Download Pharmacology 338 Neuro 3 Part 1 And Part 2(250 Questions, Answers And Rationales) 2024 Lat and more Exams Nursing in PDF only on Docsity!
Pharmacology 338 Neuro 3 Part 1 And Part
2(250 Questions, Answers And Rationales)
2024 Latest Updated Graded A+.
(ATI Book) A nurse in the post anesthesia recovery unit is caring for a client who received a nondepolarizing neuromuscular blocking agent and has muscle weakness. The nurse should expect a prescription for which of the following medications? A. neostigmine B. naloxone C. dantrolene D. vecuronium - Precise answer A. CORRECT neostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers
B. naloxone is used to reverse the effects of opioids C. dantrolene acts on skeletal muscles to reduce metabolic activity and treat malignant hyperthermia D. vecuronium is an intermediate acting nondepolarizing neuromuscular blocker (ATI Book) a nurse is providing information to a client who has early Parkinsons disease and a new prescription for pramipexole. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. hallucinations B. increased salivation C. diarrhea D. discoloration of urine - Precise answer A. CORRECT pramipexole can cause hallucinations within 9 months of the initial dose and might require discontinuation
B. inc salivation is an adverse effect of cholinesterase inhibitors. dry mouth is an adverse effect of pramipexole C. constipation is an adverse effect of pramipexole
D. discoloration of urine is an adverse effect of COMT inhibitors and not an adverse effect of pramipexole (ATI Book) a nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A. inc intake of protein rich foods B. expect muscle twitching to occur C. take this medication with food D. anticipate relief of manifestations in 24 hr - Precise answer C. CORRECT the client should take this medication with food to reduce GI effects
A. the client should avoid protein rich foods, which can result in dec therapeutic effects of levodopa B. the client should monitor and report muscle twitching which can indicate toxicity D. the client should anticipate relief of manifestations to take several weeks to months (ATI Book) a nurse is preparing to administer a medication to a client who has absence seizures. The nurse should expect to administer which of the following medications to the client (select all that apply) A. Phenytoin B. Ethosuximide C. Gabapentin D. Carbamazepine E. Valproic acid F. Lamotrigone - Precise answer B. CORRECT the only mechanism of action of ethosuximide is to treat a client who has absence seizures E. CORRECT valproic acid has a therapeutic effect when treating a client who has absence seizures and all other forms of seizures F. CORRECT lamotrigine has a therapeutic effect when treating a client who has absence seizures and all other forms of seizures ———————————————————- A. Phenytoin is prescribed for partial seizures and tonic clonic seizures C. Gabapentin is prescribed for partial seizures and tonic clonic seizures
E. CORRECT retrograde amnesia, the inability to remember the events that occurred after taking the med —————————- B. Hypotension is an adverse effect of temazepam C. Pruritus is not an adverse effect of temazepam (ATI Book) a nurse is caring for a client who is receiving moderate sedation with diazepam IV. The client is over sedated. Which of the following medications should the nurse expect to administer to this client? A. Ketamine B. Naltrexone C. Flumazenil D. Fluvoxamine - Precise answer C. CORRECT flumazenil is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzos ———————————— A. Ketamine is an anesthetic agent B. Naltrexone is an opioid antagonist used to treat opioid toxicity and alc use disorders D. Fluvoxamine is a selective serotonin reputable inhibitor used to treat depression (ATI Book) a nurse is teaching a client who has a new prescription for ramelteon. The nurse should instruct the client to avoid which of the following foods at the time of medication administration? A. Baked potato B. Fried chicken C. Whole grain bread D. Citrus fruits - Precise answer B. CORRECT high fat foods (fried chicken) prolong the absorption of ramelteon. The client should not eat high fat foods with or just before taking ramelteon (ATI Book) a nurse is caring for a client who is to undergo a surgical procedure. Which of the following preexisting conditions can be a contraindication for the use of ketamine as an IV anesthetic? A. Peptic ulcer disease B. Breast cancer
C. Diabetes mellitus D. Schizophrenia - Precise answer D. CORRECT ketamine can produce psychological effects (hallucinations). Therefore, schizophrenia can be a CI for the use of ketamine (ATI Book) a nurse is providing instructions to a client who has a new prescription for zolpidem. Which of the following instructions should the nurse include? A. Notify the provider if you plan to become pregnant B. Take the medication 1 hr before you plan to go to sleep C. Allow at least 6hr for sleep when taking zolpidem D. To increase the effectiveness of zolpidem, take it with a bedtime snack - Precise answer A. CORRECT zolpidem is pregnancy risk category C ———————————————— B. Zolpidem should be taken at bedtime C. The client should allow at least 8hr for sleep when taking zolpidem D. Zolpidem is absorbed best on an empty stomach ___________________ mimics parkison's - Precise answer parksonism what is parkinsonism usually the cause of - Precise answer AE of behavioral health meds Parkinson's has can be cured with meds T/F - Precise answer F
- no cure, drug therapy is primary treatment in parkinson's, __________ outnumbers _____________ - Precise answer ach dopamine which neurotransmitter ("messenger") is known as the excitatory messenger causing stiffness and rigidity in parkisons - Precise answer ach parkinsons affects _______ more than __________ and is usually diagnosed in what ages - Precise answer males females
what do dopaminergic agents - carbidopa-levodopa treat/provide relief - Precise answer parkinsons ____________________, lactation, and derm concerns are all CI in dopaminergic agents - Precise answer angle closure glaucoma __________________ is associated with the development of melanoma (skin cancer) - Precise answer levodopa why are derm concerns a CI in dopaminergic agents - Precise answer levodopa has been associated with the development of melanoma (skin cancer) *watch for suspicion of skin cancer/ family hx there is a caution for conditions exacerbated by dopamine receptor stimulation, pregnancy, and renal/hepatic dz in - Precise answer dopaminergic agents (carbidopa/levodopa)
- CVD, MI, arryhthmias, HTN, PUD, GU disorders, BPH, psychiatric what AE r/t to stimulation of dopamine receptors may occur if on Dopaminergic Agents - Precise answer anxiety, confusion, altered mental status, HA, fatigue, constipation, HTN, flushing, urinary retention AE of dopaminergic receptors are r/t stimulation of dopamine receptors, ___________________, and hepatic dysfunction - Precise answer bone marrow depression *watch LFTs for hepatic dysfunction What happens if you take MAOIs with Dopaminergic Agents - Precise answer inc TE of dopaminergic effects but puts you at risk for HTN crisis Stop MAOIS ________ days prior to starting Dopaminergic Agents - Precise answer 14 what happens if you take vit B6 (pyridoxine) with Dopaminergic Agents - Precise answer levodopa turns into dopamine in peripheries (does not reach brain)
Make sure to check a pts OTC meds for _________ if theyre on dopaminergic agents - Precise answer VIT B6 (pyridoxine) MAOIs, VIT B6, phenytoin, dopamine antagonists and OTC MVI are DIs of
- Precise answer dopaminergic agents - carbidopa levodopa Dopaminergic agents become less effective ______-_____ yrs into disorder since there is less neurons - Precise answer 5- if a pt experiences GI effects or urinary effects when taking dopaminergic effects you can instruct them to ________________________________________ - Precise answer take with meals urinate before taking dose since dopaminergic agents may cause anxiety, confusion, and altered mental status, be sure to perform ______________ assessments - Precise answer neurologic ________________ opposes effects of ach at receptor sites affected by Parkisnon dz (brain) (might still affect cholinergic receptors elsewhere though - Precise answer anticholinergic agents (specifically for Parkisons)
- Benztropine Benztropine is used to treat _________________ and _____________________ - Precise answer parkisons parkinsonism Since ____________ is dopamine dominant, it is CI in Benztropine - Precise answer MG What conditions exacerbated by peripheral anticholinergic effects are CI in Benztropine - Precise answer narrow angle glaucoma , GI/Urinary obstruction, BPH angle closure glaucoma is CI in - Precise answer Dopaminergic Agents and Benzos - Diazapam
What pt education would you include for COMT inhibitors - Entacapone and Tolcapone - Precise answer barrier contraceptives due to AE on fetus ________________ blocks the breakdown of dopamine - Precise answer safinamide which med is indicated to work with carbidopa levodopa to treat "off" episodes (when carbidopa levodopa stops working randomly or if symptoms worsen randomly - Precise answer safinamide severe hepatic impairment is CI in - Precise answer safinamide dextromethorphan is a DI in _______________. What effect does it have - Precise answer safinamide psychosis and abnormal behaviors will occur taking ______________ with Safinamide will cause psychosis and abnormal behaviors - Precise answer dextromethorphan Safinamide has a risk of - Precise answer HTN/ Exacerbating existing HTN which med may cause HTN or exacerbate exisiting HTN - Precise answer Safinamide What AE does safinamide have - Precise answer drowsiness *pt may fall asleep performing ADLs cholinergic agents produce similar effects as if _________________________ was activated - Precise answer parasympathetic (rest / digest) selegiline inhibits - Precise answer MAO-B *plays a role in breakdown of dopamine which med inhibits MAO-B - Precise answer selegiline which med is prescribed when pt is responding less to carbidopa-levodopa
- Precise answer selegiline
which med is used in pregnancy only if benefits > risks (CAT C) (from neuro part 1 lecture) - Precise answer selegiline selegiline has a risk of - Precise answer MAOI induced HTN which med mimics the effect of ACH ----.> mimics parasympathetic stimulation - Precise answer Direct acting cholinergic agonists (muscarinic) Bethanechol *carbachol, cevimeline, pilocarpine which med stimulates nicotonic ACH receptors at a lower level than nicotine and blocks nicotine from activating receptors - Precise answer Direct Acting Cholinergic Agonists (Nicotonic) - Varenicline *bupropion, nicotine a pt that wants to improve bladder continence may be put on - Precise answer Direct Acting Cholinergic Agonists (Muscarinic) Bethanechol (carbachol, cevimeline, pilocarpine) Bethanechol is for improving bladder emptying in nonobstructive post op/ postpartum urinary retention and - Precise answer neurogenic bladder atony *improves bladder tone/continence Why is asthma CI in Bethanechol - Precise answer this med blocks bronchodilation Which med blocks bronchodilation - Precise answer Bethanechol *asthma is CI Conditions exacerbated by parasympathetic effects ( bradycardia, CAD, hypotension), GI conditions(PUD), asthma, bladder obstruction or recent bladder surgery, epilepsy and Parkinsons is CI in - Precise answer bethanechol What is cautioned in Bethanechol - Precise answer preg/lact
careful when giving ______________ if the pt is in for chest pain, MI, or angina since this med will inc HR and BP - Precise answer varenicline perform a psychiatric assessment (pt at risk for self harm) for a pt that is on what med - Precise answer varenicline and levetiracetam (Keppra) since Varenicline increases HR and BP, what test can a nurse monitor to see any abnormalities - Precise answer EKG also listen to heart/lung sounds varenicline will inc HR/BP and _______________, __________________________________ events, nausea, dry mouth, dizziness, strange dreams, and rash - Precise answer inc seizure risk neuropsychiatric events (depression, anxiety, paranoia, stress, hallucinations, irritable) *bc less dopamine is happening which med has DIs of MAOIs, ETOH, insulin, propranolol, acetaminophen, and caffeine - Precise answer varenicline ___________ is a med for MG pyridostigmine/donepezil - Precise answer pyridostigmine (neostigmine/edrophonium) _______________ is a med for alzheimer's pyridostigmine/donepezil - Precise answer donepezil (galantamine/rivastigmine) indirect acting cholinergic agents are also called - Precise answer cholinesterase inhibitors indirect acting cholinergic agents (pyridostigmine/donepezil) work at all _______________ receptor sites ------ in parasympathetic nervous system, in _____________ and at neuromuscular junction - Precise answer ach cns a positive _____________ test indicates a pt has MG - Precise answer tensilon
___________________ is a chronic muscular dz where there is a deficit in neuromuscular transmission, autoimmune, diaphragm declines (cant breathe), weakness, and loss of muscle control - Precise answer MG ___________________- is a progressive disorder with neuro degeneration, loss of memory, affects ADLs and cause unknown - Precise answer Alzheimers indirect acting cholinergic agents ______________ block acetylcholinesterase - Precise answer reversibly if indirect acting cholinergic agents are __________________, they block/bind to acetylcholinesterase - Precise answer irreversibly what effects does pyridostigmine have on MG - Precise answer relieve s/s and inc muscle strength what effect does donepezil have on alzheimers - Precise answer treatment but meds must cross blood brain barrier in order for donepezil to treat alzheimers, meds must - Precise answer cross blood brain barrier why is pregnancy CI in indirect acting cholinergic agents (pyrdiostigmine/donepezil) - Precise answer causes uterus to contract (early delivery) bradycardia, intestinal/urinary tract obstruction, and preg/lact is CI in - Precise answer indirect acting cholinergic agents (pyridostigmine/donepezil) What effect do NSAIDs such as ibuprofen and naproxen have on pyridostigmine and donepezil - Precise answer inc risk of GI bleed pregnancy is CI in (neuro part 1) - Precise answer indirect acting cholinergic agents (pyridostigmine/donepezil)
which med has a DI with diphenhydramine (benadryl) - Precise answer atropine atropine has DIs with antihistamines (benadryl), _______________________, MAOIS and TCAs - Precise answer parkinson dz meds *these DIs inc incidence of anticholinergic effecrs a pt with current brain damage should use caution if taking - Precise answer atropine atropine has CI in conditions exacerbated by blockade of - Precise answer parasympathetic nervous system (glaucoma, GI obstruction, paralytic ileus, BPH, bladder obstruction, tachycardia, MG, cardiac arrhythmias) Atropine has AE r/t blockade of ______________________ receptors - Precise answer cholinergic ( constipation, urinary retention, palpitations, tachycardia) those with cardiac arrhythmias, tachycardia and myocardial ischemia, impaired liver/kidney function, preg/lact , HTN, and hx or or current brain damage should use caution if taking - Precise answer atropine what is the normal ICP range - Precise answer 5- _________________ Triad is seen in ICP and is inc _______, dec______, and altered resp pattern - Precise answer cushings systolic BP pulse For a pt with ICP it is important to monitor changes in - Precise answer LOC which med "dehydrates brain" - Precise answer Osmotic Diuretics - Mannitol Mannitol is for ICP and causes __________ through osmosis - Precise answer diuresis
Mannitol reduces ICP and dec cerebral edema by raising serum osmolality and drawing fluid back into ___________________- - Precise answer the vascular and extravascular space active intracranial bleed is CI in - Precise answer mannitol (will make it worse) mannitol has CI of active intracranial bleed, severe ____________, severe dehydration, and renal failure (_______) - Precise answer pulmonary edema anuria those with heart failure, renal insufficiency, electrolyte imbalances, and preg/lact should use caution while on - Precise answer mannitol - osmotic diuretics which med may cause F&E imbalances (Na & K) , metabolic acidosis, hypotension, tachycardia, worsened CHF, Pulmonary edema and peripheral edema - Precise answer mannitol *monitor F&E imbalances, BP,HR, weight, I&Os, and s/s of HF which med may cause F & E imbalances - Precise answer mannitol pentobarbital watch out for volume overload (crackles, swelling of legs and ankles) in - Precise answer mannitol *also watch out for dehydration (poor skin turgor) Mannitol has DI with lithium and _____________________ - Precise answer cardiac glycosides *digoxin inc risk of hypokalemia mannitol is given slowly through IV T/F - Precise answer F ; rapid assess ______________ frequently since it can cause ___________________ if on mannitol - Precise answer LOC
suppresses respiratory drive what electrolytes may be imbalanced if on Pentobarbital - Precise answer Na K hyponatremia or hypokalemia what may happen if pentobarbital is discontinued abruptly - Precise answer withdrawal syndrome *agitation, seizures, potentially life threatening complications *needs to be weaned/tapered off slowly glucocorticoids - dexamethasone has ______________ effects that improves cerebral flow and restores autoregulation - Precise answer anti inflammatory which med is for tumors or abscesses (metastatic cancer, brain cancer) ; short term situations - Precise answer glucocorticoids - dexamethasone which med may cause hyperglycemia - Precise answer dexamethasone dexamethasone has AE of inc ______________, infection, ________________, PUD, sodium retention, anxiety/irritability/and _______________ - Precise answer glucose osteoporosis mania (personality changes, trouble sleeping) *monitor for signs of infection since dexamethasone can cause Na/water retention and K loss, it can lead to _________________, ____________________, and serious ______________________ - Precise answer HTN edema dysrhythmias clients may need to inc dexamethasone if - Precise answer stressed dexamethasone needs to be tapered (do not stop abruptly) ; monitor for _________________ insufficiency - Precise answer adrenal *hypotension, fatigue, weakness
a pt w/ diabetes should check their blood sugar often if on ___________________ - Precise answer dexamethasone if on __________________, observe for s/s of PUD (coffee-ground emesis, bloody or tarry stools, abd pain) and notify provider if it occurs - Precise answer dexamethasone which med may cause PUD - Precise answer dexamethasone *Observe for s/s of PUD (coffee-ground emesis, bloody or tarry stools, abd pain) and notify provider if occur ________________ Seizures - caused by abnormal neurons that are very sensitive or overrespond ______________ Seizures - caused by injury, infection, drug overdose, environmental exposure, etc. (alc withdrawal) - Precise answer primary secondary (provoked by something else; once trigger is removed, seizures stop) consciousness is impaired in _______________ seizures - Precise answer complex consciousness is not impaired in _________________ seizures - Precise answer simple Seizures :
- ____ abrupt, brief periods of loss of consciousness, no muscle contractions, common in children and disappears at puberty 2._____ typically, tonic clonic seizures relates to high fevers, freq in childre, self-limited, and do not reappear 3.____seizures rapidly recur repeatedly with no recovery between seizures, most dangerous (med emergency) 4.____involve aggressive spasms, stiffening and jerking, loss of consciousness, and a period of recovery with confusion and exhaustion 5.____ short, sporadic periods of muscle contractions rare and typically secondary seizures A. tonic clonic (grand mal) B. absence C. myoclonic D. febrile
