Pharmacology for Nursing
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| What are the untoward effects of the "grand-daddy" anti-convulsant **Phenytoin (Dilantin) | show 🗑
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| show | False: one taking **Phenytoin (Dilantin) may still experience an aura.
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| What are the signs of actual toxicity with **Phenytoin (Dilantin)? | show 🗑
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| What kind of teaching would be important when administering **Phenytoin (Dilantin)? | show 🗑
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| show | PO--slow absorption
IM--unpredictable absorption (avoid IM)
IV--slow onset, irritates veins
(only soluble in Normal Saline)
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| show | IV form alternative to Dilantin--more soluble, less irritation--Dosed differently!!! (for acute seizures)
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| What's the story w/**Carbamazepine (Tegretol)? | show 🗑
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| show | Major CNS depression--sleepiness; although tolerance can be built
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| Which anti-convulsant can be life threatening if one d/c's without tapering? | show 🗑
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| show | Anorexia, nausea, vomiting--20%
Sedation, tremor
Increased hepatic enzymes
Clotting problems
All dose related--lower doses helpful
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| show | Adjunct for tonic-clonic and complex partial seizures
Also for absence seizures
Also used -- bipolar illness
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| show | **Ethosuximide (Zarontin)
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| show | • CNS depression, ataxia
• Nausea
• No effect on blood counts
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| What is an advantage of prescribing **Gabapentin (Neurontin)? | show 🗑
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| What is the drug of choice for an acute seizure attack? | show 🗑
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| show | BP and respiration rate; watch for depression.
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| Jake is taking **Levodopa (precursor to dopamine) for his Parkinson's. What should we be watching for? | show 🗑
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| Why take **Carbidopa with Levodopa to tx Prakinson's? | show 🗑
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| What's too bad about Levodopa? | show 🗑
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| show | ➢ “Wearing off” --effectiveness reduces over time (years); body loses ability to store dopamine—worse in younger clients
➢ Other motor fluctuations—dyskinesia, dystonia
➢ 50% of people after 5-10 years of treatment
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| show | Same as dopamine: anorexia, N,V, somnolence, headache, dyskinesia, cardiac dysrhythmias, postural, etc. PRE-TREAT w/ANTI-EMETIC
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| show | These are anticholinergics. All anti-parkinsonian's should:
--reduce tremor, balance gait
--reduce rigidity, improve smooth movement
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| What side effects can you expect to see when taking **Benztropine (Cogentin) for Parkinson's? | show 🗑
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| What side effects can you expect to see when taking **Trihexiphenidyl (Artane) for EPS? | show 🗑
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| show | Behavioral changes, postural hypotension (especially apparent in treating Parkinson's), among others.
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| T/F: There is no cure for MS | show 🗑
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| show | ➢ Flu like symptoms, injection site reactions (OK)
➢ Elevations of hepatic enzymes—monitor levels
➢ Neutralizing antibodies—may develop, limiting effectiveness
➢ Responsiveness to Interferons varies among individuals
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| show | Transient chest pain, flushing, dyspnea, palpitations, anxiety: THESE ARE OK, TEACH YOUR CLIENT NOT TO FREAK...
➢ Also: injection site reactions
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| How do we diagnose Myasthenia Gravis? | show 🗑
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| When administering the ACh acetylcholinesterase inhibitor **Pyridostigmine (Mestinon), what should be monitored? | show 🗑
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| show | Nope: Rare—should assume weakness is worsening of Myasthenia Gravis
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| show | Low WBC
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| show | ➢ Flu like illness—fever, nausea, vomiting, malaise—10%
➢ Hematologic, GI or liver problems—less common
➢ Monitor CBC, hepatic enzymes
➢ Low WBC—dose limiting effect
➢ LongTerm use increases risk of non-Hodgkins Lymphoma
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| What are the adverse effects of benzodiazepines like **Diazepam (Valium)? | show 🗑
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| T/F: Benzodiazepines have a low incidence of abuse? | show 🗑
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| show | Alcohol (or any other CNS depressant, but know ETOH)
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| show | **Midazolam (Versed)--Short Acting
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Monitor for therapeutic effects
--anxiety, sleep
--teach about combo with drugs and alcohol
--teach about hangover (don’t drive)
--assess suicide potential, dependence
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| Narcan is to narcotics as ___________ is to benzodiazepines. | show 🗑
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| show | While it has a quick onset, it has a much shorter duration; thus a rebound effect of the valium could occur (re-dose as needed)
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| What are the adverse effects of **Phenobarbital (Luminal)? | show 🗑
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| show | There is no reversal agent: you could call this a downside in the case of OD.
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| What happens in barbiturate toxicity? | show 🗑
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| What are important contraindications of barbiturates? | show 🗑
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| What happens when someone is in withdrawal from barbiturates? | show 🗑
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| What distinguishes the anti-anxiety drug **Buspirone (Buspar) from barbiturates? | show 🗑
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| What are the adverse affects of unopposed estrogens | show 🗑
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| Liz is partaking in a controversial estrogen replacement therapy. What is Liz at an increased risk for? | show 🗑
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| What would a woman intolerant of estrogen replacement use an oral contraceptive? | show 🗑
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| Why is it important to take BC at the same time? | show 🗑
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| show | Combo with progestins reduce some risks—lower dose decreases risks, smoking increases of clots, small increase in glucose in diabetics, Nausea, headache, breast tenderness, dizziness, Weight gain, edema (should decrease over time), maybe photosensitivity
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| Jake is concerned about spotting and breakthrough bleeding during the second month of being on oral contraceptives. How should we respond to Jake's concerns? | show 🗑
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| show | ➢ Decreased spermatogenesis (infertility)
➢ Shrink testes
➢ Paradoxical feminization
➢ Acne, baldness, gynecomastia
➢ Increase risk of prostate cancer
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| show | ➢ Early closure of epiphysis
➢ Edema—weight gain
➢ Increase LDL, decrease HDL
➢ Jaundice—(cholestatic hepatitis) depends on
➢ Hepatic cancer (high dose, long term) agent used
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| What are some adverse effects of testosterone in women? | show 🗑
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| show | Depression is a common withdrawal effect.
Others psychological effects include:
➢ Aggression
➢ Mood swings, irritability
➢ Manic-like symptoms
➢ Impaired judgment
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| show | o Matrix type is applied to scrotum
o Reservoir-type applied to torso, arms, legs
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| Where is the gel form of testosterone applied? | show 🗑
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| T/F: Oral forms of testosterone have significant first pass effects. | show 🗑
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| show | Orthostatic hypotension.
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| show | Priapism; persistent erection...> 4 hours...ouch.
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| show | Encourage good hydration--may use IV pre-hydration; also watch for blood in the urine!!
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| The heavy metal agent _______________ is used just like an alkylating agent; as an anti-neoplastic. | show 🗑
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| What is different about the adverse effects of alkalyting agents, and heavy metals as anti-neoplastics? | show 🗑
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| show | o Bone marrow suppression—WBC’s, platelets
o GI disturbances (nausea, vomiting, diarrhea)
o Neurotoxicity—coma, seizures
o Alopecia
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| What are some adverse effects of anti-mitotic drugs like ***Vincristine (Oncovin)? | show 🗑
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| show | Check cardiac function.
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| show | o Cardiac toxicity—cardiomyopathy—long term toxicity--CHF
o monitor ECG’s
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| What are the adverse effects of the taxol drug **Paclitaxel (Taxol)? | show 🗑
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| What is the anti-estrogen drug that causes menapausal-like symptoms? | show 🗑
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| show | S/S of DVTs; super common with ant-estrogen drugs.
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| show | o Fever, chills
o Nausea, dyspnea, rashes
o Neutropenia
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| What kind of PPE should be worn when handling antineoplastic medication? | show 🗑
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| What is the protocol of an IV site extravasation? | show 🗑
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| show | Nadir--lowest point in cell counts; often 1 week after treatment
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| What is an adequate neutrophil count (ANC)? | show 🗑
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| show | No fresh flowers from visitors
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| show | Monitor for edema, bone pain (may be managed with tylenol; warn client of these common reactions)
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| show | <50,000; If < 20,000 may have active bleeding that won't stop.
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| What is a normal hemoglobin? | show 🗑
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| What is important to teach a client about anemia r/t beginning cancer tx? | show 🗑
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Created by:
scottheadrick
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