question

Brand name valproic acid

answer

Depakene, or Stavzor

question

Therapeutic classification of Valproic acid

answer

anticonvulsants, vascular headache suppressants

question

Indications of Valproic acid

answer

Monotherapy and adjunctive therapy for simple and complex absence seizures., complex partial seizures, adjunctive therapy for multiple seizure types including absence seizures

question

Action of Valproic acid

answer

Increase levels of GABA

question

Therapeutic effects of valproic acid

answer

suppression of seizure activity. Decreased incidence of migraine headaches

question

Contraindications of valproic acid

answer

Hepatic impairment, known/suspected urea cycle disorders

question

valproic acid medications to use cautiously

answer

-may increase risk of suicidal thoughts/behaviors -bleeding disorders -history of liver disease -Organic brain disease -Bone marrow depression -renal impairment -women of childbearing potential -increased risk of adverse effects with geriatric patients -use in pregnancy or lactation is contraindicated can cause birth defects -children under 2 increased risk for potentially fatal hapatotoxicity

question

adverse reactions of valproic acid

answer

-Suicidal thoughts -Hepatotoxicity -pancreatitis -Hyperammonemia -hypothermia

question

most common side effects

answer

-agitation -dizziness -headache -insomnia -sedation -visual disturbances -abdominal pain -anorexia -diarrhea -indigestion -nausea -vomiting -tremors

question

adult dosing for valproic acid

answer

seizures-not to exceed 60 mg/kg/day if over 250 mg then give in divided doses Migraine prevention not to exceed 1000mg daily

question

nursing implications for valproic acid

answer

monitor for seizure location, duration, and characteristics, implement seizure precautions monitor frequency of migrainme headaches assess for suicidal tendencies Monitor for hepatic function and serum ammonia concentrations

question

Lab tests for valproic acid

answer

CBC, platelet count, and bleeding time, may cause leukopenia and thrombocytopenia

question

nursing implications for valproic acid

answer

administer with meals to avoid GI upset do not administer with milk or carbonated beverages may cause premature dissolution

question

patient teaching for valproic acid

answer

take medication as directed notify dr if you have suicidal thoughts or or worsening depression and anxiety, or changes in mood advise dr if anorexia abdominal pain severe nausea and vomiting, jaundice, lethargy, unusual bleeding or bruising, pregnancy, or loss of seizure control

question

brand name for captopril

answer

Capoten

question

therapeutic classification for captopril

answer

antihypertensives

question

pharmacologic classification for captopril

answer

ACE inhibitors

question

Indications for Captopril

answer

-management of HF -reducation of risk or death or development of HF following MI -Decrease progression of diabetic nephropathy

question

Action of Captopril

answer

-block the conversion of angiotensin I to angiotensin II -prevent the degradation of bradykinin and other vasodilatory prostaglandins -increase plasma renin levels -decrease aldosterone levels

question

Therapeutic effect of captopril

answer

-lowering of BP in hypertensive patients -improved symptoms in patients with HF -decrease progression of diabetic nephropathy

question

Normal dose range of captopril for adults

answer

Hypertension-12.5mg-25mg 2-3x daily may be increased at at 1-2 wk intervals up to 150 mg 3x daily maximum dose=450mg/day HF-25 mg 3x daily up to 50 mg 3x/day Post MI- up to 50 mg 3x/day Diabetic nephropathy- 25 mg 3xdaily

question

Contraindications of captopril

answer

-history of angiodema with previos use of ACE inhibitors -Do not use in pregnancy or lactation -renal/hapatic impairment -hyponatremia -hypovolemia

question

Adverse side effects of captopril

answer

-agranulocytosis -angioedema

question

most common side effects of captopril

answer

-cough -hypotension -taste disturbances -neutropenia (captopril only)

question

Interactions of captopril

answer

-use of other diuretics and other antihypertensives may increase the risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or angiotensin II receptor antagonists -NSAIDS and selective COX-2 inhibitors my blunt the antihypertensive effect and increase the risk of renal dysfunction -food decreases the absorption take one hour before meals

question

Nursing implications of captopril

answer

-monitor BP -assess patient for signs of angioedema -monitor for s/s of HF -may cause positive ANA titer -may cause false positive test results for urine acetone -monitor CBC with diff prior to initiation of therapy every 2 wk for the first 3 months and periodically for up to 1 yr in patients at risk for neutropenia D/c if neutrophil count less than 1000/mm3

question

patient teaching of captopril

answer

-take 1-2 hours before a meal may be crushed if patient has difficulty swallowing tablets may have sulfurous odor -can be made into an oral solution by crushing a 25 mg tablet and dissolving it ins 25-100mL/water

question

trade name for diazepam

answer

Valium

question

therapeutic classification for diazepam

answer

antianxiety agents, anticonvulsants, sedative/hypnotics, skeletal muscle relaxants

question

pharmacologic classification for diazepam

answer

benzodiazepines

question

Indications of diazepam

answer

adjunct in management: Anxiety disorder, Athetosis, anxiety relief prior to cardioversion (injection) Stiffman Syndrome, preoperative sedation, Conscious sedations, treatment of status epilepticus/uncontrolled seizures, skeletal muscle relaxant. Management of the symptoms of alcohol withdrawal

question

unlabeled use for diazepam

answer

-anxiety associated with acute MI, -insomnia

question

Action of diazepam

answer

-depresses the CNS probably by potentiating GABA -produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways. -has anticonvulsant properties due to enhance presynaptic inhibition

question

Therapeutic effects of diazepam

answer

-relief of anxiety -sedation -amnesia -skeletal muscle relaxation -decreased seixure activity

question

Contraindications for diazepam

answer

cross-sensitivity with other benzodiazepines may occur comatose patients myasthenia gravis Severe pulmonary impairment sleep apnea severe hepatic dysfunction pre-existing CNS depression uncontrolled severe pain Angle closure glaucoma some products contain alcohol, propylene glycol or tartrazine shoudl be avoided in patients with known hypersensitivity or intolerance Not to be used in pregnancy or lactation or in children less than 6 months old

question

side effects for diazepam

answer

dizziness drowsiness lethargy physical dependence psychological dependence tolerance

question

interactions of diazepam

answer

antidepressants antihistamines opioid analgesics -Cimetidine, hormonal contraceptives, disulfiram, fluoxetine, isoniazid, ketoconazole, metroprolol, propoxyphene, propranolol or valprioc acid may decrease the metabolism of diazepam increasing the actions -may decrease the efficacy of levodopa Rifampin or barbituates may increase the metabolism and decrease the effectiveness of diazepam -sedative effects may be decreased by theophylline -concurrent use or ritonavir is not recommended

question

dosage of adults for diazepam

answer

-Antianxiety- 2-10mg 2-4x daily PO, IV or IM 2-10 mg may repeat in 3-4 hours prn -Status epilepticus/acut seizure activity- IV 5-10 mg may repeat q 10-15 min to a total of 30 mg may repeat regimen again in 2-4 hours larger doses may be required -Precardioversion- IV 5-15 mg 5-10 min precardioversion -Pre-endoscopy-IV 2.5-20 mg IM 5-10 mg 30 minutes pre-endoscopy -skeletal muscle relaxation- PO 2-10 mg 3-4x daily IV IM 5-10 mg may repeat in 2-4 hr may need a larger dose for tetanus

question

nursing implications for diazepam

answer

-monitor VS during IV therapy -assess IV site frequently may cause phlebitis and venous thrombosis -assess mental status and degree of anxiety -keep seizure log intensity, duration, and location; implement seizure precautions -evaluate hapatic and renal function and CBC periodically during prolonged therapy -toxicity and overdose- Flumazenil is adjunct in the management of toxicity or overdose

question

patient teaching for diazepam

answer

-take medications every day and do not take more than prescribed or increase dosage without checking with your doctor -stopping abruptly may cause insomnia, unusual irritability, nervousness, and/or seizures -patients on med for seizure management should wear identification with the condition on it.

question

trade name for carvedilol

answer

Coreg, Coreg CR

question

Therapeutic classification of carvedilol

answer

antianginals, antiarrhythmics, antihypertensives

question

pharmacologic classification of carvedilol

answer

beta blockers (non selective)

question

Indications for carvedilol

answer

HF (ischemic or cardiomyopathic) with other agents, left ventricular dysfunction after MI

question

Action of carvedilol

answer

block stimulation of beta1-adrenergic and beta2-adrenergic receptors sites -have alpha1-adrenergic blocking activity which may result in more orthostatic hypotension

question

Therapeutic effects of carvedilol

answer

-decreased HR and BP -suppression of arrhythmias -increased Cardiac output -decreased risk of death from HF -slowed pregression of HR -prevention of MI

question

Contraindications of carvedilol

answer

-uncompensated HF -pulmonary edema -cardiogenic shotck -bradycardia -sick sinus syndrome -heart block (unless pacemaker present) -severe hepatic impairment -bronchial asthma/bronchospasm

question

use cautiosly with carvedilol

answer

-renal impairment -hepatic impairment -HF (condition may deteriorate after initial therapy) -DM (may mask signs of hypoglycemia) -PVD -Thyrotoxicosis (may mask symptoms) -history of severe allergic reactions -skeletal muscle disease -do not use in pregnancy or lactation -geriatric may have increased sensitivity use lower initial dose and consider decrease in body mass renal/hepatic/cardiac function

question

adverse reactions of carvedilol

answer

-arrhythmias -bradycardia -HF -PE

question

most common side effects of carvedilol

answer

-fatigue -weakness -intraoperative floppy iris syndrome -increase in orthostatic hypotension -erectile dysfunction

question

Adult dosage for carvedilol

answer

hypertension-6.25 mg 2xday may be increased q7-14 days up to 25 mg 2xday or extended release 20 mg 1xday dose may be doubled q7-14 days up to 80 mg 1xday HF-3.125 mg 2xday for 2 weeks, may be increased to 6.25 mg twice daily, dose may be doubled q 2 weeks as tolerated not to exceed 25 mg 2xdayin patients less than 85 kg or 50 mg 2xday in patients over 85 kg -extended release-10 mg 1xday, dose may be double q 2 wks as tolerated up to 80 mg 1xday -left ventricular dysfunction after MI-6.25mg 2xday increased after 3-10 days to 12.5mg 2xdaythen to target dose of 25 mg2xday some patientsf may require lower initial doses and slower titration or extedded release 20 mg 1xday up to 80 mg

question

nursing implications for carvedilol

answer

monitor BP and pulse frequently during dose adjustment and periodically monitor I/O ratios and daily weight assess patient routinely for evidence of fluid overload may cause and increase in BUN, serum lipoprotein, potassium, triglyceride, uric acid levels, may cause in ANA titers may cause increase in blood glucose levels monitor for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, cyanosis, seizures)

question

Nursing implementation for carvedilol

answer

Do not confuse carvedilol with captopril take apical pulse before administering if less than 60 or if arrythmia occurs withhold medication and contact the Dr.

question

patient teaching for carvedilol

answer

take medication as directed every day abrupt withdrawal may precipated life-threatening arrythmias, hypertension and myocardial ischemia -if slow pulse, difficulty breathing wheezing, cold hands and feet, dizziness, confusion, depression, rash fever, sore throat, unusual bleeding or bruising occurs then contact your Dr.

question

Brand name for dopamine

answer

Intropin

question

Therapeutic classification of dopamine

answer

inotropics, vasopressors

question

pharmacological classification of dopamine

answer

adrenergics

question

indications of dopamine

answer

adjunct to standard measures to improve BP, CO, urine output in treatment of shock unresponsive to fluid replacement, increase in renal perfusion

question

Action of dopamine

answer

-small doses (0.5-3mcg/kg/min) stimulate dopaminergic receptors, producing renal vasodilation. -Larger doses (2-10 mcg/kg/min) stimulate dopaminergic and beta1 adrenergic receptors, producing cardiac stimulation and renal vasodilation -doses greater than 10 mcg/kg/min stimulate alpha-adrenergic receptors and may cause renal vasoconstriction

question

Therapeutic effects of dopamine

answer

increased CO, increased BP, improved reanal blood flow

question

side effects of dopamine

answer

arrhythmias, hypotension

question

Drug-drug interactions with dopamine

answer

use with MAO inhibitors, ergot alkaloids (ergotamine), doxapram or some antidepressants results in severe hypertension, use with IV phenytoin may cause hypotension and bradycardia. Use with general anesthetics may result and arrhythmias, beta blockers may antagonize cardia effects

question

adult dosage for dopamine

answer

IV dopaminergic (renal vasodilation)-1-5mcg/kg/min IV beta-adrenergic (cardia stimulation) 5-15 mcg/kg/min IV alpha adrenergic (increased peripheral vascular resistance) more than 15 mcg/kg/min infusion rate may be increased as needed

question

Nursing implications

answer

Monitor VS,ECG pulmonary capillary wedge pressure, CO, CVP, and urinary output continuously during administration. - Palpate peripheral pulses and assess appearance of extremities routinely during adminstration -Toxicity and overdose in excessive hypertension occurs rate of infusion should be decreased or temporarily discontinued until BP is decreased Phentolamine may be administered if hypertension continues

question

high alert for dopamine

answer

double check order to ensure accuracy -extra vasation may cause severe irritation, necrosis and sloughing of tissue, administer into a large vein and assess administration site frequently, if extravasation occurs, affected area should be infiltrated liberally with 10-15 mL of 0.9% NaCl containing 5-10 mg of phentoloamine.

question

patient/family teaching for dopamine

answer

have patient inform you immediately if experiencing chest pain, dyspnea, numbness, intgling or burning of extremities, and pain at the adminstration site.

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