CNS Stimulants
A teenage boy will be receiving atomoxetine (Strattera) as part of treatment for ADHD. What should he be monitored for?
Possible suicidal thoughts and behavior.
Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient’s family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.
What information should the nurse provide to the patient who is receiving antiepileptic drug therapy?
Take regularly, same time each day. Take with meals to reduce GI upset. Do not crush, chew, or open extended-release forms. Teach patients to keep a journal to monitor: response to AED, seizure occurrence and descriptions, adverse effects. Instruct patients to wear a medical alert tag or ID. AEDs should not be discontinued abruptly. Follow driving recommendations.
it is a variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms
Which lab value would you want to check before giving lithium to a patient.
Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity.
Drug given for benzodiazepine overdose.
Flumazenil
What measures could be suggested to reduce unwanted side effects in a patient taking orlistat (Xenical)?
Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of Orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients.
A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 μg/mL. Which administration technique will the nurse use
Phenytoin should be mixed only with normal saline, and it should be given by slow IV infusion (but not as a continuous infusion).
Amantadine, carbidopa-levodopa, and ropinirole are most likely to cause what adverse effect.
Postural hypotension. Teach patients to change positions or get up slowly; if needed, call for assistance
Patients recently started on antidepressants are most at risk for what during the first few weeks of treatment?
a higher risk for suicide during the first few weeks of antidepressant therapy.
Medications used to treat opioid withdrawal.
Clonidine 0.1-0.2mg given every 4-6 hours PRN for s/sx of withdrawal; used 5-7 days; Check BP before administering - hold if hypotensive
Methadone: single dose of 20-30mg to suppress symptoms; repeat total first day dose dividied into 2 doses (stabilization dose) for 2-3 days; then reduce by 5-10mg daily until medication is completely withdrawn
What is important for the nurse to assess in the patient’s history before administering a serotonin agonist (aka triptans)?
The nurse should complete a thorough cardiac history as well as measurement of blood pressure and pulse rate and rhythm. If a patient has a history of hypertension, there is risk of further increases in blood pressure to dangerous levels with use of these drugs and thus the need for careful assessment and documentation. In fact, these drugs are generally not prescribed for patients with migraines who also have coronary artery disease unless a thorough cardiac evaluation has been performed.
Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. The nurse knows that risk for toxicity is higher with what lab value?
Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur.
What patient teaching should the nurse include in a patient taking an anticholinergic medication for Parkinson's Disease?
Side effects should be discussed - dry mouth/how to treat; Increase fluids; Take with a snack; Don't take at the same time as other mediations; Administered at bedtime.
Patient teaching for SSRIs
Patients should be taught that the time period for SSRIs to take effect is 4 to 6 weeks. These medications can cause GI upset, and taking them with food is recommended. SSRIs should be taken in the morning to prevent any sleep disturbances.
Treatment for alcohol withdrawal
Benzos
Monitor respiratory/cardiac function
Fluid/nutrition replacement
Thiamine/Magnesium replacement
A patient is prescribed an anorexiant. What should the nurse include in their teaching?
Caffeine in any form must be avoided by patients taking anorexiants. These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times. These drugs should not be abruptly stopped because a rebound increase in appetite may develop.
The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. What other chronic condition might this patient be taking gabapentin for?
Gabapentin is commonly used to treat neuropathic pain.
Contraindications to carbidopa-levodopa
Angle-closure glaucoma
History of malignant melanoma
Concurrent use of monoamine oxidase inhibitors (MAOIs)
Difference between serotonin syndrome and withdrawal.
Serotonin Syndrome: a result of taking too much of the medication. Agitation, tachycardia, sweating, tremors.
Withdrawal: A taper period of 1 to 2 months is needed to prevent the development of adverse effects of withdrawal from the medication, which include dizziness, diarrhea, and a worsening of the depressive mood disorder.
Clinical manifestations of delirium tremens (DTs)
Marked hypertension (hypertensive crisis), Tachycardia, Hyperthermia, Tremors, Insomnia, Agitation. CAN BE LIFE THREATENING!!!
In a patient taking orlistat (Xenical), lab studies could indicate what vitamin deficiencies?
A decrease in serum concentrations of vitamins A, D, E, and beta carotene are common, due to the blocking of fat absorption. These patients should be instructed to use a supplement that contains these fat-soluble vitamins.
A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse is knows that this medication is associated with what condition and can expect what to happen to the patient's drug level?
Autoinduction is a process in which, over time, a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations.
Patient teaching for Parkinson's medications.
Inform patient not to take other medications with PD drugs unless he or she checks with physician
When starting dopaminergic drugs, assist patient with walking because dizziness may occur.
Administer oral doses with food to minimize GI upset.
Encourage patient to force fluids to at least
3000 mL/day (unless contraindicated).
Taking levodopa with MAOIs may result in hypertensive crisis.
Patient should be taught not to discontinue antiparkinson drugs suddenly.
Teach patient about expected therapeutic and adverse effects with antiparkinson drug therapy.
Entacapone may darken the patient’s urine and sweat.
Therapeutic effects of COMT inhibitors may be noticed within a few days; it may take weeks with other drugs.
Neuromalignant syndrome is an adverse reaction of antipsychotics. This is manifested how?
high fever, unstable bp, and myoglobeniemia.
Difference between transdermal Nicotine and Nicotine gum.
The patch system uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, and patient treatment compliance seems higher than with the gum. Acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing releases an immediate dose of nicotine. The dose is approximately half the dose the average smoker receives in one cigarette, however.