NR293 Pharmacology Midterm Exam 2025

MAO-Is: Phenelzine Indication - - Highly effective * Second-line treatment for depression Disadvantage: * Numerous drug interactions * Potential hypertensive crisis with foods containing tyramine (example: cheese, wine, sausage) Antiepileptic Drugs: Nursing Implications Oral Drugs - -Oral drugs Take regularly, same time each day Take with meals to reduce GI upset Do not crush, chew, or open extended-release forms If patient is NPO for a procedure, contact prescriber regarding AED dosage & possible change of route Intravenous forms Phenytoin, Valproic acid, Benzodiazepines Follow manufacturer's recommendation Avoid extravasation of fluids Antiviral Drugs - -Amantadine, Oseltamivir, Acyclovir SSRI's Most Serious Adverse Effect - -Serotonin Syndrome Amantadine - -Indications: Only Influenza A (Now-CDC recommends against use) Parkinson's disease Amantadine Adverse effects: - -CNS adverse effects o Insomnia, nervousness, lightheadedness, GI adverse effects o Anorexia & nausea Amantadine Contraindications - -o Lactating female & 12 months old Oseltamivir Indication - -Influenza Start within 48 hours of s/s of influenza Prescribed as young as 2 weeks old & during pregnancy Oseltamivir Adverse Effects - -usually no serious adverse effects NR293 NR293 o Nausea/vomiting/diarrhea Acyclovir Indication - -Drug of choice for treatment of initial and recurrent episodes of these infections o Used to suppress replication of: HSV-1, HSV-2, VZV (Shingles) Acyclovir Routes - -Oral, topical, parenteral forms Acyclovir Adverse effects: - -nausea/vomiting, diarrhea, and headache IV infusion- room temperature & give over at least 1 hour Nursing Implications for Influenza Vaccines - -o Administered in deltoid o Can't be allergic to eggs o Rarely caused guillian-barre' syndrome o Takes up to 2 weeks to fully effective Medication administration-client education - -o Take entire course o Contact healthcare provider for adverse effects o Some antivirals: *start at earliest sign* 48 hours for anti-influenza Recurrent episodes of genital herpes or herpes zoster Applying topical meds o Glove or finger cot to avoid secondary infections o Handwashing before & after application Antifungals - -Amphotericin B, Fluconazole, Nystatin (cream or suspension): Amphotericin B Adverse Effects - -o Cardiac dysrhythmias, occasional hypotension o Neurotoxicity; tinnitus; visual disturbances; hand or feet numbness, tingling, or pain; convulsions o Renal toxicity, potassium loss, hypomagnesemia o Fever, chills, headache, nausea, gastrointestinal upset, anemia Fluconazole Adverse Effects - -o Nausea, vomiting, diarrhea, stomach pain, o Increased liver enzymes o Caution in patients with renal & liver impairment Nystatin (cream or suspension)Adverse effects - -Topical irritation (oral and topical cream) Contraindications for Antifungal - -Liver failure Renal failure Which pathway is commonly used by antifungal drugs? - - o Many metabolized by the CYP-450 enzyme system o Be aware of possible interactions NR293 NR293 o Check other drugs prescribed to see if they will interact Antifungal Nursing Implications - -Baseline VS, CBC, liver/renal function studies, & ECG Assess medications prescribed for drug interactions How can we reduce the severity of the infusion-related reactions with amphotericin B? - -Pretreat with one or more of the following: o Antipyretic (acetaminophen), o Antihistamines, o Antiemetics, and possibly o Anti-inflammatory (corticosteroids) How can we minimize GI upset? - -Some oral forms should be given with meals to decrease GI upset; others require an empty stomach—be sure to check How do we give an anti-fungal lozenge? - -Oral lozenge or troche should be slowly and completely dissolved in the mouth (not chewed or swallowed whole) e3 Nystatin suspension- How do we instruct the patient? - -Should be swished thoroughly in the mouth as long as possible before swallowing CNS Depressants Benzodiazepines - -Long-acting Clonazepam Intermediate-acting Lorazepam Temazepam -sleep Short-acting Alprazolam Midazolam -IV Sedation has amnesia properties CNS Depressants: Benzodiazepines Indications - -o Sedation & sleep induction o Anxiety & agitation o Treatment of acute seizure disorders o Treatment of alcohol withdrawal o Anesthesia and Moderate/conscious sedation o Skeletal muscle relaxation CNS Depressants: Benzodiazepines Adverse Effects - -Headache Drowsiness, dizziness or vertigo Cognitive impairment Lethargy & irritability Fall hazard for elderly persons Interfere with REM sleep o "Hangover" effect/daytime sleepiness o Irritability and difficulty with concentration NR293 NR293 CNS Depressants: Benzodiazepines Toxicity & Overdose - -Somnolence, Confusion, Coma, diminished reflexes More serious overdose: Hypotension & respiratory depression o Especially if taken with other CNS depressants Treatment symptomatic and supportive CNS Depressants: Benzodiazepines Overdose Treatment - -Treatment symptomatic and supportive o Flumazenil antidote for oral & IV overdoses CNS Depressants: Benzodiazepines - -CYP-450 food & drug interaction o Grapefruit & grapefruit juice o Increased effect & toxicity of benzodiazepines o Antifungals, calcium channel blockers, & macrolide antibiotics, CNS depressants (alcohol, opioids) CNS Depressants: Barbiturates - -Habit forming o Old standard drugs for insomnia & sedation Low, or narrow, therapeutic index Only a handful commonly used today o Better safety and efficacy of benzodiazepines Enzyme inducer drugs o Stimulate liver enzymes that cause metabolism or breakdown of many drugs o Result in shortened duration of action of other drugs CNS Depressants: Barbiturates Indications - -o Sedative, anticonvulsants, & anesthesia for surgical procedures Ultrashort-acting Secobarbital and Pentobarbital • Anesthesia- short surgical procedures (pre-op/intraop • Secobarbitial-prescribed for insomnia Long-acting- Phenobarbital • epileptic seizure prophylaxis • Phenobarbital coma for status epilepticus or head injury CNS Depressants: Barbiturates Adverse Effects - -Cardiovascular: Vasodilation, hypotension CNS: Drowsiness, lethargy, dizziness Respiratory: Respiratory depression GI: Nausea, vomiting, constipation Hematologic: Agranulocytosis, thrombocytopenia Other: Hypersensitivity reactions, Stevens-Johnson syndrome IV infusion: if too rapid, can cause hypotension and respiratory depression NR293 NR293 Reduced REM sleep, resulting in: Agitation Inability to deal with normal stress CNS Depressants: Barbiturates Toxicity and Overdose - -o leads to respiratory depression & subsequent respiratory arrest CNS depression from deep sleep to coma, and death It can be done "therapeutically" o Anesthesia induction o Uncontrollable seizures: "phenobarbital coma" CNS Depressants: Barbiturates Overdose Treatment - -o Symptomatic and supportive o Maintain adequate airway o Assisted ventilation/oxygen therapy o Fluids o Pressor support o Activated charcoal • Binds to drug in GI tract • Draws drug from circulation into GI tract CNS Depressants: Barbiturates Drug interactions - -Additive effects o Alcohol, antihistamines, benzodiazepines, opioids, tranquilizers Inhibited metabolism o MAOIs will prolong effects of barbiturates Increased metabolism o Reduces anticoagulant response (ie. coumadin), leading to possible clot formation o Reduces effect of oral contraceptives: possible unintended pregnancy Muscle Relaxants - -Cyclobenzaprine, Tizanidine Baclofen, Dantrolene Muscle Relaxants - -Majority act at CNS level Cyclobenzaprine, Tizanidine Baclofen- treats chronic muscular condi