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Pharm Final Exam

o A nurse enters a patient’s room and sees the patient convulsing in bed. Realizing the patient is having a seizure, what does the nurse do? Pad side rails, remove close objects, loosen clothing. Don't try to restrain patient. Document: aura (if any), behavior/movements, length, associated symptoms. After, monitor VS (esp Resp), put on side (suction prn), reassure fam, remain calm.
Status epilepticus seizures which continue more than an hour or more than 2 major seizures without recovery of consciousness in between.
A patient has been diagnosed with seizure disorders and needs an anticonvulsant medication. How does the provider decide what anticonvulsant to prescribe? What would the nurse monitor for no matter the antiepileptic drug prescribed? Depends on type of seizure (1. tonic-clonic and complex partial 2.absence seizures). Nurse will monitor for signs of toxicity (drowsiness?), suicidal ideation.
After 3 years of good control, a patient wishes to try withdrawing his prescribed anticonvulsant. How would this be done? In a controlled setting.
While having a serum drug level drawn a patient states, “Why do you need to know the drug level? I feel fine.” The nurse responds knowing therapeutic serum drug levels are drawn when? To promote compliance. After changing drugs or doses. With signs of toxicity. If seizures persist.
A patient with tonic clonic seizures has been prescribed Phenytoin (Dilantin). The nurse is providing teaching to the patient and includes what information regarding the medication? s/e: Gingival hyperplasia (good dental care/massage gums), hirsuitism, coarse facial features, blood dyscrasias, watch for rash, birth defects, toxicity (CNS depress, ataxia, nystagmus), will affect oral b.c., watch therap. blood levels, folic acid suppl.
What route of administration should be avoided for Phenytoin (Dilantin)? How does Fosphenytoin (Cerebyx) differ from Phenytoin (Dilantin)? Avoid IM. Cerebyx is an IV form that is more soluble, irritates less, and is DOSED DIFFERENTLY
A patient has been prescribed Carbamazepine (Tegretol) to treat his partial complex seizures. The nurse calls the provider to question the order if the patient has what other condition? CHF (because retains Na and water)
A patient who has been taking Phenobarbital tells the nurse that the medication isn't working and that he's just going to stop taking it. The nurse provides what teaching to the patient? Rapid withdrawal can cause life-threatening seizures. Must taper.
Valproic Acid (Depakote, Depakene) and Ethosuximide (Zarontin) are medications that can be used to treat absence seizures. Which one is preferred for childhood a. seizures and what are the adverse/untoward effects associated with these two medications? Zarontin for childhood a. s/e for both: N&V, anorexia, sedation (do tend to get better with time)
What does the nurse monitor for when caring for a patient who is taking Carbamazepine (Tegretol)? Blood levels, blood counts
What adverse reactions would a nurse teach to a patient who has been prescribed Phenobarbital? CNS depression, sleepiness, tolerance develops over time, Induces hepatic enzymes (requiring higher doses for effect and speeds up metabolism of other drugs), paradoxical excitation in kids. (No rapid withdrawal!)
What anticonvulsant medication is used for refractory epilepsy and can be combined with Phenytoin (Dilantin)? What are the adverse effects associated with this medication? Gabapentin (neurotonin). a/e include CNS depression, ataxia, Nausea. No effect on blood counts. Suicide in adolescents with depression who take this drug
How would the nurse explain how Lamotrigine (lamictal) works to a patient? May stabilize cell membranes, affect sodium channels and release of glutamate and aspartate (excitatory amino acids). AKA stabilizes the cells and alters the chemicals involved in seizure activity in the brain
Can Carbamezepine (tegretol) and Lamotrigine (lamictal) be taken concurrently? If not, why? No, because can cause cerebellar toxic syndrome (tremor and movement disorder)
What adverse reactions of Lamotrigine (lamictal) would the nurse teach the patient to be aware of? Dizziness, headache, double vision. usually resolves.
A patient is in Status Epilepticus. What are the dangers of Status Epilepticus and what medication does the nurse anticipate will be ordered to stop the seizure? What would be done if a patient experienced a febrile seizure? Benzodiazepines - Lorazepam (ativan) IV. Follow with phenytoin IV or phenobarbital if no response. Febrile: (are in children, caused by fever) Rectal diazepam, buccal midazolam
What signs and symptoms would the nurse expect to see when assessing a patient with Parkinson’s Disease? Rigidity, akinesia (loss of ability to move, freezing in place...), tremor, slow movement, shuffling gait.
A pt has been diagnosed with Parkinson’s Disease and has been prescribed Sinemet (Levodopa/Carbidopa). What teaching would the nurse provide to a patient regarding this prescription? Causes anorexia, N&V (gets better). s/e: drowsiness, h/a, dyskinesia, dysrhythmias, postural hypotension, hallucinations, nightmares, anxiety, compulsive behaviors. Interacts with B6, antipsychotics, anticholinergics, MAOI's (hypertensive crisis)
What medication may be used for Parkinson’s Disease before or in combination with Levodopa and has adverse effects similar to Levodopa? Bromcriptine (Parlodel): Dopamine agonist.
An elderly couple comes to the clinic. One is taking Benztropine (Cogentin), and one is taking Trihexiphenidyl (Artane), but both are complaining of blurred vision and increasing confusion. The nurse realizes the patients could be experiencing what? anticholinergic effects
What are the adverse reactions associated with Benztropine (Cogentin) and Trihexiphenidyl (Artane), and what needs to be considered if the provider decides these meds will be d/c? Anticholinergic effects: confusion, memory impairment, hallucinations in elderly. Need to withdraw slowly to avoid severe parkinson's symptoms
Sinemet Is a combo drug: Levodopa & Carbidopa. Is the most common Parkinson's med. Is more effective than levodopa alone.
nystagmus Eye movement (think drunk eye test), eyes will be twitching vertically or laterally - usually laterally
refractory epilepsy Medicines don't work well, or at all, to treat seizures
What medication is used to treat acute M.S. exacerbations? Corticosteroids. i.e. IV methylprednisolone (high dose, then tapered off).
What medication is used to prevent M.S. attacks? WHat are the adverse effects? Interferon Beta-1-b (betaseron). a/e: Flu-like symptoms (aches, pains, fever). Injection site rxns, elevations of hepatic enzymes, Neutralizing antibodies may develop over time (limiting efficacy).
Carbidopa Used to treat Parkinson's. Blocks peripheral decarboxylation (allows more levodopa to ender brain). Can lower doses of levodopa and reduce a/e.
Amantadine (Symmetrel) Used to treat parkindon's. Is an antiviral agent, increases dopamine release, inhibits reuptake and stimulates receptors. May help with motor fluctuations caused by levodopa
Glatiramer Acetate (Copaxone) Used to treat M.S. Suppresses immune response. a/e: injection site rxns, transient chest pain, flushing, dyspnea, palpitations, anxiety. Teach client: not allergy, rxn will pass.
It is suspected a patient has Myasthenia Gravis. What test would be used to confirm the diagnosis of Myasthenia Gravis? If the test was positive, what reaction would be seen and what medication might be prescribed for the patient? Tensilon Test. If strength improves 5-10 min after IV infusion, the test is positive. If positive, go on to do serum test for ach antibodies and Single Fiber EMG. Med: acetylcholinesterase inhibitor: Pyridostigmine (Mestinon). Also immunosuppresants
What adverse effects could occur with the administration of Pyridostigmine or Neostigmine? Cholinergic s/e: N/V/D, salivation, sweating, bronchial secretions, muscle cramping/twitching/weakness. Cholinergic crisis: excess chol. stim (includes bradycardia. is rare)
A patient experiences Myasthenic Crisis and is prescribed a corticosteroid. Over time the corticosteroid is tapered as Azathioprine (Imuran) is added to the medication regimen. What would the nurse monitor for when administering these two medications? WBC count (may have to decrease dose if drops too low). Also, Imuran may take 1-2 years for maximum effect to take place.
When sedatives/hypnotics are used to treat anxiety disorders/sleep disorders, what else needs to be included as part of treatment? Psychotherapy
What are the indications for the use of Diazepam (Valium)? Can Benzodiazepines be used for anesthesia, as they have “anesthetic effects?” sedation, anxiolysis, seizure control. muscle relaxation. They can be used to induce anesthesia by sedation and anterograde amnesia, but they alone do not have analgesic effect.
A patient tells the nurse he is afraid of taking Diazepam (Valium) because he might get addicted. How does the nurse respond? What would the nurse teach the patient regarding adverse reactions and medication interactions? In combo with CNS depressants, can cause resp dep. other a/e: amnesia, nightmares, paradoxical in elderly, hangover. Usually takes high doses, prolonged use for dependence to occur, and a history of substance abuse.
A patient taking Diazepam (Valium) for seizures has accidentally overdosed on the medication. When the patient is brought to the Emergency Department the nurse expects an order for what med and knows she may see what rxns upon administering the med? Flumazenil (Romazicon). Dizziness, nausea, anxiety, agitation, possible withdrawal symptoms or seizures (if have disorder). Drug has fast onset and short duration
A patient has been prescribed Phenobarbital (Luminal) but the nurse questions the prescription due to the presence of what conditions in the patient’s medical history? Porphyria, COPD
The nurse would consider what and monitor for what adverse reactions with the administration of Phenobarbital (Luminal)? High profile of abuse/dependence. Tolerance to sedation 3-14 days. Hangover common, paradox in elderly, hypersensitivity (watch for urticaria, facial swelling). No reversal agent for OD. MUST withdraw slowly.
A patient is brought to the Emergency Department after overdosing on Phenobarbital (Luminal). What signs and symptoms are associated with this type of overdose and what can be done for this patient? Respiratory depression and cardiovascular collapse. NO reversal agent- symptom management.
How does Buspirone (Buspar) differ from Benzodiazepines? What may a nurse see in a patient being switched from a sedative to Buspirone (Buspar)? Does not bind to BZD receptor. High affinity for serotonin recept, moderate for dopamine recept. No anticonvulsant or muscle relax. No evidence for abuse, little for tolerance, no rebound/withdrawal. May see withdrawal when switching if dependent on sed.
A pt who has been prescribed Buspirone (Buspar) for anxiety says, “I can’t wait until I feel better. With this medication I can wake up tomorrow and feel as good as new!” How does the nurse respond and what teaching should the nurse provide to this pt? It has a slow onset, 7-10 days
Teaching for pyridostigmine (acetylcholinesterase inhibitor to treat M.G.) Take with food to decrease nausea, monitor symptoms (adjust doses based on responses, which can change with stress or fatigue), cholinergic crisis
Side effects of Buspar Dizziness, HA, nausea, nervousness, dry mouth
What are the adverse effects and risks of unopposed estrogens? Are these risks affected by the combination of estrogen with progesterone? Increased LDL's, Na & H20 retention, up risk of endometrial & breast cancer, DTV/PE, Heart disease, stroke, cholecystitis. Combo with progesterone may reduce some of these risks
What are the recommendations from the Women's Health Initiative Study in regards to Hormone Replacement Therapy? Lowest dose possible, for the shortest time possible (no >5 years). Not to be used with hx of thromboemboli, heart disease
A patient asks the nurse about taking phytoestrogens from soy or black cohosh instead of getting a prescription for estrogen from her physician. How does the nurse respond? There is no evidence that phytoestrogens are more safe or even effective.
What were the effects of Diethylestibestrol (DES) on the children of the women who took the "Day After Pill" while pregnant? This one was used to PREVENT miscarriage. Effects on child: Infertility, risk of vaginal cancer, increased cancer risk for males and females
A patient has been prescribed an oral contraceptive for the first time. The nurse plans to teach the patient about adverse effects and when/how to take the medication. What information does the nurse include in her teaching? a/e same as with estrogen (lower dose and/or combo with progest less risks), smoke up risks of clots, sm up in glucose in diabetics, Naus, h/a, breast tender, dizzy, wt gain, edema, should decrease, maybe photosens, up cerv cancer, decr uter/ovar canc
A patient who has been taking oral contraceptives for less than 1 month calls the clinic and complains of spotting and breakthrough bleeding. How does the nurse respond? What if the patient had called and stated she missed her period? This is normal. Even missed period could be normal, but ask if could be pregnant, have take a test
A patient asks the nurse how oral contraceptives protect against STDs. What teaching does the nurse provide? They do not
A patient has just received an injection of Depo-Provera (Medroxyprogesterone). The nurse teaches the patient that the medication is effective in how many days and lasts for how many months? Onset in 5 days, lasts 3 months
A patient has had a Norplant (Levonorgestrel) Implant. Where is the implant placed and what are potential complications? How long does the implantation site need to be covered and how long does the implant provide coverage for? Upper arm. Irritation, scarring, abnormal bleeding. Cover for 3 days, onset in 24 hours, lasts 5 years.
Within what time frame does "Plan B" need to be taken? What are the adverse effects and contraindications of "Plan B?" within 72 hours after intercourse.
An athletic team is suspected of using Testosterone as an anabolic steroid and a nurse has been asked to educate them on the physical effects of steroids What info does the nurse include in her teaching? No up in strength, just size. a/e: (dosedependent, oral worse) early close epiphysis (shorter), edema/wt gain, up LDL,, cholestatic hepatitis, Hep canc, decr spermgenesis (infert), shrink testes, feminization, acne, bald, gynecomast, up risk prost. canc.
A patient is suspected of having Benign Prostatic Hyperplasia. What condition needs to be ruled out before a diagnosis is made? Prostatic cancer
A patient has been prescribed Finasteride (Proscar) and asks the nurse how long the medication takes to work. How does the nurse respond and what adverse effects should the nurse tell the patient about? (for baldness - androgen inhibitor). May take 6-12 months. a/e: decreased libido, erectile dysfunction.
What is an unopposed estrogen? Estrogen taken alone (without progesterone)
What are the psychiatric effects of anabolic steroid use? Aggression, mood swings, irritability, manic-like symptoms, impaired judgment, depression upon withdrawal
What are the effects of anabolic steroids on women? Masculinization, male-patterned baldness, facial hair growth, suppress menstruation, enlarge clitoris, deepened voice.
Tamoxifen Citrate is what type of medication An antiestrogen and antineoplastic medication
Created by: anamichelle