chamberlain college of nursing nr565 week 4 midterm exam study guide nr 565 week 4 midterm exam study guide v3latest
2020
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NR 565 (NR565)
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NR565 Week 4 Midterm Exam Study Guide
Chapter 15: Drugs Affecting the Central Nervous System
Anorexiants (p. 226): Short-term adjuncts to calorie limiting, cognitive-
behavioral, weight-loss programs for severely obese individuals.
Nonamphetamine appetite suppressants are commonly used today but are
chemically and pharmacologically related to amphetamines.
(Phendimetrazine, Benzphetamine, Diethylpropion HCl, Phentermine,
Lorcaserin)
Precautions and Contraindications: High risk of tolerance and
dependence. Should be used in caution with patients who have a history of
alcohol or drug dependence. Use should be limited to 6 months and
discontinued at any sign of tolerance.
Substance Abuse: Patients who abuse substances such as cocaine,
phencyclidine, and methamphetamine should not be prescribed
anorexiants because of the potential for excessive adrenergic
stimulation.
Alcoholics: Actively drinking alcoholics taking anorexiants have
experienced depression, paranoia, and psychosis.
Diabetes: Patients with diabetes may experiences altered insulin or
oral hypoglycemic dosage requirements.
Lorcaserin: Serotonergic drug. Patients may develop serotonin
syndrome or Neuroleptic Malignant Syndrome like reactions if
coadministered with serotonergic drugs. Pregnancy Category X and is
not approved in children under 18.
Anticonvulsants (p. 227):
Hydantoins: First line treatment of choice for tonic-clonic and partial
complex seizures and the lease sedating drugs used to treat seizure disorders
of any type. (phenytoin-Dilantin, ethotoin-Peganone, fosphenytoin-
,Cerebyx).
Pharmacodynamics: Inhibit and stabilize electrical discharges in the
motor cortex of the brain by affecting the influx of sodium ions into
the neuron during depolarization and repolarization, slowing the
propagation and spread of abnormal discharges.
Metabolism and Excretion: Metabolism takes place in the liver
and excretion via the kidneys. Plasma half-lives range from 6-
24 hours.
Precautions and Contraindications: Contraindicated under conditions
of hypersensitivity. Phenytoin induced hepatitis is a common
hypersensitivity reaction. Other hypersensitivity reactions include
fever, rash, arthralgias, and lymphadenopathy.
Phenytoin: May cause severe cardiovascular events and death
has resulted from too-rapid IV administration. Phenytoin has a
Black-Box Warning that IV administration should not exceed
50mg/minute in adults and 1-3 mg/kg/minute in pediatric
patients owing to risk of cardiovascular reactions associated
with a too rapid rate of administration. Contraindicated in sinus
bradycardia, sinoatrial block, second-and third-degree AV
block, and Stokes-Adams syndrome. Should be used cautiously
in patients with hepatic or renal disease.
Ethotoin: Contraindicated in the presence of hepatic or
hematological disorders.
Fetal Defects: Pregnancy Category D. About 10% of babies
have defects in Mother’s who take phenytoin during pregnancy.
Newborns exposed to phenytoin is utero may experience
decreased levels of Vitamin K-dependent clotting factors and
the mother should receive Vitamin K before delivery and the
newborn at birth.
Adverse Drug Reactions: CNS effects (agitation, ataxia, confusion,
dizziness, drowsiness, headache, and nystagmus), Cardiovascular
, effects (hypotension, tachycardia, atrial and ventricular conduction
depression, and ventricular fibrillation), GI effects (nausea, vomiting,
anorexia, altered taste, constipation, dry mouth, and gingival
hyperplasia), GU effects (urinary retention and reddish-brown
discoloration of urine), Dermatologic reactions (Stevens-Johnson
Syndrome and toxic epidermal necrolysis).
Drug Interactions: Interactions that increase hydantoins effect
because of increased metabolism, competition for binding sites or for
unknown reasons occur with benzodiazepines, cimetidine, disulfiram,
TCAs, salicylates, and valproic acid. Interactions that decrease
hydantoin’s effect include barbiturates, rifampin, theophylline,
influenza vaccine, pyridoxine, and antacids. Oral contraceptives effect
is decreased with use of hydantoins. Acute alcohol intake may
increase phenytoin serum levels, whereas chronic alcohol use may
decrease levels. IV phenytoin should only be mixed with normal
saline.
Monitoring: Patients should be assessed for phenytoin
hypersensitivity syndrome (fever, skin rash, lymphadenopathy), which
usually occurs at 3-8 weeks. Baseline CBC, urinalysis, and LFTs
should be assessed prior to onset of treatment, with frequent
reassessment during the first few months of treatment. Plasma levels
should be monitored, especially when drugs that increase plasma
hydantoin, such as ibuprofen, are used.
Patient Education: Abrupt withdrawal may lead to status epilepticus.
Advise the patient to wear a medical identification bracelet, to avoid
hazardous situations if drowsiness occurs, and to report adverse
effects to the clinician. Patients should avoid alcohol use. Maintain
good oral hygiene to prevent tenderness, bleeding, and gingival
hyperplasia. Phenytoin may color the urine red, pink, or reddish
brown but the color change is not a cause for alarm. Advise diabetic
patients to monitor blood glucose levels and report significant changes
to the clinician.
Iminostilbenes (p. 235): (Carbamazepine-Tegretol and oxcarbazepine-
, Trileptal). Structurally related to TCAs. Used to treat epilepsy, bipolar
affective disorder, aggressive and assaultive behavior, and some neuralgias.
Pharmacodynamics: Thought to affect the sodium channels, slowing
influx of sodium in the cortical neurons and slowing the spread of
abnormal activity. Carbamazepine exerts its effect by depressing
transmission in the nucleus ventralis anterior of the thalamus. This
area is associated with the spread of seizure discharge.
Metabolism and Excretion: Carbamazepine is metabolized in
the liver and has the unique ability to induce its own
metabolism (autoinduction). Due to autoinduction, initial
concentrations within a therapeutic range may later fall despite
good compliance. It also induces the metabolism of many
CYP450 enzymes and other substrates. Excretion is through
urine and feces. Oxcarbazepine is metabolized into an active
metabolite 10-monohydroxy metabolite, which is responsible
for the pharmacologic effect of the drug. The metabolites of
oxcarbazepine are excreted 95% in urine, 4% in feces, and 1%
unmetabolized oxcarbazepine.
Precautions and Contraindications:
Carbamazepine: Contraindications include hypersensitivity to
carbamazepine or TCAs, history of bone marrow suppression,
and current administration with MAOIs. Carbamazepine is
Pregnancy Category D; tetratogenic defects have occurred
including spina bifida. Black-Box Warning regarding serious
dermatological reactions, particularly among patients of Asian
ethnicity (Stevens-Johnson Syndrome, toxic epidermal
necrolysis and risk of developing aplastic anemia and
agranulocytosis). Patients of Asian ethnicity should be screened
for presence of the HLA-B*1502 genetic variant prior to
starting carbamazepine. Caution is advised in patients with a
history of previous adverse hematological reactions to any
drugs and in those with cardiac, renal, or hepatic impairment.
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