一些复习讲义 NS & drugs

Mnemonic for cranial nerves:Oh (Olfactory)Oh (Optic)Oh (Oculomotor)To (Trochlear)Touch (Trigeminal)And (Abducens)Feel (Facial)Virgin (Vestibulocochlear)Girls' (Glossopharyngeal)Vaginas (Vagus)And (Accessory)Hymens (Hypoglossal)To remember motor, sensory or both:SomeSayMarilynMonroe,ButMyBrotherSaysBridgetteBardotMovesMen Nerve [Classification] [Major functions] AssessmentI Olfactory Sensory Smell Have patient identify a familiar scent with eyes closed (usually deferred).II Optic Sensory Vision (acuity and field of vision); pupil reactivity to light and accommodation (afferent impulse)Have patient read from a card or newspaper, one eye at a time. Test visual fields by having patient cover one eye, focus on your nose, and identify the number of fingers you’re holding up in each of four visual quadrants.III Oculomotor Motor Eyelid elevation; most EOMs; pupil size and reactivity (efferent impulse)Check pupillary responses by shining a bright light on one pupil; both pupils should constrict. Do the same for the other eye. To check accommodation, move your finger toward the patient’s nose; the pupils should constrict and converge. Check EOMs by having patient look up, down, laterally, and diagonally.IV Trochlear Motor EOM (turns eye downward and laterally)Have patient look down and in.V Trigeminal Both Chewing; facial and mouth sensation; corneal reflex (sensory)Ask patient to hold the mouth open while you try to close it and to move the jaw laterally against your hand. With patient’s eyes closed, touch her face with cotton and have her identify the area touched. In comatose patients, brush the cornea with a wisp of cotton; the patient should blink.VI Abducens Motor EOM (turns eye laterally)Have patient move the eyes from side to side.VII Facial Both Facial expression; taste; corneal reflex (motor); eyelid and lip closureAsk patient to smile, raise eyebrows, and keep eyes and lips closed while you try to open them. Have patient identify salt or sugar placed on the tongue (usually deferred).VIII Acoustic Sensory Hearing; equilibriumTo test hearing, use tuning fork or rub your fingers, place a ticking watch, or whisper near each ear. Equilibrium testing is usually deferred.IX Glossopharyngeal Both Gagging and swallowing (sensory); tasteTouch back of throat with sterile tongue depressor or cotton-tipped applicator. Have patient swallow.X Vagus Both Gagging and swallowing (motor); speech (phonation)Assess gag and swallowing with CN IX. Assess vocal quality.XI Spinal accessory Motor Shoulder movement; head rotationHave patient shrug shoulders and turn head from side to side (not routinely tested).XII HypoglossalMotorTongue movement; speech (articulation)Have patient stick out tongue and move it internally from cheek to cheek. Assess articulation.Reference: http://rn.modernmedicine.com/rnweb/a....jsp?id=120796 AIRBORNE: Single room, use negative airflow pressure, use MASK or Resp Protection device, Put mask on client if he leave room. MeaslesChikenpoxTBVaricella ZosterDroplet: Private room or cohort, Use mask and place mask on client when he is leaving the roomDiptheriaFluEpiglotitisMeningitisMumpsPertusisPnemoniaScarlet FeverSepsisStrep PharingitisCONTACT: Private or Cohort- USE GLOVES and GOWNEnteric infections: C. difficileRSV (and other resp infection)Wound infectionsSkin infections (herpes, impetigo, diptheria, pediculosis, staph, varicella zoster, conjunctivitis)from saunder 4th edition pg191-192 Parkinson’s Disease:Two main classes- meds that activate dopamine receptor and meds that block acetylcholine. Use- doesn’t halt progress of PD but helps with symptoms- helps in ability to perform ADL, absence of tremors and reduction of irritability and stiffness) Levadopa- protein decreases the effectiveness! Mirapex (causes sleep attacks) Congentin (causes atropine like effects- dry mouth, blurred vision, urinary retention and constipation), causes drowsiness Symmetrel- (causes confusion and atropine like effects, discoloration of skin Sinemet (levadopa + carbidopa- causes abnormal movements and psychosis) Requip Parlodel Artane SIDE EFFECTS: N/V, dyskinesias (head bobbing, tics, grimacing), Orthostatic hypotension, discoloration of sweat, psychosis, tachycardia, activation of malignant melanoma. Medication holiday may be indicated Antipsychotic:Convention Antipsychotic Drugs- Examples: thorazine, Haldol, Moban, Navane, Trilafon, Prolixin. Side effects include extrapyramidal symptoms, acute dystonia (spasm of tongue, face, neck and back), parkinsonism, akathisia, causes neuron malignant syndrome (sudden high grade fever, muscle rigidity, changes in LOC, coma), anticholinergic effects, hypotension, sedation, seizures, agranulocytosis, skin effects, sexual dysfunction, and finally dysrhythmias. Atypical Antipsychotics Drugs-Examples: Clozaril, Risperdal, Zyprexa, Seroquel, Abilify. Used for severe schizophrenia. Side effects: agranulocytosis, seizures, weight gain, diabetes, inflammation of the heart muscle Depression:Antidepressants- TricyclicExamples- Elavil, Tofranil, Sinequan Use: depression and bipolar disorder Side Effects: hypotension, anticholinergic effects (THINK ANTIdepressant and ANTIcholinergic), sedation, toxicity Don’t give with MAOIs Don’t give with antihistamines and other anticholinergic agents Therapeutic effect may take 1-3 wks. Sudden discontinuation may cause relapse. Selective Serotonin Reuptake Inhibitors: Examples: Prozac, Celexa, Lexapro, Paxil, Zoloft Used for depression, OCD, Bulimia, Panic disorders and PTSD Side effects: sexual dysfunction, weight gain, serotonin syndrome (mental confusion, agitation, anxiety, hallucinations, hyperreflexia tremors), withdrawal syndrome, rash, fatigue Don’t take with MAOIs b/c increases risk of serotonin syndrome. Therapeutic effect may take 1-3 wks. Sudden discontinuation may cause relapse. MAOIsExamples: Nardil, Marplan Used for atypical depression, OCD, Bulimia Side effects: Anxiety, orthostatic hypotension, HYPERTENSIVE CRISIS due to intake of tyramine…. IF HYPERTENSIVE CRISIS OCCURS THEN GIVE IV PHENTOLAMINE!!!!!!!!!! (ALSO CAN GIVE SUBLINGUAL NITRO) Don’t give to people with pheochromcytoma, heart failure, and renal insufficiency. If you give with Demerol it can cause hyperpyrexia. Clients should restrict food with tyramine including aged cheese, salami, avocados, bananas, protein, dietary supplements and red wine. Other Antidepressants: Wellbutrin, Remeron, Effexor, Vestra, Desyrel- Used to treat depression and help in quitting smoking Side effects: seizures, headache and constipation, dry mouth Mood stabilizersLithium, (levels should be monitored closely, meds taken 2-3 x per day, maintain adequate sodium intake) valproic acid (depakote), Tegretol Side effects: diarrhea, tremors, polyuria, renal toxicity, goiter Don’t give to women who are breast feeding Benzodiazepines:o Examples: Valium, xanax, Ativan, Libriumo Used for anxiety, seizures, insomnia, muscle spasm, alcohol withdrawal, panic disordero Causes CNS depression, amnesia, anxiety, insomnia, teratogenesis, acute toxicityo Take with mealso May get dependent on medsHypotonic Non Benzodiazepines:o Examples: ambien, sonata, lunesta, desyrel. o Used to manage insomnia o Causes daytime sleepinesso don’t take with alcohol or other CNS depressants Anxiolytic:o Examples: BusParo Used for anxietyo Causes CNS effects like lightheadedness, faintness, nauseao take with mealso Effects may be seen in a weekCNS Stimulants:o Examples Ritalin, Concerta, Dexdrine, Adderal, Caffineo Used for ADHD, Narcolepsy, Obesity, weight reductiono Side effects: CNS stimulation (insomnia restlessness), weight loss, dysrhythmias chest painCholinesterase Inhibitors: (increases amount of acetylcholine (ach))Ex: Neostigmine, physostigmine used for myasthenia gravis Side effects: increase GI motility, increase GI secretions, bradycardia and urinary urgency. Other side effect is cholinergic crisis but antidote is atropine. Use cautiously in clients with seizure disorders, hyperthyroidism, PUD and asthma, bradycardia and hypotension. Antiepileptic- use- control seizure Examples: Phenobarbital (causes drowsiness and confusion, toxicity) Dilantin CNS effects, nystagmus, gingival hyperplasia , skin rash, tetrogenic, dysrhythmias, coarse facial features) Valium- causes resp depression and amnesia. DON’T GIVE IF LIVER DISORDER! Ativan Tegretol (blood dyscrasis) Zarontin (only for absence seizures) Depakote (also known as valproic acid) causes pancreatitis and thrombocytopenia Neurontin (causes CNS effects like nystagmus) Trileptal Klonopin Lamictal Neuromuscular Blockading AgentsUse: promote muscle relaxation, promote spontaneous respirations in people on the vent, used to diagnose myasthenia gravis Tuborcurarune Succinylcholine (can lead to apnea, malignant hyperthermia, hyperkalemia) Pancuronium (Pavulon) General Side effects: hypotension and respiratory arrest Local Anesthetics:Lidocaine, Pontocaine, and Novocain. LOC does not occur…. blocks pain in certain area. Side effects are CNS excitement, hypotension, prolong L&D, spinal headache and urinary rention General Anesthetics: Produces LOC and loss of all sensation. Side effects: hypotension, resp and cardio depression, malignant hyperthermia, hepatoxicity, GI content aspiration Muscle Relaxants:Examples: Valium Dantrolene (dantrium): treats malignant hyperthermia, causes hepatic toxicity Flexeril Skleaxin- hepatic toxicity Baclofen (Lisoresal)- causes constipation and urinary retention! DON’T TAKE CNS DEPRESSANTS WHEN TAKING THESE MEDSAdrenergic Agonists:examples: epinephrine, dopamine, dobutamine, isoproterol Dopamine cause renal vessels to dilate, others lead to vasoconstriction, increased heart rate, increased myocardial contractility, bronchodilation, decreased nasal congestion (due to vasoconstriction) Side effetcs: increase heart rate, vasoconstriction, increased oxygen demand leading to angina, dysrhythmias Don't give to pt with tachydysrhymias, or v. fibrillation. Al Alpha Adrenergic Blocker:Examples: Minipress aka prazosin, Cardura aka doxazosin Used to treat hypertension, doxazosin may decrease symptoms of BPH Side effects hypotension take with food but avoid OTC NSAIDS b/c decreases antihypertensive effects Alpha Adrenergic Agonists:examples: catapress, tenex, aldomet Used for hypertension Side effects: dry mouth, sedation, rebound hypertension (so don't just stop taking the meds with talking to DR.) BETA BLOCKERS- END IN-LOLUsed to decrease HR, myocardial contractility and rate of conduction through AV node. Used for angina, hypertension, dysrhythmias, MIA and heart failure Causes bradycardia (if BP is less than 60 then hold meds) decreased Cardiac Output, AV Block, hypotension, Propranolol causes bronchoconstriction Theses drugs can masks the signs of hypoglycemia!!!!! ACE INHIBITORS END IN -PRILUsed for hypertension, heart failure MI and diabetic and nondiabetic neuropathy Causes orthostatic hypotension, cough, hyperkalemia, rash and angioedema. Also causes neutropenia.. think about it like this... ACE inhibitors causes Angioedemia, Cough and Excessive-potassium . ANGIOTENSION II RECEPTOR BLOCKER ENDS IN -SARTANUsed for hypertension, stroke, diabetic neuropathy (vasodilation). Causes angioedema (skin wheeling and swelling of tongue), fetal injury CALCIUM CHANNEL BLOCKERS END IN -PINEUsed vasodilation by blocking calcium channels in blood vessels. Used for angina pectoris and hypertension. Verapamil is also used for cardiac dysrhythmias Side effects: reflex tachycardia, peripheral edema, toxicity, hypotension, constipation HYPERTENSIVE CRISIS:Examples: sodium nitroprusside, hyperstat side effects: hypotension, cyanide poisoning and thiocyante poisoning sodium nitroprusside may have slightly brown color but discard if it is blue, red or green and don't mix other meds with sodium nitroprusside NITROGLYCERINE:Used for stable angina Side effects: headache, hypotension, reflex tachycardia, tolerance, If you give it with Viagra it could result in life threatening hypotension! also alcohol use and contribute to antihypertensive effects Sublingual: take at FIRST sign of chest pain, use prior to activity that will cause chest pain, place under tongue and allow to dissolve, store in cool dark place, and discard after 24 months. Transdermal: patch should not be cut, place on hairless area and rotate sites,. wash skin with soap and water and dry thoroughly before placing patch, remove patch at night so that you don't develop tolerance if pain is unrelieved in 5 mins then call 911, client can take up to two more doses at 5 minute intervals. DIGOXIN (cardiac glcosides)used to increase force of myocardial contraction but decrease heart rate so ventricles have more time to fill. Treats heart failure and atrial fibrillation. Side effects dysrhythmias, monitor potassium b/c hyperkalemia and lead to dig toxicity, monitor dig level to ensure that it is between .05-.08 SIDE EFFECTS_ GI: n/v, anorexia, abdominal pain, fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects Ace inhibitors increase risk of hyperkalemia which decreases effects of digoxin, quindine increase risk of dig toxicity if used concurrently. Notify DR if heart rate is less than 60 bpm in adults, 70bpm in children and 90bpm in infants before taking meds. treat bradycardia with atropine Read antidysrthmic drugs.... it is complex.... meds to control Cholesterol end in -STATINSide effects- heptoxicity, myopathy, peripheral neuropathy meds to control triglycerides include LOPID, Lofibra, tricorside effects: gall bladder stone, mypopathy, hepatoxicity take meds 30 mins before breakfast and dinner BILE ACID SEQUESTANTS- Questran and Colestid:Used to lower cholesterol, decreases LDL Side effetcs are constipation Don't give to someone with biliary disease Child Immunizations:Hep B- given at birth, 1-2 months, 6-18 months (don’t give Hep B to people with allergy to Baker’s Yeast)HIB and PCV- given at 2,4,6,12-15 monthsDTAP and IPV- given at 2,4,6, 18 months, and 4-6 years (don’t give DTAP if excessive crying)TDAP and Meningococcal (MCV4)- given 11-12 yearsMMR- given at 12-15 moths and 4-6 years (don’t give to pregnant or children w/ allergy to eggs, or to those with hx of thrombocytopenia)Tetnus booster- given everyb10 yearsFlu sot- annually after age 6 months (don’t give if allergy to eggs)Hep A- 12 monthsVaricella Vaccine given at 12-18 months (don’t give to pregnant, cancer pts, or those with allergy to neomycin or gelatin)Reminders:For infants and young children, administer in vastus lateralis Don’t give aspirin to treat fever b/c of Reyes Syndrome Adult Immunizations: Flu vaccine- given yearly after 50 (risk of Guillian Barre) PPV- give does at 65 and then every 6-8 years Give IM in deltoid muscle Immunoglobulin- IgG given for passive immunity – don’t have live virus within 3 months of IgG. Used for CLL, bone marrow suppression, HEP A & B exposure and Measles rubella and chicken pox exposure. Immunostimulants ex: Interfeon Alfa, Interluken 2 are used for hairy cell leukemia, CML, Malignant melanoma, and Aids-related Kaposi sarcoma. May cause flu-like symptoms, hypotension and bone marrow suppression also alopecia, cadiotoxicity and neurotoxicity Immunosuppressants include- Cyclosporines (monitor liver and kidneys, if given with antifungal then cyclosporine level will increase, mix w/ milk or organge juice), sandimmune, gengrat, neural, glucocorticoids (cause osteoporosis, fluid retention, hyperglycemia, adrenal insufficiency), cytotoxic-imuran (causes bone marrow suppression), prograf, methotrexate. Used to treat RA, SLE, myasthenia gravis, organ rejection (with organs rejection life long therapy is necessary) General Side effects of Immunosuppressants: tetrogenic, increase risk for infection Antihistamines: Benadryl, Phenergan (for N/V), Dramamine (for N/V), (given for mild allergy, anaphylaxis, motion sickness, insomnia) May cause sedation, anticholinergic effects, GI discomfort, acute toxicity (flushed face, high fever, tachycardia) Claritan, Zyrtec, Allegra, Clainex REMEMBER due to anticholinergic effects give cautiously to people with asthma, urinary retention, glaucoma, hypertension and prostate hypertrophy. (I don't really know why the ATI book lumps antimetics like Phenegran with antihistamines.... let me know if you have an idea.) Chemotherapy: Cytoxan, cisplatin, methotrexate, rheutrex, purinethol, taxol, onxol, Elspar, Megace, Lupron, tamoxifen, nolvadex etc…. Destroys both cancer and good cells. Side Effects- bone marrow suppression, gi discomfort, alopecia, mucosistis, reproductive toxicity, hyperuricemia Most of them can cause hypersensitivity reactions. Most cause renal toxicity. TB drugs cause heptatoxicity. So if you get a question with choices related to heptatoxicity or nephrotoxicity, just remember that most of them will be renal! Instruct patient to complete the prescribed course of therapy Penicillin or anything that ends in “cillin” (also Zosyn and Augemtin)First choice for meningitis and syphilis, prophylaxis for bacterial endocarditis Side effect: RENAL IMPAIRMENT, hyperkalemia Don’t mix penicillin and aminoglycosides in the same IV Take oral w/ a full glass of water before meals or two hours after Give ERYTHROMYCIN if there is a penicillin allergy Cephalosporins or anything beginning with “cef”, “ceph”Cross allergy to penicillin Bleeding tendencies thrombophlebitis Notify DR. if diarrhea Disulfurm reaction so don’t take with alcohol (most/all meds shouldn’t be taken with alcohol so lets just assume that NO MEDS SHOULD EVER BE TAKEN W/ ALCOHOL) Take oral “cephs” w/ food Vancomycin § Used for MRSA§ Administer slowly over 60 mins§ Causes RENAL IMPAIREMENT, thrombophlebitis, OTOTOXICITYTetracycline:Used for Acne Vulgaris and GI infections caused by H. pylori YELLOW BROWN TOOTH DISCOLORATION (don’t give to pregnant women), LIVER TOXICITY, PHOTOSENSITIVITY Don’t give w/ milk, calcium, iron, magnesium, laxatives or antacids—causes chelates Decreases the effect of Oral contraception’s (OC) Doxycycline and minocycline can be given to people with renal impairment Gentamicin- ototoxicity, nephrotoxicity, respiratory depression. Streptomycin causes neuro disorders like peripheral neuritis, tingling in hands and feetTMP-SMZUsed for UTI Take on empty stomach with glass of water Don’t take if folate deficiency or pregnant Causes blood dyscrasis, Crystaluria, Kernicturs, photosensitivity Macrodantin:Causes blood dyscrasis, peripheral neuropathy, GI discomfort, Don’t give to clients with renal impairment URINE WILL BE BROWN ANTI-TB drugs (Isoniazid, ethambutol, pyrazinamide§ Most are given for at least 6 months§ Causes peripheral neuropathy (if this occurs give B6), heptatoxicity,§ Take INH on empty stomach but take with meals if gastric problems occurRifadin/Rifampin: used to treat Leprosy, masks body fluids orange, causes heptatoxicity, decreases the efficacy of OCAntiviral- has the letter “vir” in it ex: acyclovir, ribavirn, also amantadineUsed for herpes, CMV, varicella zoster Causes nephrotoxicity, granulocytopenia and thrombocytopenia, reproductive toxicity (don’t give pregnant women), phlebitis Ciprofloxacin- causes Achilles tendon rupture- if this happens then refrain from exercise, causes supra infection. Aluminum, Magnesium, Milk and dairy products decrease the absorption. Antiprotozoals- flagyl- causes GI discomfort and metallic taste, DARK URINE (WAVE A FLAG TO LET THE CLIENT KNOW THAT HE WILL HAVE DARK URINE), numb extremities, seizuresAntifungal- many end in “zole”, also FUNGIZONE aka Amphotericin BCauses thromboplebitis, nephrotoxicity, hypokalemia, gynocomastia and irregular menstrual flow DISCARD IF YOU SEE PERCIPITATION Ketakonazole causes heptotoxicity Information on Myasthenia gravisnot contagious/not inheritedMuscle weakness disease in which the body's own immune system produces antibodies that BLOCKS the acetylcholine from attaching to the receptors in the muscles.Acetylcholine action : muscle contraction.Points:Autoimmune diseaseseen mostly in young adults, but can affect anyone of any age/race.Muscles esp. effected: eye muscles (double vision)swallowingchewingtalkingfacial expressionmuscles controlling the neck and breathing movements.Risk for complication: Respiratory failure (monitor)Cardinal s/s : muscle weakness with activity and goes away after rest.Intervention: plenty of rest - Well balanced diet, esp. high in potassium to ease fatigue.Potassium rich foods: orange , bananas Meds: cholinesterase inhibitors: Neostigmine and pyridostigmine.Action: improve nerve signals to muscles and increase muscle strengthImmunosuppressive drugs: Prednisone, cyclosporine and azathioprine Action: supress the production of abnormal antibodies. Monitor carefully: major side effects"What is the role of the thymus gland in MG? The thymus gland, found in the upper chest area beneath the breastbone, is a part of the body's normal immune system. In most adults with MG, the thymus gland is abnormal. Some people with MG develop thymomas or tumors on the thymus gland. Generally thymomas are benign, but they can become malignant (cancerous). The relationship between the thymus gland and MG is not yet fully understood."S/S myasthenia gravis:Drooping of one or both eyelids (ptosis) Blurred or double vision (diplopia) due to weakness of the muscles that control eye movements Unstable or waddling gait Weakness in arms, hands, fingers, legs, and neck Change in facial expression Difficulty in swallowing and shortness of breath Impaired speech (dysarthria) Shortness of breath Source: http://www.4woman.gov/faq/mgravis.htm Meds. for Infections: Everything noted down is from Genny's note on meds for infections. ThanksEmpty stomach:TMP-SMZ (UTI)Penicillin : before meals or two hours afterAnti Tb medsWith food:CephalosporinsLiver toxicity:tetracyclineINH (Anti Tb)Ketakonazole (Antifungal)No to pregnancy:TetracyclineTMP-SMZ (UTI)Anti viralDecrease the effect of OC (Oral contraception)TetracyclineRifadine/rifampin (anti TB med)