• Body Weight
• Age
• Gender
• Genetics
• Biorythmic Cycles
• Tolerance
• Accumulation
• Psychological Factors

• inaduequate gastric acid inhibits absorption of meds that require an acid medium to dissolve
• Diarrhea causes oral meds to pass too quickly
• Vascular Insufficiency prevents distribution of a medication to an affected tissue
• Liver Disease impairs mediction metabolism may cause toxicity
• kidney disease prevents medication excretion which may cause toxicity

• Infants have immature liver and kidney function, gastric juices, and blood brain barrier
• increased absoprtion of topical
• Lower BP
• High body water content
• decreased serum protien binding
• dosages are based on weight or BSA
• check dosage with other nurse

increased gastric PH

decreased GI Mobility

decreased blood flow

decreased hepatic enzyme function

decreased kidney function

decreased body water

decreased protien binding sites

impaired memory

polypharmacy - many meds

QUESTION #1

when giving a medication that is highly protein bound to an infant, will ther be more or less free medication available? Will medication effects be increased or decreased?

QUESTION #2

A nurse is preparing to administer a small amount of liquid oral medication to a toddler. Which of the following interventions should the nurse use in order to prevent medication error.

1. Stir measured med into a glass of perferred drink
2. verify identity with children's parent
3. calculate medication amount in tsp or ounces before
4. check with other nurse on dosage
5. administer medication using a plastic needless syringe

QUESTION #3

a nurse is reinforcing d/c teaching to an older adult client who states she has difficulty remembering to take her daily medications. Describe a nursing intervention that could be used to promote medication adherence for this client?

MED CLASSIFICATION 

sedative hypnotic anxiolytic

BENDZODIAZEPINE

• Diazepam
• Alproazolam (Xanax)
• Lorazepam (Ativan)
• Chlordiazepoxide (Librium)
• Clorazepate (Tranxene)
• Oxazepam (Serax)
• Clonazepam (Klonopin)

• Anxiety Disorder
• Panic Disorder
• Seizures
• Insomnia
• Muscle Spasm
• Alcohol Withdrawal
• Induction of Anesthesia

• CNS Depression - use with other depressants may result in Respiratory Distress
• Anterograde Amnesia
• Acute Oral Toxicity
• Paradoxical Response
• Withdrawal

• Diazepam is pregnancy Risk D
• Schedule IV under controlled Substances
• Diazepam not with sleep apnea or resp distress
• use Diazepam cautiously in clients with substance abuse and liver disease

• avoid abrupt d/c
• administer with meals or snacks if upset occurs
• possible devlopment of dependancy

MEDICATION CLASSIFICATION

atypical anxiolytic/nonbarbiturate anxiolytic

panic disorder

OCD

Social Anxiety Disorder

PTSD

Dizziness

Nausea

HA

Agitation

• Pregnancy Risk Category B
• not recommended for nursing mothers
• use cautiously in older adults and clients with liver/renal dysfunction
• Concurrent use of MAIO may result in hypertensive
• graprefruit juice, erythromycin, ketoconozole may increase effects

• take with meals
• effects do not occur immediatley
• tolerance, dependance, or withdrawal symptoms should not occur

MEDICATION CLASSIFICATION

selective serotonin reuptake inhibitor

SSRI ANTIDEPRESSANTS

• Paroxetine
• Sertraline (Zoloft)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)

• GAD
  Panic Disorder
• OCD
  Social Anxiety Disorder
• PTSD
• Depressive Disorders

• nausea
• diaphoresis
• sexual dysfunction
• weight gain
• GI Bleed
• Hyponatremia
• Serotonin Syndrome
• Bruxism
• Withdrawal

Pregnancy risk D

clients taking MAOIs or TCA should not take

avoid alcohol

use cautiously with liver and renal dysfunction seizures, HX of Gi bleed, or taking anticoagulants

• take with food
• taking in morning may help decrease sleep disturbances
• take on daily basis
• may not experience effects for 1-3 weeks

QUESTION #1

a client should reciece a does of Flumazenil (Romazicon) to treat symptoms of which of the following

• OCD
• benzodiazepam overdose
• panic disorder
• seretonin syndrome

QUESTION #2

a nurse is reinforcing teaching to a client who is prescribed Diazepam (valium) for anxiety. which of the following indicates understandin

• I should not take this med at bedtime
• I should not take this med is I am taking acetaminphen
• I will tell my doctor before I stop taking this med
• I will need to take this med for the rest of my life

I will tell my doctor before I stop taking thie med..

this medication could cause withdrawal symptoms medication may need to be tapered

QUESTION #3

For what reason might a client be prescriber Busprione instead of Diazepam

QUESTION #4

A client who has bee takin paroxetine (paxil) for several weeks to treat anxiety disorder suddenly develops bruxism. what is bruxism and what treatment should the nurse expect to be prescribed for this adverse reaction?

MEDICATION CLASSIFICATION

Tricyclic Antidepressants (TCA's)

• Amitriptyline (Elavil)
• Imipramine (tofranil)
• Doxepin ( Sinequan)
• Nortriptyline (Aventyl)
• Trimipramine (Surmontil)

• Depression
• Chronic Pain
• Enuresis

Orthostatic Hypotension

Anticholenergic Effects

Sedation

Toxicity

Decreased Seizure threshold

Excessive Sweating

Pregnancy Risk C
should not be given with seizure disorder

coronory heart disease

diabetes

liver/kidney disorders

resp problems

urinary retention

glaucoma

hyperthyroidism

benign prostatic hypertrophy

MEDICATION CLASSIFICATION

SSRI's

meds

Fluoxetine (Prozac)

Citalopram (Celexa)

Escitalopram (Paxil)

Sertraline (Zoloft)

• major depression
• OCD
  Bulimia Nervosa
• Panic Disorders
• PTSD

Sexual Dysfunction

CNS Stimulation

Weight Loss

Seretonin Syndrome

Withdrawals

Hyponatremia

Rash

Sleepy

GI Bleed

Bruxism

• Preg Risk C
  clients taking MAOIs and TCAs
• dont take with Warfarin can increase levels
• riskof bleeding when taken with anicoagulants

MEDICATION CLASSIFICATION

Monoamine Oxidase Inhibitors (MAOIs)

• Phenelzine (Nardil)
• Isocarboxasid (Marplan)
• Tranylcypromine (Parnate)
• Selegiline (Emsam) - transdermal

• Atypical Depression
• Bulimia Nervosa
• OCD

• CNS Stimulation
• Orthostatic Hypotension
• Hypertensive Crisis - intake of tyramine
• local rash with transdermal

• Preg Risk C
• Dont use with SSRI's
• not with diabetes or seizures
• dont use with TCA's

MEDICATIONS CLASSIFICATION

atypical antidepressant

• depression
• alternative for SSRI users that had sexual dysfunction side effect
• aid to quit smoking
• prevention of SAD (seasonal affective Disorder)

• HA
  inreased heart rate
• insomnia
• suppress appetite
• weight loss
• seizures

•  Preg Risk B
• dont use with MAOI's
• use cautiously with patients who have seizures

QUESTION #1

a client who has depression just begun a new prescription for wellbutrin. which of the following side adverse effects should the nurse plan to watch for

• Excessive Sleepiness
• Seizures
• Increased BG
• Bleeding

QUESTION #2

1. a nurse is reinforcing teaching a client whi is startinf amitryptiline for treatment of depression. Which should the nurse include?
   Expect effects to occur in 12 hours
2. stop taking medication if improved mood
3. change positions slowly
4. decrease dietary fiber to control diarrhea
5. chew sugarless gum to prevent dry mouth

QUESTION #3

a nurse is caring for a hopitilized client who takes an MAIO antidepressant. The client was discovered eating foods rick in tyramine. List physical manifestations for which the nurse should monitor.

QUESTION #4

a nurse is caring for an older client who is prescribed Paxil, which of the followin lab values should the nurse plan to monitor?

WBC
BUN
Serum Potassium

Serum Sodium

QUESTION #5

A nurse is caring for a client who has depression and has been taking Pazil for two days. The client suddenly develops a high fever, hallucinations, and anziety. Which adverse effect is most likely happening

Bruxism

Serotonin Syndrome

Anticholinergic Effects

Hypernatremia

MEDICATION CLASSIFICATION

Mood stabilizer

• episodes of acute mania
• alcoholism
• bulimia
• schizophrenia

• GI Distress
• tremors
• polyuria
• weight gain
• Renal Toxicity
• Goiter Hyperthyroidism
• Bradydysrythmia, hyoptension
• electrolyte imbalance

Preg Risk D

alternatives to breast feeding

concurrent use of Nsaids

• monitor serum lithium levels
• effects begin within 7 - 14 days
• take with food
• monitor signs for toxicity

MEDICATION CLASSIFICATION

mood stabilizing antiepileptic drugs (AEDS)

• Carbamazepine (Tegretol)
• Valproic Acid (Depakote)
• Lamotrigine (Lamictal)

manic and depressive episodes

CNS - double vision vertigo

Blood Dyscrasias

Teratogenisis

Hypo-Osmolarity

Skin Disorders (rash)

Gi Effects

Hepatoxicity

Pancreatitis

Thrombocytopenia

Teratogenesis

double or blurred vision

serious skin rashes

Preg Risk D

Carbamezipine with bone marrow suppression or bleefding disorders

valproic acid with liver disorders

QUESTION #1

a client who has been taking lithium carbonate for several months and whose mania has been stabilized, has a serum lever of 1.4 mEq/L, which manifestations should the nurse find

• Coarse Tremors
• Muscle Weakness
• Extreme Polyuria
• Seizures

Muscle Weakness

REVIEW THIS ON PAGE 117

QUESTION #2

a client who started taking lithium carbonate a month ago tells the nurse she has just begun taking multiple daily doses of Ibuprofen for tension headaches. Should the client avoid Ibuprofen? Why or Why not? what is the appropriate action for the nurse to take

QUESTION #3

a nurse is caring for a client who has been taking lithium carbonate for almost a year, the nurse knows that the levels should be monitored

• every 2 - 3 weeks
• every 1-2 weeks
• every 1-3months
• every 6 months

QUESTION #4

a client has prescription for valprioc acid. Which of the following lab values should the nurse anticipate montoring

• Thrombocyte Count
• WBC Count
• Amylase Level
• LFT
  Serum Potassium Level

Thrombocyte count

Amy Level

LFT

MEDICATION CLASSIFICATION

antipsychotics - coventional

• chlorpromazine (Thorazine)
• Haloperidol (Haldol)
  Fluphenazine (Prolixin)
• Thiothixene (Navane)

acute chronic psychosis

schizo

Bipolar

Tourettes

Dementia

Acute Dystonia

Parkinsonism

Akathisia

Late EPS, TD

Neuroleptic Malignant Syndrome

Anticholinergic Effects

Orthostatic Hypotension

Sedation

Neuroendocrin Effects

Seizures

Sexual Dysfunction

Skin Effects

Agranulocytoss

prolongation of Q-T Intervals

dont give pts in coma, depression, parkinsons,hypotension

advise that they do not cause addiction

therapeutic effects may be noticable in a few days, but significant improvement may take 2-4 weeks

MEDICATION CLASSIFICATION

antipsychotics - atypical

• Riseridone (Risperdal)
• Olanzipine (Zyprexa)
• Quetiapine (Seroquel)
• Aripiprazole (Abilify)
• Ziprasidone (Geodone)
• Clozapine (Clozaril)

• schizo
• psychosis
• relief of psychotic symptoms in other disorders

• New onset of DM
• Weight Gain
• Hypercholesterolemia
• Orthostatic Hypotension
• AntiCholinergic effects
• Agitation
• May cause miled EPS

Risperidone is preg risk c

dont use with dementia

avoid alcohol

QUESTION #1

a nurse is caring for a client who takes chlorpromazine for schizo. for which of the following symptoms should nurse expect to see improvment

• poverty of speech
• bizarre behavior
• impaired social interactions
• hallucinations
• decreased motivation

poverty of speech

Bizarre behavior

Hallucinations

QUESTION #2

a nurse is reinforcing teaching for a client who has a new prescription for olanzapine. which should the pt be taught to prevent common adverse effects

• increase daily exercise
• prevent exposure to light
• avoid low sodium diet
• taking afternoon naps

QUESTION #3

a client has been taking chlorpromazine for several years for paranoid schizo. which of the following manifestations should lead the nurse to suspect the client is developing tardive Dyskinsia

• Hand tremors
• Shuffling Gait
• Painful Neck Spams
• Lip-Smacking

QUESTION #4

a nurse is caring for a client who has a new prescription for clozapine. the nurse is monitoring the clients WBC count every two weeks. For what reason is this done?