HESI Pharm Review Study Guide Top-Rated Graded A

PHARMACOLOGY HESI REVIEW DRUGS AFFECTING THE NERVOUS SYSTEM ANTICONVULSANTS/ANTISEIZURE MEDICATIONS Prototype : a. Hydantoins - phenytoin (Dilantin) b. Barbiturates - phenobarbital ( Luminal) Adverse effects : - sedation & drowsiness, gingival hyperplasia - diplopia, nystagmus, vertigo, dizziness - thrombocytopenia, aplastic anemia Nursing considerations : 1. Advise female clients to use contraceptives. 2. Inform clients taking phenytoin that harmless urine discoloration is common. 3. Warn clients with diabetes that hydantoins may increase blood sugar level. 4. Reassure that barbiturates are not addictive at a low dosage. 5. Avoid taking alcohol with barbiturates. 6. Administer IV phenytoin slowly to avoid cardiotoxicity. 7. Avoid mixing other drugs in same syringe with phenytoin. ANTIPARKINSONIAN AGENTS Prototype : a. Anticholinergic agents - trihexyphenidyl (Artane), benztropine (Congentin) b. Dopaminergic agents - Levodopa, carbidopa-levodopa (Sinemet), amantidine (Symmetrel) Adverse effects of dopaminergic agents: a. levodopa–nausea, vomiting, anorexia, orthostatic hypotension, dark-colored urine and sweat b. amantidine – ankle edema, constipation Nursing considerations: 1. Give dopaminergic agents after meals to reduce GI symptoms. 2. Reassure client that levodopa may cause harmless darkening of urine and sweat. 3. Avoid taking Vit B6 (pyridoxine) because it reverses effects of levodopa. 4. Change positions slowly to avoid orthostatic hypotension. 5. Elevate leg to reduce ankle edema. DRUGS AFFECTING MENTAL FUNCTIONING SEDATIVES, HYPNOTICS, AND ANXIOLYTICS – induce sleep, sedate & calm clients Prototype: a. Benzodiazepines (end with –epam) - diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), flurazepam (Dalmane) b. Barbiturates - phenobarbital, Adverse effects: - hangover-effect, dizziness, CNS depression - respiratory depression, drug-dependence Nursing considerations: 1. Warn clients of injuries and falls. 2. Brief period of confusion and excitement upon waking up is common with benzodiazepines. 3. Warn clients not to discontinue medications abruptly without consulting a physician. 4. Avoid alcohol while taking these drugs. 6. Rotate and don’t shake the ampoules of barbiturates. Don’t mix with other drugs. 7. Warn female clients that diazepam is associated with cleft lip. ANTIDEPRESSANTS AND MOOD DISORDER DRUGS Prototype: a. Tricyclic antidepressants - amitriptyline (Elavil), imipramine (Tofranil), desipramine b. MAOI (monoamine oxidase inhibitors) -phenelzine (Nardil), tranylcypromine (Pernate) c. Second-generation antidepressants - fluoxetine (Prozac) Adverse effects: - dry mouth, blurred vision, urine retention, constipation (anticholinergic effects) - orthostatic hypotension, insomnia - hypertensive crisis (MAO) Nursing considerations: 1. Caution client to rise slowly to reduce the effects of orthostatic hypotension. 2. Take antidepressant with food to enhance absorption 3. Explain to client that full response may take several weeks (2 weeks) 4. Assess client for constipation resulting from tricyclic antidepressant use. 5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid hypertensive crisis. -aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast 6. Inform physician and withhold fluoxetine if client develop rashes. ANTIPSYCHOTIC DRUGS (Neuroleptics) Prototype: a. Phenothiazines - chlorpromazine (Thorazine), - thioridazine (Mellaril) b. Other Agents – olanzapine (Zyprexa) , haloperidol (Haldol) Mechanism of action: - block dopamine receptors in the limbic system, hypothalamus, and other regions of the brain. Adverse effects: - Extra pyramidal syndrome (or EPS) such as dystonia, pseudoparkinsonism, and an irreversible tardive dyskinesia as manifested by: a. lip smacking b. fine wormlike tongue movement c. involuntary movements of arms and leg - Neuroleptic malignant syndrome (NMS) a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse b. muscle rigidity, seizures. - Orthostatic hypotension Nursing considerations: 1. Teach family members the signs of EPS and NMS, and report to physician immediately 2. Normalization of symptoms may not occur for several weeks after beginning of therapy 3. Watch out for orthostatic hypotension and photosensitivity with phenothiazine. 6. Be sure that oral doses are swallowed, and not hoarded.