Antiepileptic
During discharge, the patient makes these statements about their new carbamezapine prescription. Which statement needs correcting?
A. If a rash appears I need to let my health care provider know
B. I am happy I only have to take this medication for a couple of weeks.
C. I will make sure to keep using my birth control while on this medication.
D. I will avoid eating grapefruit while taking this medication.
B. You need to stress drug adherence
The nurse should question the administration of which anesthetic agent in the patient with a history of psychiatric illness?
Ketamine
You patient is taking levodopa/carbidopa and he reports feeling dizzy whenever he stands. What should you tell the patient to do to help with this.
How do cholinesterase inhibitors work and what is their main side effect?
They prevent the breakdown of acetylcholine and GI upset is a common side effect.
What drugs are used to treat spasticity?
Baclofen
Diazepam
Dantrolene
What side effects of phenytoin are dose dependent?
(Bonus: What side effects are idiosyncratic?)
CNS: nystagmus, ataxia and increases seizing (>30), stupor and coma (>40)
Idiosyncratic: gingival hyperplasia, skin rash, arrhythmias, hirsutism, birth defects
The nurse is preparing a patient for a surgical procedure. The provider plans to coadminister lidocaine with epinephrine as local anesthetics. Why is epinephrine used?
A. Epinephrine induces sleep
B. Epinephrine acts as a vasconstrictor
C. Epinephrine is used to induce mild amnesia
D. Epinephrine paralyzes the skeletal and smooth muscles
B. Epinephrine acts as a vasoconstrictors
Epinephrine minimizes the chance of drug toxicity and prolongs the anesthetic. **Though it can cause tachycardia and palpitations**
While providing discharge teaching to a patient prescribed Pramiprexole, you make it priority to teach the patient about what side effect?
A. Drowsiness
B. Dry mouth
C. Coughing
D. Dark sweat or saliva
The answer is A. This medication is known to cause sudden drowsiness that can cause a person to randomly fall asleep. Therefore, it is PRIORITY to teach the patient to not take this medication when they be driving or operating machinery etc…to prevent injury.
Which medications are widely used pharmacology stimulant drugs?
Amphetamines and methylphenidate
What drug causes malignant hypertermia and how do you treat it?
Succinylcholine
Treat with chilled saline and dantrolene
What drugs cause Steven-Johnson's syndrome?
Carbamazepine
Oxycarbamazepine
Ethosuximide
Lamotrigine
What are the guidelines for applying topical anesthetics?
Apply the smallest amount needed
Avoid application to large areas
Avoid broken/irritated skin
Avoid raising temperature which can increase absorption rate
A patient is taking Rasagiline “Azilect” for treatment of Parkinson’s Disease. What foods do the patient want to limit in their diet? Select all that apply:
A. Liver
B. Aged Cheese
C. Sweetbread
D. Beer
E. Fermented foods
F. Shellfish
The answers are B, D, and E. Rasagiline “Azilect” is a MAO Inhibitor Type B (Monoamine Oxidase Inhibitor). The patient should avoid foods high in tyramine which can cause a hypertensive crisis. This includes: aged cheese, smoked/cured meats, fermented food, beer.
A patient with Alzheimer's is prescribed 10mg of memantine. Based off the nurse and HPI's assessments, what would warrant the reduction in the dose?
A. The patient has a heart rate of 60 bpm
B. The patient has a urine output of 150 ml for 8 hours
C. The patient has increased hand tremors and drooling
D. The patient blood pressure reading is 120/80 mmHg.
B. Oliguria indicated decreased renal function
What is the difference between pancuronium and succinylcholine?
(Bonus points. Which has an antidote and what is it?)
Pancuronium is NON-DEPOLARIZING. It has the antidote neostigmine.
Succinylcholine is depolarizing and it ACTS FASTER so it is used in emergencies
What drug induces itself?
Carbamazepine
How often do you need to discard propofol? What do you need to watch for in patients on propofol?
Every 6 hours
Monitor triglycerides due to pancreatitis risk. Watch respiratory drive and blood pressure
You’re patient with Parkinson’s Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening?
A. Anticholinergic (Benztropine)
B. Seligiline (MAO-B)
C. COMT Inhibitor (Entacapone)
D: Beta blockers (Metoprolol)
C.
Tx for wearing off:
-shorten dosing interval
-COMT
-Dopamine Agonist (pramiprexole)
- used controlled release dosing
What does guanfacine help with in patients with ADHD?
Tics
Administration of dantrolene for the treatment of muscle spasticity is contraindicated in which patient?
A. A patient with cerebral palsy
B. A patient with a C6 spinal cord injury
C. A patient experiencing malignant hyperthermia
D. A patient with multiple sclerosis and underlying cirrhosis
D. Dantrolene causes hepatotoxicity
Which one is correct? (Bonus: points if you can fix the incorrect ones)
A. Ethosuximide 50-100 mcg/ml
B. Valporic Acid 40-100 mcg/ml
C. Phenobarbital 15-40 mcg/ml
D. Carbamezapine 10-20 mcg/ml
E. Phenytoin 4-12 mcg/ml
C. Phenobarbital 15-40 mcg/ml
(Ethosuximide 40-100, Valporic Acid 50-100, carbamazepine 4-12, phenytoin 10-20)
What would you monitor for a patient on isoflurane?
Respiratory status
Blood pressure; dose dependent vasodilation
What drugs interact with entacapone?
Methyladopa, dobutamine, and isopuranole
What are five common side effects of stimulants?
Decreased appetite
Poor growth
Dizziness
Insomnia
Rebound
Tics
Psychosis
Misuse
How is dantrolene different from other muscle drugs for spasticity?
It works directly on the skeletal muscle to suppress calcium.