NUR 2474 Pharmacology for Professional Nursing

NUR2474 Exam 1 Review

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Please review general tips from Quiz review document (test taking strategies,

select all that apply questions, etc.). The test will utilize Respondus browser

and monitor (using webcam). No notes or textbook allowed on the test.

Calculator will be enabled in the browser.

General tips for studying:

1. Memorize names of medication categories from the presentation (SSRI’s,

benzodiazepines, first/second generation antipsychotics, etc.) used to

treat common neuro conditions (PD, Alzheimer’s disease, BPD, ADHD,

etc.)

2. Memorize key drugs from categories above (there are many questions

with specific drug names)

3. Use generic names

4. When reviewing particular drugs note category, indications, common side

effects, toxicity signs (if applicable)

Topics to review:

1. Lithium therapy (blood testing, therapeutic levels, toxicity levels, side

effects, toxic effects)

a. Blood level drug testing should occur early in therapy every 2-3

days, until a therapeutic dose has been established, then long term

for every 3 to 6 months while using the drug.

b. Therapeutic Level= 0.8-1.4

c. Toxic Level= Greater than 1.5

d. SE at therapeutic level: GI effects, tremors, polyuria, renal toxicity,

goiter, hypothyroidism, teratogenesis.

e. Toxic SE: will be much worse and possibly life threatening i.e.

tremor that becomes larger with muscle incoordination.

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2. BPD patients on Lithium and adjunct meds for mania/depression

a. The bipolar patient will have periods of mania, depression, and

psychosis, and will need a mood stabilizer lithium to control their 

mood, an antidepressant (SSRI), and an antipsychotic (2nd genolanzapine, risperidone) to control the psychosis.

3. Benzodiazepines and alcohol withdrawal

a. The benzo will help one withdraw from alcohol by decreasing the

withdrawal manifestations and intensity, while making one sleepy

and having CNS depression. Plus, it is easy to give IM and will

work quickly.

4. Alprazolam therapy and anxiety

a. Alprazolam is a benzo that is used to treat anxiety.

b. It works by reducing anxiety by inhibiting the GABA in the CNS,

depressing the CNS.

c. SE: CNS depression, anterograde amnesia (patient cannot

remember much), sleep driving (not safe), paradoxical effects (still

anxious, stays up, rowdy), respiratory depression.

d. Interacts w/ CNS depressant medications (additive effects), and

ETOH.

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5. Treatment of anxiety patients with sedative/hypnotics

a. Can use benzo’s (pam/lam), atypical anxiolytic buspirone, SSRIs

paroxetine/fluoxetine, TCAs, MAOIs, trazodone.

b. Sedative hypnotics can cause the patient to have sedation,

sleepiness, CNS depression, anterograde amnesia (patient cannot

remember much), sleep driving (not safe), paradoxical effects (still

anxious, stays up, rowdy), respiratory depression.

c. They must always be taped by the HCP, not the patient.

d. Teach no ETOH use, no sleep driving.

e. Withdrawal can occur- PO= drowsiness, lethargy, confusion, IV=

hypotension, respiratory arrest, cardiac arrest.

6. Methylphenidate (Ritalin) therapy in children

a. Methylphenidate is used to increase attention and focus in

children (NOTHING DEALING W/ BEAHVIORS)

b. Use of methylphenidate with kids can decrease their appetite and

cause insomnia if given late in the day.

c. ALWAYS: give the drug in the morning, after breakfast, and give

the last dose before 4pm, or else the child will not sleep at night.

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7. Donepezil (Aricept) therapy in pt’s with Alzheimer’s disease

a. Patients who have Alzheimer’s have treatment available to slow the

decline of the disease, but does not cure the disease.

b. Donepezil works to slow the progression of the disease by causing

reversible inhibition of cholinesterase and the cholinergic

receptors.

8. Review therapy discontinuation for depression

a. If an antidepressant is stopped abruptly (cold turkey), the patient

can go into withdrawal syndrome (s/s HA, Nausea, visual

disturbances, sweating, dizziness, tremors).

b. We must gradually taper the drug over weeks slowly and call the

HCP to have them guide the patient through the process.

c. DO NOT let patient discontinue antidepressants themselves!

9. Sertraline (Zoloft) and nursing infants

a. Sertraline is a SSRI, and when this drug is used with a patient who

is pregnant or nursing infants, the infant can have neonatal

abstinence syndrome occur.

b. It is safe to use but may cause this.

c. We must educate the patient on potentially using other

medications during this time period, as it can cause potential birth

defects and the baby to become sick.

10. Duloxetine (Cymbalta) and alcohol abuse

a. Duloxetine is a SNRI and when used with ETOH, it can interact

with the medication and make the patient very sick.

b. The patient must avoid ETOH while taking any of these

medications. 

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