Nursing Competency Program Transes PDF

PRELIMS - NCP - 2nd line Tx PHARMACOLOGY ★ Imipramine SNS PNS ★ Amitriptyline S/E -...

PRELIMS - NCP - 2nd line Tx PHARMACOLOGY ★ Imipramine SNS PNS ★ Amitriptyline S/E - sedation sympathetic parasympath A/E - cardiotoxicity fight or etic (arrhythmias, prolonged QT flight rest and interval) “stress” digest T - tyline, pramine dry response “peace” wet C - cardiotoxicity response A - antok Monoamine Oxidase Inhibitors adrenergic cholinergic (MAOIs) anticholiner anti ★ Parnate gic (blocks adrenergic ( PNS) blocks SNS) ★ Nardil sympathomi parasympath ★ Marplan metic (S omimetic ( *tyramine free mimic) P mimic) WOF: hypertensive crisis >180 mmHg “headache” SNS - under stress body (blood goes to Avoid: processed food, smoked, organs where it needs, if stress brain releases permented, aged, pickled, chocolate, more cortisol) vasoconstriction → ↑VS → yogurt, banana, avocado, aged ↑BP, RR → bronchodilation (relax cheese, cheddar cheese, miso soup, bronchioles) → pupil dilation (mydriasis - soy sauce, mustard blurring) → ↓GIT function (constipation) → Safe foods: cottage cheese, cream GUT targets bladder/smooth muscle (if cheese, american cheese stress bladder is at rest) (might get urinary retention) → dry mouth/eyes (dry response) S *Therapeutic effect: 2-4 weeks →↑blood glucose (lag period) T *do not mix PNS - vasodilation → ↓VS → M *do not change AD quickly bronchoconstriction → pupil constricted DANGER (miosis) →↑GIT function (diarrhea) → ↳ serotonin syndrome frequent urination →salivation, teary eyes S/E: (wet response) → ↓ blood glucose ↑VS tremors pupil dilation Fentanyl - opioid (↓VS) (concerns respi) ALOC ↳morphine, codeine, oxycodone coma Antidepressants - ↓NE,S Goal: ↑NE,S S/E: SNS =SNS O - Orthohypotension (P: - AD triggers SNS slow move) SSRI (pram, ine: mostly) D - Dizziness - 1st line of Tx - lesser S/E D - Dry mouth (P: candy) ★ Citalopram ★ Fluoxetine Lithium ★ Sertraline - mania ★ Paroxetine - TL: 0.6 - 1.2 meq/L S/E WOF: - S/E: polyuria ★ Suicide - Prone: ↓ Na, (Ⓝ 135 - 145 meq/L) ★ Sexual dysfunction - maximum of 3 liters of water per (↓libido/drive) day ★ Rapid ↑wt. gain - maximum of 3 grams of salt per ★ Insomnia day Tricyclic AD (pramine,tyline) - prone of toxicity 1  V - vomiting/visual S/E: red brown A - anorexia discoloration ( urine N - nausea & saliva) D - diarrhea Both: A - abdominal cramps ↓ CHON L - loss of coordination (ataxia) ⛒ vitamin B6 ↳ dysarthria = slurred speech food sources (whole grains) ↳ tremors: fine = OK! 2. Anticholinergics course = REPORT! C - Cogentin *VANDAL w/ tinnitus A - Artane *may lead to organ failure = anuria B - Benadryl Contraindications A - Akineton - pregnant *also given! Extrapyramidal Side Effects - diuretics 3. MAO-B Inhibitors - NSAIDs + lithium = renal selegiline - diet: tyramine impairment free *it may take 3 weeks to work 4. Dopamine Agonist *not addictive bromocriptine amantadine (antiviral) Other Effects: Myasthenia Gravis (MG) orthostatic hypotension - weakness (descending) dizziness ↳ ptosis, diplopia dry mouth Dx = tensilon test ↳ edrophonium (drug used) →(+) Depression = ↓ NE ↓ S test = improved muscle strength = Goal: ↑ NE ↑ S = SNS suggests myasthenia gravis as the likely diagnosis. Schizophrenia = ↑ dopamine - IV route Goal: ↓ dopamine →S/Sx: Parkinson's - 5 min. fast acting medication Mainstay! - “stigmine” Antipsychotics “neuroleptics” neostigmine Typical Atypical pyridostigmine *cure? NO! = improve - classical/con - “new” ventional - for (+) - For: (+) symptom Cholinergic Crisis Myasthenic Crisis symptom and (-) “overmed” “undermed” (schizo) symptom - causes (5A’s) S - salivation Exacerbatio E.P.S.E - less E.P.S.E L - lacrimation n Drugs: & fast U - urinary Mgt: chlorpromaz acting incontinence ↑ dose ine Drugs: D - diarrhea give the thioridazine clozapine = *antidote - drug fluphenazin ↓ WBC atropine sulfate drug e ↓ (ATSO4) compliance haloperidol agranulocyt ↓ osis hepatotoxic fever Parkinson's Disease = ↓ dopamine (prior: sore throat check liver mouth sores Goal: ↑ dopamine = psychosis function) *CBC ↳ hallucination - confirmator 1. Dopaminergic = levodopa y = carbidopa + levodopa olanzapine (sinemet) risperidone seroquel 2 S/E: SNS w/odd Osteoporosis photosensitivity 1. Calcium + Vit. D (Calcitriol) sedation ↳ absorption of calcium in ↓ libido GIT amenorrhea 2. Raloxifene wt. gain ☑ estrogen replacement Report: E.P.S.E ☑ bone formation dystonia - spasm ☑ wt. gain, bloating oculogyric crisis - uncontrolled ☑ breast tenderness rolling back (eye) WOF: DVT akathisia - restless ↳ HT: encourage ambulation akinesia - weakness *not indicated for pregnant 3. Calcitonin - blood →CA→bone ↳WOF: HypoCa = S/Sx: tetany Pseudo parkinsonism = S/sx of Parkinson's 4. Bisphosphonates “-pronate” Tardive dyskinesia - involuntary movement alendronate of face = tongue protrusion/teeth grinding ibandronate *take in the morning before breakfast Neuroleptic Malignant Syndrome - only *take w/ 1 full glass of water only deadly* *NPO for 30 mins. after taking drug in S/Sx: upright position hyperthermia ALOC Gout - food →purine muscle rigidity ↓ xanthine oxidase uric acid Anxiety 1. Colchicine 1. Benzodiazepines - “zolam” “zepam” - acute attack of gout 2. Barbiturates - “-barbital” - agranulocytosis 3. Non benzodiazepines 2. Allopurinol buspirone - maintenance drug zolpidem = given to insomnia - headache/dizziness ↳ zombie 3. Probenecid - eliminates U.A. through urine ADHD *all of these drugs with meals DOC: methylphenidate Avoid: - it prolongs attention span A - alcohol, anchovies - Given: before breakfast & lunch, 6 L - legumes hours before bedtime L - lentils - BID, OD B - beer, beans WOF: O - organ meat growth retardation - check ht. & wt. Y - yeast *drug holiday - pt stops taking the drug S - seafood, salmon (vacation) Digoxin - TL: 0.5 - 2.0 mg/ml Muscle Relaxants ☑ HF carisoprodol (soma) ☑ (+) inotropic = ↑ force (contraction) baclofen (-) chronotropic = ↓ cardiac workload ↓ cyclobenzaprine ↓ HR methocarbamol - check HR before giving drug in 1 Given: muscle spasms full minute (apical pulse) *improvement of mobility → result - monitor K → hypokalemia triggers *Multiple Sclerosis - okay toxicity *MS - muscle - weakness/spasm Toxicity: 3 V - vomiting and visual disturbance shave (xanthopsia) →yellow vision (cause microabrasion) A - anorexia 12° - 14° ON N - nausea 10° - 12° OFF D - diarrhea rotate sites: shoulder, inner A - abdominal cramps upper arm, back Antidote: Digibind or DigiFab (Digoxin (prevent drug tolerance) Immune Fab) *in terms of discarding, fold the sticky *↓ K ↓ HR = ⛒ Digoxin parts together Anti Hypertension NTG x Viagra (Sildenafil) 1. Central Anti Adrenergic - Clonidine ↳ fatal hypotension (Catapres) 2. Beta Blockers (“-olol”) Cardiovascular Drugs - ↓HR 1. Antihyperlipidemics (statins) - bronchoconstriction - S - sip of water only - T - take it at night Contraindicated: - A - aching muscle (rhabdomyolysis)! COPD - T - teratogenic Asthma - I - inc. HDL/ dec. LDL Heart block - N - normal liver function 3. CCB “(-dipine”) 2. Anticoagulant (- parin, - xatan) D - Diltiazem - prevents blood clot V - Verapamil - *bleeding precaution Ex. Heparin - PTT TL - 60 -80 sec N - Nifedipine (antidote: Protamine) A - Amlodipine Warfarin - PT TL - AOG 12w - Doppler Heart tone absent 11 History: grapelike clusters upon UTZ Diet: ↑ protein, ↓salt, ↓fat Associated with: CHORIOCARCINOMA seizure precaution - Oxygen MGT: Avoid getting pregnant for at least 1 Suction Machine year Pad side rails Methotrexate DOC → magnesium sulfate IM →WOF: D&C Antidote for toxicity: D Hysterectomy calcium gluconate IV R Anti - HTN O INCOMPETENT CERVIX If eclampsia, STAT delivery! P - Premature dilation of the cervix Causes: 2. Station - relationship of unknown presenting part to ischial spine damage due to previous surgery or trauma PHASES OF LABOR Assessment: painless, pink stained discharge bright red bleeding Management: Cervical Cerclage - suturing of the cervix *when to remove: 37th week of pregnancy bag of water ruptures Avoid: FHR VARIABILITIES heavy lifting prolonged standing intercourse Placenta Previa Abruptio Placenta Risk Factors: Risk Factors: Maternal age >35 trauma African American HTN Previous history of cocaine use previa DM - Smoking polyhydram nios Pain: painless Pain: painful Bleeding: bright Bleeding: dark red red Uterus: hard, rigid, Uterus: soft, boggy board like CARDIOVASCULAR DISEASES Management for both: monitor VS & FHR left side lying oxygen fluids Management: Plaque bed rest clot → cholesterol → CAD left side lying 12 ↳dec. blood flow to cardiac muscles - ✔ chest pain (crushing substernal) ↳ ↓O2 → lactic acid → pain → MI - radiates to shoulder, jaw , left arm N - 40 mg/dl - not responsive to nitroglycerin LDL - bad = N -