Maryville NURS 615 Exam 2025

What blood values should be monitored with carbamazepine (Tegretol)? - -CBC test every 3-4 months to monitor for decrease in WBCs, platelets, and trouble with RBC production. What are the pharmacodynamics of carbamazepine (Tegretol)? - -- Auto-metabolizes leading to lower serum levels despite compliance. - Half-life 30 hours as single dose, 15 hours when given repeatedly. What are the Black Box Warnings for carbamazepine (Tegretol)? - -- Stevens-Johnson Syndrome (SJS) - Toxic Epidermal Necrolysis (TEN) Carbamazepine (Tegretol) is what type of drug? - -Anticonvulsant drug What should families be taught regarding the monitoring of seizure activity? - -- Prevention of seizures - Patient Safety - Quality of life issues - Do not discontinue medication due to increased risk of seizures What electrolyte imbalance is noted with the administration of topiramate (Topamax)? - -Decrease in sodium bicarbonate leading to hyperchloremic metabolic acidosis. What are adverse effects of topiramate (Topamax)? - -- Weight loss, especially in higher dose patients - May affect ability to sweat What are pregnancy precautions for valproate (Depakote)? - -- Pregnancy Category X - Teratogen (an agent that causes malformation of an embryo) What instructions will you provide to a woman who wants to get pregnant and has a seizure disorder controlled with valproate (Depakote)? - -- Pregnant women should be advised to switch to another anticonvulsant during the first trimester, such as levetiracetam (Keppra), then switch back to volproate (Depakote) in the second trimester. - All anticonvulsants for pregnant women should be monitored by a high-risk obstetrician. What are precautions and contraindications for tricyclic antidepressants? - -- Caution cardiac disease patients (may act as an antiarrhythmic) - HTN, tachycardia, and convulsions when used with MAOIs NUR 615 NUR 615 What are adverse effects of tricyclic antidepressants? - -- Anticholinergic effects (dry mouth, sedation, constipation, increased appetite, blurred vision, tinnitus, euphoria, and mania) Phenylzine (Nardil) is an MAOI. What are the precautions and contraindications? - -- Avoid foods high in tyramine (fermented foods, wine, alcohol, aged cheeses, yogurt, soy sauce, summer sausage, processed meats, etc.) - Avoid St. John's Wort (Serotonin Syndrome) -Many other drug-drug interactions How long does it take to clear an MAOI from the body? - -2 full weeks, 5 weeks before using fluoxetine (Prozac) What are the symptoms of hypertensive crisis? - -Headache, heart palpitations, stiff or sore neck, chest tightness, tachycardia, sweating, and dilated pupils. Can be life threatening. How long does it take for SSRIs to produce an effect for depression? - -2 - 6 weeks (most are full effect at 4 weeks) When are buspirone (Buspar) and an SSRI combined? - -Treatment of anxious or agitated depression What type of diet is recommended for lithium? - -Consistent sodium intake diet Adverse effects of MAOIs - -- CNS stimulation - Orthostatic hypotension - Hypertensive crisis Adverse effects of SSRIs - -- Anxiety -Nervousness - Insomnia - Suicidal thoughts - Sexual dysfunction - Serotonin syndrome What is the first line drug of choice for mild to moderate generalized anxiety disorder? - -buspirone (Buspar) Adverse effects of SNRIs - -- Headache - Abnormal dreams - Abnormal ejaculation - Serotonin syndrome When will improvements from SSRI citalopram (Celexa) be seen? - -Improved appetite and concentration 1 -2 weeks NUR 615 Serotonin syndrome symptoms - -Cognitive effects: - Headache - Agitation - Mental confusion - Hallucinations - Coma Autonomic effects: - Shivering - Sweating - Hyperthermia - Vasoconstriction - Tachycardia Somatic effects: - Myoclonus (Spasms of muscle groups) - Hyperreflexia - Tremor List of tricyclic drugs - -- amitriptyline (Elavil) - imipramine (Impril) - amoxapine (Asendin) List of MAOIs - --phenylzine (Nardil) - linezolid (Zyvox) List of SSRIs - -- fluoxetine (Prozac) - paroxetine (Paxil) - sertraline (Zoloft) - citalopram (Celexa) - escitalopram (Lexapro) List of SNRIs - -- venlafaxine (Effexor) - desvenlafaxine (Pristiq) - duloxetine (Cymbalta) What receptors do benzodiazepines act on? - -GABA-A receptors (gamma-aminobutyric acid) List of benzodiazepines - - - alprazolam (Xanax) - clonazepam (Klonopin) - diazepam (Valium) - lorazepam (Ativan) - midazolam (Versed) - temazepam (Restoril) NUR 615 NUR 615 What benzodiazepine is most likely to cause dependence? - -alprazolam (Xanax) Action of benzodiazepines - -- Sedative - Hypnotic - Anxiolytic - Anticonvulsant - Muscle relaxer What benzodiazepines are used to treat anxiety? - -Long-acting benzodiazepines - diazepam (Valium) What benzodiazepines are used to treat insomnia? - -Short-acting benzodiazepines - midazolam (Versed), alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril), clonazepam (Klonopin) What benzodiazepine is a good choice for panic disorder? - -diazepam (Valium) What are benzodiazepines useful for treating? - -- Anxiety - Insomnia - Agitation - Seizures - Muscle spasms - Alcohol withdrawal - Pre-medication (medical and dental) Action of anorexiants - -Decreases hunger by altering chemical control of nerve impulse transmission in the appetite control center of the hypothalamus. What chemicals are released with Phentermine? - -- Epinephrine - Norepinephrine What action does epinephrine and norepinephrine have for weight loss? - -The breakdown of stored fat by fat cells Interactions for Phentermine - -- St John's Wort - SSRIs Causes serotonin syndrome - topiramate (Topamax) Increases levels in the body - Alcohol Causes adverse CNS events NUR 615 NUR 615 NUR 615 How long should Phentermine be used? - -Should not be used longer than 6 months due to tolerance What factors place the patient at risk for antibiotic resistance? - -Not finishing antibiotic therapy thus producing bacteria cells that are immune to their effects What are the safest antibiotics for pregnant women and children? - -penicillin and amoxicillin clavulanate (Augmentin) What antibiotics should be avoided by pregnant women and children? - -Tetracyclines and fluoroquinolones Which antibiotics inhibit cell wall synthesis? - -- Beta-lactam antibiotics - Vancomycin Why is clavulanate added to amoxicillin? - -To work as a beta-lactamase inhibitor What is the percentage of anaphylaxis reaction to beta-lactam antibiotics? - -0.01% What is the percentage of non-severe reactions to beta-lactam antibiotics? - -1% What is the proper dosing of amoxicillin for dental surgery? - -amoxicillin 2 grams (adults) and 50 mg/kg (children) Patient education for penicillin-induced diarrhea - -- Continue taking medication - Increase water intake - Eat yogurt or take probiotics to repopulate flora Black Box Warning for Fluoroquinolones - -Tendon rupture What infections should levofloxacin (Levaquin) be reserved for? - -- Hospital-acquired pneumonia - Community-acquired pneumonia with como