Medications for Pharm Quiz/Exam #2 PDF

**[Meds to Know for Pharm Quiz \#2 and Exam\#2-CNS/PNS & Behavioral Drugs: Chap.17-31; Chap 38 & 39]** **1-methylphenidate HCl (Ritalin)-amphetamine-like drug, most commonly used for ADHD, especially with pediatric patients. What is the action of Ritalin? Think of Ritalin as a \"focus flashlight\"...

**[Meds to Know for Pharm Quiz \#2 and Exam\#2-CNS/PNS & Behavioral Drugs: Chap.17-31; Chap 38 & 39]** **1-methylphenidate HCl (Ritalin)-amphetamine-like drug, most commonly used for ADHD, especially with pediatric patients. What is the action of Ritalin? Think of Ritalin as a \"focus flashlight\" that helps students with ADHD shine a brighter light on their studies, making it easier to concentrate and stay on track. How does it work? Could it also be used for narcolepsy? When should it be administered? Morning or earlier in day. Why? Causes wakefulness.** **2-trazodone (Desyrel)-antidepressant and sedative; can be used for insomnia; side effects are drowsiness, dry mouth, dizziness, suicidal thoughts.** **3-temazepam (Restoril); instruct the patient to call for help when getting OOB** **4-midazolam (Versed); Mild analgesic often used for conscious sedation or as a pre-op sedative to help relax the patient** **5-phenytoin (Dilantin); Class is Hydantoin; suppresses Na++ influx to decrease abnormal electrical impulses in the brain for grand mal (tonic-clonic) seizures; Always monitor Dilantin levels; Patient should take med same time every day: Patient cannot stop med abruptly & may be on Dilantin for life; it may cause decreased coordination so pt is high risk for falls (Nursing dx); may cause gingival hyperplasia which is overgrowth of gum tissue & cause bleeding gums; many antiseizure drugs inhibit Vit K (what would you be concerned about with inhibition of Vitamin K?-could it be bleeding risk?)** **6-carbidopa-levodopa (Sinemet); Dopaminergic used in Parkinson's disease; Increases the available dopamine in the brain to increase mobility; Sinemet negatively interacts with Dilantin, Benzos & tricyclic antidepressants (Elavil) to *decrease* the levodopa effect** **7-rivastigmine (Exelon); Acetylcholinesterase inhibitor; slows the progression of the symptoms of Alzheimer's-it does NOT cure it; comes in oral capsules or liquid and in transdermal patches. Exelon is an excellent drug for Alzheimer's.** **8-neostigmine (Prostigmin); Acetylcholinesterase inhibitor; used to treat myasthenia gravis which is an autoimmune disease; it helps to prevent the destruction of ACh; helps promote muscle contraction and increases muscle strength** **9-baclofen (Lioresal); used to decrease muscle spasticity; it has a calming effect & can cause drowsiness; it is a skeletal muscle relaxant for MS and for spinal injuries. Avoid driving until effects are evident. Why?** **10-lorazepam (Ativan); A benzodiazepine used for anxiety and also as an anti-seizure drug; avoid caffeine & alcohol; contraindicated in pregnancy d/t teratogenic effects; Ativan can be used as 1st line drug for acute seizures but must be followed by Keppra or Dilantin IV. Benzodiazepines cannot be abruptly discontinued because signs of withdrawal will occur. Ativan has to be gradually decreased. Do NOT stop abruptly. Taking alcohol with Ativan may increase sedative effects.** **Think of lorazepam as a security blanket for Anxiety and Seizures, but remember to slowly ease off it rather than abruptly ripping it away.** **11-antipsychotic meds for neuroleptic syndrome (NMS) can cause rhabdomyolysis. NMS is a rare, but possibly fatal condition associated with antipsychotic drugs. Dehydration is a predisposing factor. What is rhabdomyolysis? A breakdown of muscle tissue that releases a damaging protein (myoglobin) into the bloodstream. Myoglobin can damage the kidneys.** **12-Valproate drug class-valproic acid (Depakene) and divalproex (Depakote) are both antiepileptics. Depakote is used for grand mal, partial (focal), and absence (petit mal) seizures. These 2 Valproate drugs are very similar and should not be taken at the same time. They are also used to treat bipolar disorder and migraines.** **13-What drug is best used for alcohol (ETOH) withdrawal? Benzodiazepines are the best drugs for ETOH withdrawal; lorazepam (Ativan) and [diazepam (Valium)]** **14-lithium use and lithium toxicity: advanced symptoms of toxicity are [seizure, vomiting, and ataxia.] The nurse should monitor drug levels for lithium and also serum sodium for patient taking Lithobid (lithium)** **15-benzodiazepines common therapeutic use is [anxiety.]** **16-Antipsychotics common therapeutic use is [ schizophrenia]** **17-infliximab (Remicade) Is in the drug classification of Immunomodulator and used for Crohn's disease and RA.** **18-colchicine (Colcrys) is used 1^st^ to combat gout acutely and then allopurinol (Zyloprim) is prescribed for long-term treatment for [Chronic Gout]. What syndrome is allopurinol used to reduce the risk of? [Hyperuricemia] because it reduces uric acid production. Colchicine decreases the leukocytes that migrate to the inflamed area (anti-inflammatory specifically for Gout). What should the nurse teach the patient about? Take with Food, avoid alcohol and caffeine.** **19-OTC drugs (are NOT Schedule I drugs): Tylenol, Toradol, Naprosyn, Motrin. What are schedule 1 drugs? Are Motrin and Naprosyn considered to be opioids or non-opioids? When do you think the nurse should teach the patient about the best time to stop taking Naprosyn (naproxen) prior to surgery? Why? Stop 7 days prior to surgery to reduce the risk of bleeding.** **20-Schedule II drugs: Demerol (meperidine), Roxanol (morphine sulfate), Dilaudid (hydromorphone), and Duragesic (fentanyl) are all Schedule II drugs. Are fentanyl and morphine opioids? Yes. What is the antidote for morphine? Narcan** **21-When is acetaminophen (Tylenol) contraindicated? Is Tylenol contraindicated for alcoholic patients? Why? What lab values should be monitored when taking Tylenol? Liver enzymes AST and ALT. And why? Metabolized in liver-liver toxicity. What drug class does Tylenol fall under? What is the antidote for Tylenol? Mucomyst. What are the 2 main uses for Tylenol? Reduce fever and pain** **22-gabapentin (Neurontin)-promotes GABA. Does this med fall under the class of anticonvulsants? Does it fall under the Adjuvant category? Would it be considered an adjuvant medication? Adjuvant analgesics were developed for other purposes and then later found to be effective for pain relief in neuropathy. Antiseizure medications such as gabapentin on the CNS and peripheral nerves to decrease neuronal firing which decreases seizures, but it also decreases the pain from neuropathy.** **23-cyclooxygenase enzymes-COX-1, COX-2, COX-3, and COX-4. Does COX-1 promote platelet aggregation and protect the stomach lining? Does the COX-2 enzyme trigger pain and inflammation?** **24-Which med should be avoided in children who have a viral infection? And why? Aspirin-it increases the risk of Reye Syndrome. Reye syndrome is a rare and potentially fatal pediatric illness defined as acute noninflammatory encephalopathy with fatty liver failure; swelling in brain and liver. ASA increases bruising and may cause GI bleeding so tell patient to watch for tarry stools** **25-alprazolam (Xanax) therapeutic use and what should the nurse teach the patient? What safety issue should be discussed with the patient when they are taking Xanax? Avoid driving, using heavy equipment, or other activities that require alertness.** **26-NSAIDS-indication and examples of 3 medications in this category such as ASA, Ibuprofen, and Naproxen. What are the 3 main uses for NSAIDS (Example \#1-Antipyretic; also, analgesic and anti-inflammatory) REMEMBER acetaminophen (Tylenol) is NOT an NSAID.** **27-cephalosporin indications, side effects, and patient teaching (Example- Teach the patient to report mouth ulcer. What would this be a sign of? (Yeast/Fungal infection like candida) Also, note\* patients with PCN allergies may be allergic to the early generations of cephalosporins, not the later ones.** **28-piperacillin-tazobactam (Zosyn) indications, pt teaching, and nursing actions (Example-Nursing action would be to send specimen for Culture and Sensitivity prior to starting the antibiotic. Why? (Is it to make sure the bacteria is sensitive to the drug) Also, remember to teach patient to take entire prescribed dose.** **29-acyclovir (Zovirax) indications and patient teaching. Indicated for Herpes, Chicken Pox, and Shingles. (Example-Teach the patient to perform oral hygiene several times a day. Why? Pt may have mouth ulcers) Can acyclovir be stopped as soon as the symptoms are gone? Viral shedding and spread of the virus can continue after the initial symptoms have stopped so the entire prescribed dose must be completed. Acyclovir does not cure genital herpes, it only controls the symptoms. Teach pt to drink 6-8 glasses water/day to keep the kidneys working well. Can be taken with or without food.** **30-vancomycin (Vancocin) is a gylcopeptide antibiotic indicated for patients with clostridium difficile (Cdif) infection and also multi-resistant staph aureus (MRSA); can be given oral or IV. Adverse reactions-diarrhea, Red Man Syndrome or Red Neck Syndrome (Vanco infusion reaction) causing red blotching face, neck, arms, upper body (this is caused more by toxicity from too rapid of an infusion, rather than an allergic reaction), tinnitus, ototoxicity (can result in permanent hearing loss), and nephrotoxicity. Labs: Peak and Trough, and BUN/Creatinine. What adverse reaction would be a priority to report to the physician? It is a priority that the nurse should report any adverse reactions after administering vancomycin, such inspiratory stridor or wheezing, hives, tinnitus, hearing loss.** **31- What is MRSA and what would be the antibiotic of choice? Vancomycin is the antibiotic of choice for multi-resistant-staph-aureus** **32-azithromycin (Zithromax) indication, adverse reactions, and patient teaching; Instruct the patient to report any loose stools or diarrhea.** **33-trimethoprim-sulfamethoxazole (TMP-SMZ) An antibacterial sulfa drug for UTI; very important to teach patient to increase fluid intake. Why? Keep well hydrated with fluids to avoid the development of crystals in the urine or kidney stones.** **34-ciprofloxacin (Cipro)-indications and patient teaching. Is there a Black Box warning? Yes-tendon rupture. Teach the patient to report any tendon discomfort.** **35-sulfasalazine (Azulfidine) for ulcerative colitis and rheumatoid arthritis because it is an anti-inflammatory. What class is this under? It is an NSAID; non- steroidal anti-inflammatory drug. Do not administer if pt allergic to ASA.** **36-Sulfonamides-What are they used for? teach patients they must increase their fluid intake. Why? Some older, earlier forms of sulfonamides can cause crystals in the urine so these patients must increase their fluid intake.** **37-nystatin (Mycostatin)-indications and patient teaching; Could this be used for oral thrush? What is another name for oral thrush? Candida Albicans. What kind of infection is this?**  **Oral thrush is a fungal infection caused by Candida albicans, a normal organism in your mouth that can overgrow and cause symptoms. What does it look like? White spots inside the mouth.** **38-isoniazid and rifampin-indications and patient teaching (Example-Teach the patient to report numbness, tingling, and burning of hands and feet.) Teach the patient to have periodic eye exams-*Why?* What optic symptoms might occur? Does this med change the color of the urine/body fluids? Yes, it turns orange-red.** **39-metronidazole (Flagyl)-indications and patient teaching. What is this drug used for? An antibiotic that is in the nitroimidazole class used to treat infections in GI tract such as H. Pylori (heliobacter pylori). Flagyl can be used in conjunction with vancomycin to treat C Diff (Clostridium difficile)** **40-antiviral medications such as acyclovir-[patient teaching such as make sure to teach the patient to hydrate well]** **41-penicillin (PCN)-Antibiotics that fall under the drug class Penicillins. Which antibiotics should not be given if the patient is allergic to PCN? Any meds in the Penicillin family such as Ampicillin, Amoxicillin or Amoxicillin-clavulanate (Augmentin). Patient teaching: Teach the patient that broad spectrum penicillin, amoxicillin, ampicillin can decrease the effectiveness of oral contraceptives. Use an additional form of birth control.** **42-theophylline (Theo-24)-class, indications, and patient teaching. What should the patient avoid when taking theophylline? Should they take it on an empty stomach or with food? You can take it with or without food. It may work best on an empty stomach because it gets into the blood stream faster but could be taken with food if it causes gastric distress. Beware... a high protein, low carb diet increases theophylline elimination. Should patients avoid caffeine when taking theophylline? Yes, avoid caffeine. Why? *It is a stimulant*, so it it may cause headaches, nausea, nervousness, increased HR and increased BP.** **42-inhalers and correct administration-if patient is on a glucocorticoid inhaler, should they rinse their mouth out with water after using the inhaler? Yes. Why? To decrease the risk of a fungal infection by decreasing the drug deposits in the mouth. Should the patient look in their mouth for a white coating? Yes. Why? It is an adverse reaction causing a fungal infection known as candida albicans. Candida albicans is a fungal infection caused by a yeast.** **43-Patients with severe asthma-what medications should they receive and in what order? Review albuterol (Proventil) ipratropium (Atrovent), and methylprednisolone (Solumedrol). AIM to help asthma** **1^st^ administer Albuterol-Proventil which is used to dilate the larger airways; it is a PRIORITY intervention for the nurse to take for COPD exacerbation because it has a quick, rapid onset B-2 agonist with a longer duration** **2^nd^ administer Ipratropium (Atrovent) because it is an anticholinergic bronchodilator; it works deeper in the lungs to relax and open the bronchial tubes and the bronchioles, and stop bronchospasm** **3^rd^ administer methylprednisolone (Solumedrol) because it is a synthetic steroid in the corticosteroid family that reduces inflammation** **44-montelukast (Singulair)-class, indications, patient teaching: Singulair's drug classification is leukotriene modifier. It is used in the treatment of asthma to suppress the release of histamine and other mediators** **45-diphenhydramine (Benadryl)-class, indications, patient teaching regarding adverse effects and contraindications. Contraindicated in people with narrow-angle glaucoma. Antihistamines can cause a glaucoma attack and block the fluid from leaving the eye, blocks the drain angle, causing a dangerous rise in ocular pressure) in some patients who have narrow angle glaucoma.** **Should the patient be taught about a dry mouth and what could be done for that? Chew on sugarless gum or lozenges.** **46-guaifenesin (Robitussin)-indications and patient teaching (Example-Teach patient to take this with a glass of water-why??) To decrease thickness of mucus and loosen secretions to make it easier to expectorate.** **47-lorazepam (Ativan)-what class of drug and what is it used for? Is it a benzodiazepine used for anxiety and seizures** **48-colchicine (Colcrys)-what class of drug and what is it used for? Anti Inflammatory Anti-Gout Drug used for hyperuricemia for acute gout attacks.** **49-If a patient has an allergy to penicillin, which other antibiotics should be avoided?** **49-risperidone (Risperdal)-Management of schizophrenia and bipolar disorder. May cause orthostatic hypotension, dizziness, dry mouth, insomnia, anxiety. Pt may be at increased risk for falls due to orthostatic hypotension.** **50-fluoxetine (Prozac)-is an antidepressant; it is in the drug class SSRI (selective serotonin reuptake inhibitor). SSRIs *inhibit* the reuptake of serotonin and norepinephrine at neuron membranes, so it increases serotonin inside the nerve cells (increases at the synapse). It is used for depression, panic disorder, OCD, and bulimia. Drug dose should be decreased for older adults. Contraindications: increased sensitivity when patient is also taking MAOI therapy. Full effect may take 3-4 weeks initially. Interaction with grapefruit juice can lead to possible toxicity. Patient should avoid grapefruit juice.** **51-amitriptyline (Elavil) is an antidepressant in the drug class Tricyclic Antidepressants (TCAs). It may cause orthostatic hypotension (drops the BP), dizziness, drowsiness, dry mouth, and blurred vision. The onset of the antidepressant effect is 2-4 weeks; full effect is seen in 6-12 weeks. The drug should be administered at night because it makes you feel sleepy. The drug should be discontinued slowly.** **[10 Meds to review for the Quiz-5 of these meds will be on the Quiz (the other 5 will be on the exam):]** **1-risperidine (Risperdal) 6. trazadone (Desyrel)** **2-lorazepam (Ativan) 7. temazepam (Restoril)** **3-fluoxetine (Prozac) 8. midazolam (Versed)** **4-lithium (Lithobid) 9. phenytoin (Dilantin)** **5-amitriptyline (Elavil) 10. carbidopa-levodopa (Sinemet)** **[Antiparkinson drugs-MAO Inhibitors:]** **MAO enzymes break down dopamine and serotonin in the brain so that theses neurotransmitters *don't* linger around too long. MAO enzymes help to keep a balance in the brain and they "clean-up" after the dopamine or serotonin is released into the nerve synapse to prevent it from continuously signaling. Example: MAO B enzymes regulate the level of dopamine at the synapse so that the dopamine neurotransmitter does not keep signaling and cause disruptions in the brain.** **The MAO enzymes keep a balance of the dopamine and serotonin neurotransmitters. But if a patient has Parkinson's Disease (PD) they do not have enough dopamine (low dopamine levels), Providers will prescribe Antiparkinson meds such as Monoamine Oxidase B Inhibitors (MAO-B Inhibitors) to stop (inhibit) the release of the MAO-B enzyme so that the cells can increase the dopamine levels.** **MAO Inhibitors allow the chemical messengers to communicate between brain nerve cells to *stop* the function of the MAO-B enzyme in order to increase levodopa action.** **Dopamine does not cross the blood-brain barrier; therefore, Providers will prescribe levodopa to treat Parkinson's since levodopa does cross the blood brain barrier. Levodopa is the precursor of dopamine; there is a brain enzyme that converts levodopa into dopamine; then dopamine is stored in the neurons of the brain.** **We need dopamine because it helps control physical movement, helps motivate people to seek out rewards. Responsible for feelings of pleasure and happiness, and plays a role in memory.** **Additional info (NOT ON THIS EXAM but important to know for foods to avoid) Monoamine Oxidase Inhibitors are also used as antidepressants. What food items should be avoided with MAOIs? The nurse must assess the patient's dietary intake for foods that contain [tyramine] such as chocolate, sausages, bologna sandwiches, hot dogs (cured meat): foods that contain tyramine may lead to hypertensive crisis and heart attack.** **\*Physicians/Providers don't really like to prescribe MAOIs because of all the dietary restrictions. They like SSRIs (serotonin reuptake inhibitors) better. SSRIs inhibit the reuptake of serotonin before the nerve synapse (pre-synapse) so they push the serotonin, from being stuck inside the nerve cell, to be available for transport between the neurons. They make more serotonin available to improve transmission of messages across the synapse; better communication between the neurons, more serotonin helps with depression. SSRIs differ in potency so if one doesn't work, the Doc can try another. Increased risk of bleeding with NSAIDs. Suicidal thoughts may occur during 1^st^ few weeks while body is adjusting.**