FA23 Exam 4 Blueprint PDF

449 Exam 4 Blueprint Exam 4 Final Blueprint Module 12: Mood/Affect ● Difference between depression, bipolar, psychosis ● Age related and pregnancy related considerations in treating depression, bipolar disorder, psychosis, schizophrenia, ADHD o Children: ▪ Children will usually not be prescribed...

449 Exam 4 Blueprint Exam 4 Final Blueprint Module 12: Mood/Affect ● Difference between depression, bipolar, psychosis ● Age related and pregnancy related considerations in treating depression, bipolar disorder, psychosis, schizophrenia, ADHD o Children: ▪ Children will usually not be prescribed these drugs, unless it is really necessary ● Other methods will be utilized before medications o Pregnancy: ▪ Some antidepressants are contraindicated with pregnancy and other can be used only if the benefits outweigh the risks to the fetus or neonate ● SSRIs: Use, Action, Adverse Effects, Patient Teaching o Use: ▪ Depression ▪ Bulimia ▪ Panic disorder ▪ OCD o Action: ▪ Inhibit the reuptake of serotonin to increase amount that circulates in the brain o Adverse Effect: ▪ HA, Sexual dysfunction ▪ Nervousness, Insomnia ▪ N/V/D, Dry mouth ▪ Anorexia, sweating ▪ Serotonin Syndrome ● Often due to drug interaction SSRI, TAC, MAOI o Pt Teaching: ▪ Will take 3-4 weeks to achieve full therapeutic effect Won’t work right away ▪ SSRIs are preferred over other classes due to less adverse effects ▪ Should be weaned off slowly over 2-4 weeks ● SNRIs: Use, Action, Adverse Effects, Pt Teaching o Use: ▪ Treatment for major depressive disorder o Action: ▪ Decrease neuronal reuptake of both serotonin and norepinephrine o Adverse Effects: ▪ N/V, constipation ▪ Hyperhidrosis, erectile dysfunction ▪ Tachycardia, abnormal bleeding ▪ Angle closure glaucoma o Pt Teaching: ▪ Assess for worsening depression, suicidality, bipolar disorder ▪ Impaired liver or renal function ▪ Should only be taken when benefits outweigh the risks Pregnancy ▪ Will take 3-4 weeks to achieve full therapeutic effect ● Tricyclic antidepressants Amitriptyline: Use, Adverse Effects, Pt Teaching o Use: ▪ Predominately for major depression and occasionally for milder situational depression ▪ Neuropathy ▪ Fibromyalgia o Adverse Effects: ▪ Orthostatic hypotension ▪ Dysrhythmias ▪ Sedation ▪ Weight gain ▪ Anticholinergic effects ● Dry mouth, dry eyes, blurred vision, constipation o Pt Teaching: ▪ Monitor patient for suicide risk ▪ Patient drug education ● Slow position changes ▪ Watch for cardiac problems for up to 5 days ▪ Overdose: ● Heart block, dysrhythmias, tachycardia, hypotension, seizure, coma o Use activated charcoal, Na bicarb, gastric lavage ● MAOIs: Use, Adverse Effects, Patient Teaching o Use: ▪ Unresponsive to other anti-depressive therapy or in whom other anti-depressive therapy is contraindicated o Adverse Effects: ▪ Hypertensive crisis ● Caused by: Tyramine Antidote (calcium channel blocker) ▪ Caused by release of NE causing acute hypertension ● Symptoms: Headache, hypertension, sweating, dilated pupils, tachycardia, chest pain o Pt Teaching: ▪ Do not take with OTC medication without consulting with provider ▪ Monitor blood pressure ▪ Low tyramine diet ▪ Monitor CBC ● Differences between SSRI, SNRI, tricyclics, MAOIs – why would the prescriber choose one over the other’ ● Typical vs atypical antipsychotic drugs: haloperidol vs olanzapine: Use, Adverse Effects, Pt Teaching, Pt Monitoring o Typical: Older Has more AE ▪ IV kicks in fast, lots of AE ▪ Block dopamine receptors, preventing the stimulation of postsynaptic neurons by dopamine o Atypical: Newer Has less AE ▪ PO, Given regularly, Relieve hallucinations ▪ Both block dopamine and serotonin receptors o Use: ▪ Schizophrenia, hyperactivity ▪ Combative behavior, agitation in elderly, severe behavioral problems in children o Adverse Effects: ▪ Black Box: ● Older patients with dementia are at increase risk for death when taking conventical antipsychotics ▪ EPS: Extrapyramidal effects ● Involuntary facial movements, restlessness, tremor, and stiffness ▪ Sedation ▪ Orthostatic hypotension, ▪ Anti o Pt. Teaching: ▪ Importance of taking med as directed ▪ Do not stop abruptly o Pt. Monitoring: ▪ Monitor for involuntary movement ▪ Monitor for orthostatic hypotension ● ● Lithium: Use, Action, Therapeutic Levels, Pt. Teaching, Pt. Monitoring, signs of lithium toxicity o Use: o Action: ▪ Bipolar disorder ▪ Inhibit release of norepinephrine and dopamine, but not serotonin from stimulated neurons o Therapeutic Level: ▪ 0.6 to 1.5 Desired ▪ 1.5 to 2 Mild to Mod toxicity ▪ 2 to 2.5 Mod to Severe toxicity ▪ > 2.5 Life threatening o Pt. Teaching: ▪ Excreted from the kidneys (95%), sweat, and feces ● The kidneys treat lithium and sodium similarly, which is the reason sodium depletion can significantly elevate lithium ▪ Avoid: ● Dehydration ● Sodium depletion ● Sweating ● Diarrhea ● Diuretic ● Metabolic disorders o Pt. Monitoring: ▪ Lithium Levels ● Blood levels should be checked by nurses ▪ Sodium ▪ Monitor o Signs of toxicity: ▪ Early: ● Tremor, V/D, blurred vision and speech ▪ Late: ● Seizure, coma, arrythmia o Over 1.5 ▪ Lethargy, slurred speech, muscle weakness, N/V complex multiorgan toxicity = death ● What is ADHD o Characterized by developmentally inappropriate behaviors involving difficulty in paying attention or focusing on tasks ▪ Characterized by poor attention span, behavior, control issues, and hyperactivity ● Age related considerations for medication administration o Children, adolescents, and young adults (ages 18 to 24) are at greater risk for suicidal ideation o Increases risk of suicide ● Stimulants, how they work to help ADHD o CNS stimulants act at the cortex and RAS, increasing stimulation of an immature RAS which leads to more selective response to incoming stimuli ▪ Helps them focus on specific stimuli ● Methylphenidate (Ritalin): Use, Action, Adverse Effects, Pt.. Monitoring o Use: ▪ ADHD ▪ Narcolepsy o Action: ▪ CNS stimulants act at the cortex and RAS, increasing stimulation of an immature RAS which leads to more selective response to incoming stimuli ● Helps the reticular activating system to be more selective in response to incoming stimuli o Adverse Effect: ▪ Nervousness, insomnia, dizziness ▪ Headache, blurred vision ▪ Anorexia, Weight loss Especially in children o Pt. Monitoring: ▪ Monitor weight especially in children Daily weights ▪ Monitor CBC ▪ Monitor VS, appetite, anxiety, resp assessment CAD/MI ● Modifiable and nonmodifiable risk factors for CAD o Modifiable: ▪ Tobacco use Vasoconstrictor ▪ Sedentary lifestyle ▪ Obesity ▪ Diabetes mellitus Causes inflammation + increased risk for atherosclerosis ▪ HTN ▪ High cholesterol o Non-Modifiable: ▪ Age ▪ Race ▪ Gender ● Nitroglycerin, Action, Routes, Adverse Effects, Contraindications, Patient Monitoring o Action: ▪ Act directly on vessel smooth muscle causing relaxation and depress muscle tone o Allows for vasodilation (drop in blood pressure can occur) Routes: ▪ Sublingual: Acute angina ● Must dissolve completely (Don’t chew) ● Can give every 5 mins up to a max of 3 ● Will burn/tingle under tongue ▪ Patch/ointment: Chronic angina ● Must rotate site (leave off for 12 hours) ● Must be a shaven area ● Nurse should wear gloves and wash hands ▪ Spray: Acute angina ● Under tongue ● Can give up to 3 doses ▪ IV: ● Watch BP hypotension ● Special IV tubing design ● Infusion pump o Contraindications: ▪ NO VIAGRA! Or PDE-5 Inhibitors o Adverse Effects: R/T vasodilation and decrease in blood flow ▪ Headaches ▪ CV: Hypotension, tachycardia ▪ CNS: Dizziness, vertigo, weakness o Patient monitoring: ▪ Monitor blood pressure ▪ Take apical pulse before and after ▪ Monitor headache give Tylenol ▪ Assist with gradual changes in position o Patient Education: ▪ Replace every 6 months ▪ Sublingual should burn/tingle ▪ Keep in original packaging no light or heat ● Calcium channel blockers mechanism of action, common adverse effects o Action: ▪ Inhibit calcium from moving across cell membranes ● Decrease contraction contractility ● Decrease in preload, afterload, and workload ● Depress impulse formation o Adverse Effect: ▪ Liver hepatotoxic ▪ CV: Hypotension, bradycardia, peripheral edema, heart block ▪ CNS: dizziness, headache, fatigue ● Angina, unstable angina and acute MI: symptoms, drug therapies; associated labs o Unstable angina: ▪ Symptoms: ● Chest pain: o Sudden onset + not normal ● Duration ● Unpredictability Occurs without clear cause ● Intensity Increased intensity ▪ Labs Vasopressors ● Describe the various shock types ● Goals of pharmacologic therapy for hypovolemic vs cardiogenic shock o Decreased of ineffective tissue perfusion extremities Clamp down to send blood to ● Norepinephrine (Levophed) MOA, indications, and adverse reactions o Action: ▪ Increases contractility and heart rate ● Causes vasoconstriction o Indications: ▪ Used to treat hypotension and shock o Adverse effects: ▪ Watch blood pressure ▪ WATCH FOR ARRHYTMIAS ● Dopamine: mechanism of action, adverse effects, patient monitoring, agent for extravasation o Action: ▪ Stimulate receptors of the SNS cause vasoconstriction and increase heart rate ▪ Generally used to treat hypotension and shock ● Decreased or ineffective tissue perfusion o Adverse Effect: o Patient monitoring: ▪ Watch for extravasation of IV site Cause necrosis ▪ All given as a titrated drip via IV pump ● We have to constantly monitor to make sure the patient doesn’t go into a hypertensive state o Agent for extraversion: ▪ Dilute phentolamine Quickly vasodilates and returns blood flow to skin ● Dobutamine: mechanism of action, indications for use o Action: ▪ Increases cardiac output ● Increases myocardial contractility without much change in rate and does not increase oxygen demand of cardiac muscle o Indication: ▪ Used to treat heart failure ▪ Generally used to treat hypotension and shock ● Decreased or ineffective tissue perfusion Clamp down to send blood o Caution: ▪ Don’t give with beta blockers ● Considerations across the lifespan, particularly the elderly o Older Adult: ▪ Goal should be at the lowest effective dose Nurse needs to watch blood pressure and turn med down ▪ Increased risk for adverse effects ▪ Higher risk for toxicity o Pediatric: ▪ Double check dosage calculation ▪ Monitor child closely ▪ Be cautious with OTC meds o Adults ▪ Treat shock and shock like states ▪ Constant monitoring and dosage adjustment needed ▪ Start at low dose ● When is low dose dopamine indicated o All are given as a titrated drip via IV pump in an ICU o At LOW doses causes renal and mesenteric arterial dilation 5 to 10mg ▪ Increases the blood flow to the kidneys, preventing the diminished renal blood supply and possible renal shut down that can occur with epinephrine and norepinephrine