NUR2407 / NUR 2407 Exam 1 Review (Latest 2022 / 2023): Pharmacology - Rasmussen College, Study Guides, Projects, Research of Nursing

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NUR 2407 Exam 1 Review

Guide your studies by knowing the drug classification and what it is used for with all meds included below; drugs in the same classifications have many similar side effects, nursing considerations, nursing interventions, and patient teaching. 10 Rights of Medication Administration – know what they are and what they mean (examples of each)

• Right patient- use 2 identifiers name and date of birth
• Right drug- check medication 3 times with order
• Right dose- check dose 3 times with order
• Right route- how the drug is administered
• Right time- is it being given in the right time window 30 mintutes before or after scheduled time with a meal
• Right assessment- pain temp blood pressure behavior
• Right documentation- nurse initials time, route ,dose, date
• Right to education - make sure the patient knows why they are taking the medication
• Right evaluation- follow up temp pain level bp
• Right to refuse- a patient has the right to refuse Illegible RX – nursing action (what to do?)
• Don’t guess call the provider to have it clarified.

Nursing considerations with regard to lack of medication compliance

• Why is the patient noncompliant, can they afford their medication, have they been educated of the importance, are they competent enough to be able to medicate themselves.

Half-life – what does it explain?

• Time it takes for half of the drug to leave the body

Tolerance – what is it?

• A person’s diminished response to a drug. It takes a larger dose to achieve the same therapeutic effects that a previous dose was once able to give

Know the considerations with crushing medications – what can/can’t be crushed

• Not all medications can be crushed. Contin, XL, SR, EC, XR,

Patient teaching for transdermal therapy

• Make sure to remove previous patch, cleanse area prior to putting patch on, rotate site of patch. Some patches must go in a specific place on the body.

Symptoms of allergic response and what to do

• Anaphylactic shock, lips swelling, unable to breath, throat closing. Stop medication immediately notify provider follow orders.

Know the responses that the body has to adrenergics, cholinergics, adrenergic blockers, anticholinergics, sympathomimetics, sympatholytics.

Review the handout on ANS from class and compare it to the charts in purple boxes in Kee text that review what response each classification of these drugs causes – you will review that some classifications cause similar responses, yet responses may be

more prominent in a specific classification – this takes critical thinking with regards to the medications primary purpose/effect Adrenergic beta blocker – atenolol – use, side effects Anticholinergics: side effects/nursing considerations (Cogentin) benztropine – use, side effects, patient teaching Atropine – use, side effects, nursing interventions and considerations with use and after dose Cholinergics: side effects/nursing considerations bethanacol – use, side effects Adderall (dextroamphetamine) – use, client teaching, nursing considerations, dose timing CSS II; Preg C Use: ADHD client teaching: limit caffeine; may impair judgement; advise provider of behavior changes, chest pain, SOB, fainting and if nervousness, restlessness, insomnia, dizziness, anorexia, dry mouth becomes severe; notify if dumbness, pain, skin color change, unexplained wounds appear.

nursing considerations: Amphetamines can cause adverse effects in the central nervous system and the cardiovascular, gastrointestinal (GI), and endocrine systems. Side effects and adverse reactions include restlessness, insomnia, tachycardia, hypertension, heart palpitations, dry mouth, anorexia, weight loss, diarrhea, constipation, and impotence.

dose timing: at least 6 hours before bed to avoid sleep distrubances

Aricept (donepezil) – use, side effects

• Donazepril (Aricept) used to help treat dementia/Alzheimer’s / side effects: headache, diarrhea, nausea, a-fib, HTN, depression, weight loss
• Assess cognitive functions, monitor HR may cause bradycardia, contraindicated in sick sinus syndrome SSS, seizures, asthma, or COPD / take med at same time each day, my take weeks to see results, may cause dizziness. Benzodiazepines – mechanism of action, side effects, precautions, contraindications clonazepam/lorazepam – use, client teaching, side effects, precautions, contraindications

mechanism of action: Enhance inhibitory effects of transmitter GABA; Acts at many levels in the CNS to produce anxiolytic effect. May produce CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. side effects: Dizziness, drowsiness, lethargy, confusion, hangover, headache, mental depression, paradoxical excitation, blurred vision, constipation, diarrhea, nausea, vomiting, rashes, physical dependence, psychological dependence, tolerance. precautions: renal impairment (lower dose); hepatic impairment (lower dose); concurrent use with nefazodone, fluvoxamine, cimetidine, fluoxetine, hormonal contraceptives, diltiazem, isoniazid, erythromycin, clarithromycin, or grapefruit juice; history of suicide attempt, alcohol/drug dependence, debilitated patients – can cause peridoxical effect contraindications: pre-existing CNS depression, severe controlled pain, angle-closure glaucoma, obstructive sleep apnea or pulmonary disease, concurrent use with itraconazole or ketoconazole, OB:lactation

clonazepam(Klonopin) AND lorazepam(Ativan) – use: (Klonopin: CSS IV; Preg Cat D) anticonvulsants; (Ativan: CSS IV; Preg Cat D) analgesic adjuncts, antianxiety agents, sedative/hypnotics. client teaching: (Klonopin) take as directed; short term use, does not cure underlying problem; do not share; drowsiness, dizziness; notify provider of all OTC, RXs, and herbal supplements, avoid alcohol and other CNS depressants; notify provider of unusal tiredness, bleeding (anything usual) and unusal behavior or mood changes, pregnancy concerns, carry identification of medication at all times, follow up exams are important (Ativan) decrease dose gradually to minimize WD symptoms; teach other methods to reduce anxiety – exercise, support groups, relaxation techniques; take as directed; short term use; drowsiness, dizziness; avoid alcohol and other CNS depressants; pregnancy concerns; follow up exams are important side effects: (Klonopin) behavorial changes, drowsiness, ataxia (Ativan) Dizziness, drowsiness, lethargy precautions: (Ativan) under 18 & elderly; renal failure; mental health; chronic respiratory disorders; Neuromuscular; addiction risk contraindications: (Ativan) do not use with patient with seizure disorder; glaucoma; coma/shock; neonates

Buspar (buspirone) – use, mechanism of action, nursing considerations Use: (non benzo) short term treatment of anxiety. mechanism of action: binds to serotonin and dopamine receptors in the brain; increases norepinephrine metabolism in the brain. nursing considerations: use of grapefruit juice can lead to toxicity; does not cause sedation or pose risk of dependence or abuse; do not use MAOI within 2 wks of this medication; interaction- erthromycin, ketoconaole

Barbituates – mechanism of action, side effects, precautions, contraindications Reduce effects of anticoagulants; enhance and can mimic the actions of GABA; powerful respiratory depressants; antidote is activated charcoal; CSS IV; depressants: sedatives & hypnotics mechanism of action: sedative-hypnotic “Downers” enhances GABA side effects: Amnesia, decreased HR & BP, tachycardia, apnea, resp depression. (short term use due to high tolerance)

secobarbital – use, side effects CSS II; preg cat D use: sedative/hypnotic; insomnia; per-op side effects: excess sedation, mental depression, vertigo

phenobarbital

CSS IV; pre cat D; anticonvulsant, sedative/hypnotic; need periodic hepatic and renal function and CBC labs; SIDE EFFECTS: hangover, respiratory depression, suicidal ideation

Opiates – use, mechanism of action, side effects, precautions, nursing considerations/assessment, nursing interventions, client teaching MS Contin, Morphine Pain medication. Binds to opiate receptor to alter perception and response to painful stimuli without producing generalized cns depression. Use in prevaustion with head trauma severe renal hepatic or pulmonary disease increased risk for respiratory depression. Assess pain intensity and location and respiratory status resp rate and 02 sat before and after medication administration. Level of consciousness blood pressure. Assess for risk of opioid addiction abuse or misuse. Educate on high risk for addiction advise to change positions slowly, no driving, no alcohol, prevention of constipation.

Know considerations and nursing responsibilities for C2 controlled substances Must be counted between shifts. Highly controlled increased risk for abuse and addiction. Must see a provider every time RX needs refilled must be a written RX sometimes a 72 hours emergency supply can be called in via phone order. Know the nursing considerations, dosing considerations, and client teaching when using Vicodin, NSAIDS, and APAP Max dose of Tylenol 3g-4g per day may be less in patients with liver failure. Client teaching/nursing considerations for clients taking high dose ASA, know concerns with toxicity

• Increased potential for bleeding, if brusing or bleeding occurs notify provider, may need to stop medication prior to procedure always make sure provider knows that it is being taken. Reyes syndrome (brain swelling and liver damage if given to kids with viruses), Salicylate toxicity is a risk with chronic use more increased with renal insufficiency signs and symptoms nausea vomiting diaphoresis and tinnitus are early signs vertigo and hyperventilation and hyperactivity as it progresses agitation delirium and lethargy. (sodium bicarbonate is the antedote for asa)

Know antidotes for overdoses of barbituates, opioids, benzodiazepines

• The antidote for opiates: Narcan (naloxone) – when overdosing, breathing slows down or stops
• The antidote for benzodiazepines: Romazicon (flumazenil) administered by rapid IV injection
• The antidote for barbiturates (phenobarbital): activated charcoal for phenobarbital

Atypical neuroleptics and traditional neuroleptics – uses, know onset of action, concerns/symptoms that could occur with use of multiple neuroleptics Seroquel (quetiapine) – uses and side effects, how would you know it is working? ) – uses: schizophrenia, depressive episodes of bipolar, acute mania with bipolar, adjunctive treatment depression and side effects: NMS, seizures, dizziness, pancreatitis, stevens-johnson syndrome, weight gain of how would you know it is working? Decreases manifestation of psychoses, depression, or acute mania

Zyprexa (olanzapine) and Thorazine (cholorpromazine) – what category of drugs are they, what are they used for, and what concern is there if they are taken together? antipsychotics what are they used for: schizophrenia, bipolar, treatment resistant depression; 2 nd^ line treatment for schizophrenia, hyperexcitable,combative behavior in children, nausea/vomiting, intractable hiccups, preop sedation, acute intermittent porphyria and what concern is there if they are taken together? Both have anticholinergic properties – tachycardia, increased BP, broncho dilation… Risperdal (risperdone) – use, side effects, onset of action – how does its onset of action compare to that of Haldol? Haldol (haloperidol) – indications (used for), side effects/adverse effects, why cautioned with Parkinson’s , onset of action

Lithium – use, side effects, nursing considerations and interventions, implications/considerations of therapeutic window for nursing care use: Bipolar disorder side effects: seizures, fatigue, headache, impaired memory, ECG changes, abdominal pain, anorexia, bloaing, diarrhea, nausea, polyuria, aceiform eruption, folliculitis, hypothyroidism, leukocytosis, muscle weakness, tremors nursing considerations: large changes in sodium intake may alter renal elimination; avoid caffeine-containing herbs, haloperidol, diurectics, and NSAIDS. Admin with food/milk to lessen GI irritation and interventions, implications/considerations of therapeutic window for nursing care: monitor serum levels twice a week during initiation of therapy and draw labs in morning before dose. Watch for signs of toxicity (vomiting, diarrhea, slurred speech, muscle weakness, twitching) Narrow therapeutic window: 0.5-1.5mEq/L Neuroleptic malignant syndrome – know risk factors and symptoms Life threating neurologic disorder caused by an adverse reaction to a neuroleptic drug. Symptoms include high fever sweating unstable blood pressure stupor muscle ridgity and autonomic dysfunction. Extrapyramidal symptoms – what are they, what classification of meds are they associated with? Drug induced movements psudoparkinsonism (stooped posture shuffling gait rigidity bradykinesia tremors at rest pill rolling motion of the hands) acute dystonia (facial grimacing involuntary upward eye movement muscle spasms of the tongue face nect and back laryngeal spasms) akathisia (restless trouple standing still paces the floor feet in constant motion rocking back and fourth) Tardive dyskinesia protrusion and rolling of the tounge sucking and smacking movements of the lips chewing motion facial dyskinesia involuntary movements of the body and extremities. Status epilepticus – what is it and and what is treatment Prolonged seizure activity usually greater than 5 minutes. Treatment is IV or IM Ativan Depakote (valproic acid) – use, side effects, client teaching, nursing considerations, toxicity

- symptoms and nursing interventions with toxicity – know therapeutic lab values

Dilantin (phenytoin) – use, pregnancy class, side effects, nursing considerations, client teaching/ safety considerations (consider teaching for self care and for young women) treatment of tonic-clonic seizures watch for rash in first 2 wks of therapy (phenytoin hypersensitivity syndrome), monitor for behavorial changes, monitor CBC, serum calcium,

albumin and hepatic functions monthly for first several months then periodically client teaching/ safety considerations (consider teaching for self care and for young women): take as directed/same time each day, may cause drowsiness/dizziness, avoid alcohol/CNS depressants, teach good oral hygiene, advise that brand name of phenytoin may not be equivalent, diabetic – monitor glucose carefully, do not take within 2-3 hours of antacid, FEMALES: use additional non-hormonal method of birth control during therapy.and complex partial seizures; termination of ventricular arrhythmias pregnancy class: D side effects: nursing considerations: assess oral hygiene – concern of gingival hyperplasia; Know purpose of psychotropic washout period Psycothropic washout period is used to establish a new baseline of the disorder. Period when changing antidepressants time to dc and let the prior med out of the system before starting the new med and time it takes for the new med to build a therapeutic level. Psycotrophic washout period is the time when a medication is being discontinued prior to starting a new medication. Increased risk of suicide due to coming off and starting a new medication which will take longer to achieve therapeutic results from the new medication.P

Know precautions to consider when switching antidepressants and why? Know about suicide risk and psychotropic washout period. Why need for prolonged suicide watch? Increased suicide risk due to changing medciations and having time while not on a medication and the time period it takes for a medication to be effective or to know of side effects of new medication SSRIs – fluoxetine – use, side effects, patient teaching

Know symptoms and causes of serotonin syndrome

• Symptoms - dizziness, headache, sweating, and agitation
• Causes – St Johns Wart use with amphetamines, trazodone, or tricyclic antidepressants may cause serotonin syndrome. Sumatripton may cause Drug: Risk of vasospasm and blood pressure elevation with dihydroergotamine and other ergot alkaloids; increased levels and toxicity within 2 weeks of MAOIs; increased risk of serotonin syndrome or neuroleptic malignant syndrome with SSRIs

MAOIs – monoamine oxidase inhibitor use, foods to avoid with them and why use depression as a last resort.

- Foods to avoid - drug-food interaction occurs when an antidepressant of the monoamine oxidase inhibitor (MAOI) type (e.g., phenelzine) is taken with tyramine-rich foods such as cheese, wine, organ meats, beer, yogurt, sour cream, or bananas. These foods have sympathomimetic-like effects; more norepinephrine is released, and the result could be a hypertensive crisis. These foods must be avoided when taking MAOIs.

TCAs– amytryptilline – use, side effects, symptoms with overdose

donazepril – use, side effects

• Donazepril (Aricept) used to help treat dementia/Alzheimer’s / side effects: headache, diarrhea, nausea, a-fib, HTN, depression, weight loss
• Assess cognitive functions, monitor HR may cause bradycardia, contraindicated in sick sinus syndrome SSS, seizures, asthma, or COPD / take med at same time each day, my take weeks to see results, may cause dizziness. Flexeril (cyclobenzaprine) – use, side effects/ patient teaching and precautions while taking Rx - used to treat muscle spasms / anti- cholinergic - May feel effects including drowsiness, dizziness, light headedness, flaccidity - Always take with food to avoid any GI disturbances and DO NOT drink with alcohol or increased effects will occur. Lyrica (pregablin) – uses (used for what type of pain and why?) and patient teaching - Medication for nerve pain. An anti-epileptic, anti-convulsant/ mood stabilizer sustain GABA (a calming peptide), herpetic neuralgia, diabetic neuropathy
• Do not stop taking unless authorized by physician; can increase seizures or withdrawal symptoms. Do not change dosage without doctor advice and tell doctor if medication does not work or if you are experiencing any adverse symptoms. report unexplained muscle pain, weakness, tenderness especially with fever or malaise; thoughts of suicide, or worsen depression, changes in mood or behavior – report; may cause edema, weight gain; preg risk; Know the antidotes for overdose of opiates, benzodiazepines, and barbiturates (phenobarbital)
• The antidote for opiates: Narcan (naloxone) – when overdosing, breathing slows down or stops
• The antidote for benzodiazepines: Romazicon (flumazenil) administered by rapid IV injection
• The antidote for barbiturates (phenobarbital): activated charcoal for phenobarbital - The antidote for aspirin is sodium bicarb - The antidote for Tylenol is Mucomyst