotic depending on the dose and patient responsiveness
Non- REM consist of these effects:
drifting off to sleep
relaxation, can be easily woken up
Deep sleep- respiratory rate, pulse, and blood pressure decreases
difficult to wake up the person, dreaming, bed wetting, sleepwalking
REM consists of:
fast eye movements
this can occur by discontinuing a sedative -hypnotic drug. The patient then has abnormally large amount of REM sleep?
ability to depress the CNS- hypothalamic, thalamic, limbic systems in the brain
Do not suppress REM sleep
What therapeutic effects do Benzos have?
relief of anxiety
treatment of acute seizure disorders
Benzos cause what for the elderly?
low therapeutic index
CNS depressant that works on the brainstem- reticular formation
stimulate the action of enzymes in the liver- cause drugs to be metabolized faster
reduce nerve impulses to the cerebral cortex
Effect peoples REM sleep (deprive them)
What are some adverse effects from Barbiturates?
What areas for stimulants affect in the CNS?
excitatory neurotransmitters like dopamine, norepinephrine, serotonin
Ability to cause elevation of mood, reduction of fatigue, sense of increased alertness, aggressiveness
solid form( tablet, capsule, powder)
liquid- absorbed more quickly
enteric coated drugs have a coating that prevents the gastric pH to break it down, thus causing it to be?
not absorbed until it reaches the large intestine, slower absorption.
DO NOT CRUSH
Enteral drug dosage forms:
sublingual or buccal tablets
Parenteral drug dosage forms:
Topical drug dosage forms:
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