NUR 2474 Exam 1 2023 Blueprint
Half-life- time required for the concentration or amount of drug in the body to be reduced by one-half
handwritten
... [Show More] orders- A prescription for medications/ referrals
Application of Pharmacology in Patient care= (1) pre-administration assessment, (2) dosage and administration, (3) evaluating and promoting therapeutic effects, (4) minimizing adverse effects, (5) minimizing adverse interactions, (6) making PRN decisions
Receptor binding Binding of a ligand to a receptor changes its shape or activity, allowing it to transmit a signal or directly produce a change inside of the cell. Stages of signal transduction: ligand-receptor binding, signal relay, response.
Pharmacokinetics -Absorption-distribution-metabolism-Excretion-- how a body processes a drug
Pharmacodynamics- what a drug does to the body)
Adverse effect/side effect and expected and unexpected.
Teratogenic effect- are drugs, chemicals, or even infections that can cause abnormal fetal development
Paradoxical effect-not the intended effect (lavender to calm but it makes em crazy)
Cholinergic vs Anticholinergic side effects
• Anticholinergic o Can’t see, can’t pee, can’t spit, can’t shit
• Cholinergic o S-alivation o L-acrimation (tears) o U-rination o D-efication
Dosage Calculations
Medication Rights
• Right dose, person, time, med, route
Nursing Process: Assessment, diagnosis, planning, implementation, and evaluation. (ADPIE)
Terminology: EPS, Tardive dyskinesia, Akathisia, dystonia, parkinsonism
• Extrapyramidal symptoms. Weird mouth movements. Fidgeting. Involuntary muscle contraction.
• Parkinsonism is any condition that causes a combination of the movement abnormalities seen in Parkinson's disease — such as tremor, slow movement, impaired speech, or muscle toughness — especially resulting from the loss of dopamine-containing nerve cells. AKA EPS
Carvidopa/levodopa (Sinemet)- *Parkinson Med*
- Know action (what does it do), Nurse recommendation for patients who develop SE/AE of medication, Anticipated SE/AE of this medication, Pt education
• BASICALLY- levodopa turns into dopamine, increasing dopamine in the brain and balancing dopamine and acetylcholine. Carbidopa helps the body absorb levodopa which makes it more available to the CNS. C/L=Dopamine agonist
AE/Recommendations
• N/V-can be reduced by administering with meals
• Dyskinesias-can be managed in 3 ways- lower med dose, give amantadine, or surgery/electrical stimulation
• Hypotension-can be reduced by increasing salt and water intake
• Psychosis-can be reduced by lowering dose, anti-psych meds (have their own SE)
• Expected SE: Anticholinergic effects, GI upset, fall risk, hallucinations
Neuroleptic Malignant Syndrome
-What is this? How does this occur? Interventions?
• NMS happened when someone takes 2 types of neuroleptic drugs at one time. Hold med if toxicity is suspected.
• F-E-V-E-R
Alzheimer’s Medications (Donepezil; Galantamine; Memantine)- Cholinesterase Inhibitors -What is their action?
• Block the action of acetylcholinesterase - This increases the concentration of acetylcholine in the brain which may improve memory and cognitive function.
How do they help?
• Delay progression of disease- does not cure
Nurse recommendation for patients who develop SE/AE of medication
• Monitor CNS, give in the PM
• Cardiovascular effects-bradycardia, which can lead to falls and fainting- drug withdrawal may be indicated
Anticipated SE/AE of this medication
• Loss of appetite, PEPTO, More frequent bowel movements, Bruising, Muscle cramps, Headaches, Fatigue
Pt education
• Give at bedtime, can be sedating, can cause bad dreams
Contraindications
• Contraindicated if the pt has had a previous allergy to cholinesterase inhibitors, liver/heart disease or bradycardia.
Drugs for MS
Interferon Beta 1a
-Know action (what does it do), Nurse recommendation for patients who develop SE/AE of medication, Anticipated SE/AE of this medication, Pt education
• Inhibits inflammatory WBC from getting to the brain and suppresses T- helper cell activity. (antiviral)
• SE: flu like sx-can be avoided by starting med at a lower dose or giving NSAIDs. Hepatotoxicity-reduction in dosage is indicated. injection site reactions-rotate sites, ice before and warm after injection.
Baclofen (Muscle relaxant, Anti spastic)
- Know action (what does it do), Nurse recommendation for patients who develop SE/AE of medication, Anticipated SE/AE of this medication, Pt education
• Acts w/in the spinal cord to suppress hyperactive reflexes.
• SE: drowsiness, dizziness, weakness, fatigue (CNS depression)-can be minimized with smaller med doses.
Drugs for seizures
Phenytoin (Dilantin)- Class: Anticonvulsant
• Know action (what does it do): used to prevent and control seizures
• Nurse recommendation for patients who develop SE/AE of medication: Start doses smaller and gradually increase
• Anticipated SE/AE of this medication, Pt education: Headache, Pepto, dizziness, feeling of spinning, drowsiness, trouble sleeping,
• Therapeutic level: 10.0-20.0 mcg/mL
Phenobarbital- (Solfoton) Med Class: Barbiturate, Anticonvulsants/hypnotics.
• Know action (what does it do). This medication is used alone or with other medications to control seizures.
• Nurse recommendation for patients who develop SE/AE of medication: Watch Liver and renal function,
• Anticipated SE/AE of this medication, Pt education, reversals Dizziness, drowsiness, excitation, headache, tiredness, loss of appetite, Pepto
Methylphenidate- (Ritalin), Lisdexamfetamine (Vyvanse)
Amphetamine sulfate (Adderall)-CNS Stimulants
Know action (what does it do)
• Releasing norepinephrine (NE) and dopamine (DA). These actions take place in the CNS. CNS and resp. Stimulation with weak symptomatic activity
Nurse recommendation for patients who develop SE/AE of medication
• CNS stimulation-can be treated by starting with a lower dose
• weight loss-take in the AM
• Psychosis-treated with psych care
• cardiovascular effects- ECG Nursing Interventions?
• Monitor VS
• Also used for ADHD
• Ensure that all timed-release tablets and capsules are swallowed whole, not chewed or crushed. Dispense the least feasible dose to minimize risk of overdose. Give before 6 PM to prevent insomnia. Monitor CBC and platelet counts periodically in patients on long-term therapy
, Anticipated SE of this medication
• Hyperactivity, insomnia, restlessness, hypertension, anorexia, tachy and tremors.
Haloperidol (Haldol)- Med Class: Antipsychotic
• Know action (what does it do): First-generation (typical antipsychotic) which exerts its antipsychotic action by blocking dopamine D2 receptors in the brain.
• Nurse recommendation for patients who develop SE/AE of medication: Not for Parkinson patients. Watch VS, ECG, blood pressure, tachycardia.
• Anticipated SE/AE of this medication: Stiff neck, Parkinsons shuffle, Dizziness, lightheadedness akathisia (restless movements), anticholinergic effects, sedation. Not recommended for Elderly patients.
• Pt education, notifying provider: Do not Drive or use alcohol with this medication.
Traditional neuroleptics and non-traditional neuroleptics
(antipsychotic meds)/ FGA’s vs SGA’s
• Not much of a difference effect wise. the SGAs are less likely to cause EPS, including TD. SGAs carry serious metabolic effects—weight gain, diabetes, and dyslipidemia
-SE/AE
-what would the nurse assess the patient for?
-contraindications
-treatment for SE/AE management
Sertraline (Zoloft); Duloxetine (Cymbalta) - combo med for Anxiety & Depression; Fluoxetine (Prozac) - SSRIs
- Know action (what does it do),
• Treatment of Major depressive Disorder, OCD, Anxiety / Preg Class D
Nurse recommendation for patients who develop SE/AE of
medication
• Sexual dysfunction-can be treated w/ a drug holiday or other drugs (Viagra)
Pt Education:
• do not use with MAOIs
• can cause neurolytic malignant syndrome, suicidal thoughts, tremors, serotonin syndrome,
• monitor mood changes in patient
• takes 1-4 weeks for therapy to be effective
• No alcohol
Anticipated SE/AE of this medication
• sleepiness.
• drowsiness.
• tired feeling.
• nervousness.
• sleep problems (insomnia)
• dizziness.
• nausea.
• skin rash.
Amitriptyline (Tricyclic Antidepressant)
Know action (what does it do)-
• Affects certain chemical messengers (neurotransmitters) that communicate between brain cells and help regulate mood.
Nurse recommendation for patients who develop SE/AE of medication:
• Restrict drug access for depressed and potentially suicidal patients. Give IM only when oral therapy is impossible. Do not administer IV. Administer major portion of dose at bedtime if drowsiness, severe anticholinergic effects occur (note that the elderly may not tolerate single daily dose therapy). [Show Less]