Pharm Quiz 4

1. Degeneration of dopaminergic neurons in the substania nigra

2. Imbalance of dopamine and acetylcholine.

3. Cardinal S/S: Bradykinesia, tremor, rigidity, impaired balance (later in dx)

4. Masked face, involuntary tremors and pill rolling.

5. Who is at risk?

1. sleep problems, shuffling gait, masked face, stooped posture, depression, inability to smell certain foods, small handwriting, dizziness, constipation, urinary urgency, frequency, incontinence, sexual dysfunction.

1. lesson symptoms

2. maximize qol

3. move faster

4. decrease tremors

5. loosen joints/muscles

6. meds do not slow or stop disease progression

1. dopamine replacement

2. dopamine agonist

3. monoamine oxidase B inhibitors

4. catechol-o-methyltransferase (COMT) inhibitors

5. dopamine antagonist

6. Anticholinergics

1. Dopamine Replacement / Dopaminergic

2. MoA: levodopa crosses blood brain barrier and is converted into dopamine; carbidopa permits more levodopa to the brain

3. Goal of therapy: relieve tremor and rigidity

4. SE: nausea, lightheadness, orthostatic hypotension, hallucinations, discolored urine, disrupted sleep, urinary retention

5. Take with LOW protein foods

6. Contra: narrow-angle glaucoma

7. Monitor orthostatic hypotension

8. NC: on-off phenomena, dyskinesia "too much movement"

1. Dopamine Agonist

2. MoA: stimulates dopamine receptors

3. Goal of therapy: improve motor symptoms

4. SE: drowsiness with sudden sleep attacks, compulsive behaviors, pedal edema, lightheadness/orothostatic hypotension and dyskinesia

5. Less tendency for dyskinesia compared to other medications

6. Caution: >70, exhibiting compulsive behaviors.

1. monoamine oxidase B (MAO-B) Inhibitors

2. MoA: inhibits the enzyme that breaks down dopamine

3. SE: insomnia, xerostomia(dry mouth), lightheadness

4. Hypertensive crisis: Avoid foods high in tyramine, wine and cheese effect

5. Severe drug reactions with antidepressants (TCAs or SSRIs)

6. Monitor BP

7. Give with morning meal

1. Incurable dementia / marked cognitive dysfunction

2. Cause unknown

3. Three stages: mild, moderate and severe

1. Goal: lesson symptoms, perform ADLs for as long as possible

2. Medications target neurotransmitters acetylcholine or glutamate

3. Cholinesterase Inhibitors - donepezil (Aricept)

4. N-methyl D-aspartate (NMDA) antagonist- memantine (Namenda)

1. Cholinesterase inhibitor

2. MoA: increases the amount of acetylcholine in neuron receptors

3. Improves cognitive function

4. SE: GI upset, insomnia, dizziness, bradycardia, syncope, anorexia, weight loss

5. Take with food and at bedtime to decrease GI upset

1. Report loss of appetite, weight loss, significant n/v

2. monitor/supervise ambulation- high potential for dizziness. Assist to stand and walk.

3. Report temporary loss of consciousness (syncope)

4. Monitor weight at least weekly.

1. N-methyl D-aspartate (NMDA) receptor antagonist

2. used for moderate to severe Alzheimer's disease

3. MoA: regulates activity of glutamate

4. SE: dizziness, headache, constipation, confusion

5. Decrease symptoms to enable some to maintain ADL longer

6. Can be used in combination with cholinesterase inhibitors.

1. mood disorder causing persistent feelings of sadness and loss of interest

2. many possible causes: insufficient amount of brain neurotransmitters, inherited traits, hormones, environmental, traumatic or stressful event, abuse of alcohol or drugs, chronic illness

3. symptoms: sad, anxious, empty, sleeping too much or too little, decreased energy, fatigue, suicidal thoughts, weight changes, loss of interest/hopelessness, unable to concentrate, make decisions.

1. Reactive: sudden onset after an event, person knows why he/she is depressed

2. Major: loss of interest, inability to concentrate, complete tasks, excessive or difficulty sleeping and feelings of worthlessness.

3. Bipolar disorder: mood swings between depressive (dysphoric) and manic (euphoric)

1. norepinephrine

2. serotonin

3. dopamine

1. tricyclic antidepressants (tca)

2. selective serotonin reuptake inhibitors (ssri)

3. serotonin norepinephrine reuptake inhibitors (SNRI)

4. atypical

5. monoamine oxidase inhibitors (maoi)

1. black box warning: increased risk of suicide especially in children and adolescents

2. expect long term use

3. takes weeks to feels the effects

4. do not stop abruptly. taper when stopping

5. older adults require lower doses

6. sexual dysfunction

7. time of day important for sleep disturbances.

1. tricyclic antidepressants (TCA)

2. Blocks the reuptake of norepinephrine and serotonin in the brain

3. Effects 1-3 weeks

4. sedating, take at night

5. taper over 2 weeks if stopping

6. decreased dose for older adults

7. SE: dizziness, orthostatic hypotension, extrapyramidal syndrome, blurred vision, dry mouth, constipation, weight gain

1. Selective serotonin reuptake inhibitors (SSRI)

2. Block the reuptake of serotonin at the nerve terminal

3. fewer side effects than TCAs

4. Effects 3-4 weeks

5. SE: dry mouth, blurred vision, dizziness, hyperhidrosis, asthenia, insomnia

6. Sexual dysfunction

7. drug dose decreased for older adults

8. suicidal ideation

1. Serotonin Norepinephrine reuptake inhibitors (SNRI)

2. Inhibit reuptake of serotonin and norepinephrine

3. Interaction with St. Johns wort

4. Take with food in the morning

5. Don't take within 14 days of MAOIs: risk of serotonin syndrome

6. SE: n/v, anorexia, headache, hypertension, sexual dysfunction, bruxism, insomnia, confusion

1. Monoamine Oxidase Inhibitors (MAOIs)

2. inhibits MAO enzyme allowing neurotransmitters to rise

3. SE: insomnia, orthostatic hypotension, and anticholinergic effects

4. Hypertensive crisis: food and drug interactions: foods containing tyramine - must avoid, TCA anti antidepressants, vasoconstrictors, cold medicine with phenylephrine and pseudoephedrine, frequent bp monitoring.

1. second generation antidepressant

2. inhibits dopamine uptake

3. available in sustained release and extended release

4. pharmacologically like tcas

5. SE: n/v, weight loss, CNS effects, increased seizure risk, insomnia

6. NI: weekly weights, take with food to minimize nausea

7. Contraindications: hx of seizure activity, eating disorders, head trauma

1. observe for suicidal tendencies, mood changes, insomnia, apathy or lack of interest

2. monitor VS (bp) and weight

3. Full effectiveness may take weeks

4. discuss pregnancy planning with physician

5. take with food to minimize gi distress

6. alternative/complementary therapy may need to be discontinued

7. do not stop abruptly

8. Do not consume alcohol or any CNS depressant.

1. expulsion of gastric contents

2. bodies defense mechanism

3. must identify the underlying cause

4. conditions associated with n/v

5. nursing concerns: aspiration, dehydration, electrolyte imbalances

1. Vestibular center - motion, pregnancy, h1 and muscarinic receptor

2. Vomiting center: muscarinic h1

3. Chemoreceptor trigger (CTZ): drugs, toxins, receptors, dopamine ht3 (serotonin)

4. Cerebrum- processes sensory info: emotions, pain, repulsion at sight and smell

1. high risk (>= 90 freq of emsis)

2. moderate risk (30-90 freq of emesis)

3. low risk (10-30% freq of emesis)

4. minimal risk (<= 10 freq of emesis

1. weak teak

2. ginger

3. flat soda

4. crackers and dry toast

5. peppermint

6. aromas

1. Bismuth subsalicylate (pepto-bismol)

2. OTC

3. Upset stomach due to overindulgence in food and drink

4. Warning: children with flu symptoms

1. Antihistamines

2. Anticholinergics

3. Dopamine antagonists / pro kinetics

4. Phenothiazine Antiemetics

5. Butyrophenones

6. Benzodiazepines

4. Serotonin-receptor antagonists

8. Glucocorticoids (corticosteroids)

9. Cannabinoids

1. Antihistamine

2. moa: blocks h1 receptor

3. SE: drowsiness and anticholinergic effects (dry mouth, urinary retention, mydriasis)

4. Nursing: take 30 mins before travel, safety due to drowsiness, mydriasis (dil of pupil)

1. Anticholinergic

2. Moa: dry GI secretions and reduces smooth muscle spasms

3. SE: drowsiness, tachycardia, mydriasis, dry mouth

4. Contra: glaucoma

5. Nursing: safety due to drowsiness/mydrasis, remove if symptoms are not tolerable

1. Serotonin-receptor antagonist

2. Moa: blocks serotonin 5 ht3 receptors in the CTZ

3. SE: headaches, constipation/diarrhea, ekg changes

4. SSRIs/SNRIs risk of serotonin syndrome

5. Nursing: ODT: orally disintegrating tablet, monitor for headaches, can cause serotonin syndrome

1. Dopamine antagonist / prokinetic

2. stimulates motility, increases peristalsis

3. SE: dystonia, fatigue, restlessness, visual disturbances and headache

4. Contra: tardive dyskinesia, GI obstruction, hemorrhage or perforation.

5. Black box warning: dystonia (involuntary muscle contractions)

1. Antihistamine

2. blocks h1 receptor

3. SE: drowsiness/sedation, xerostomia, tachycardia, extrapyramidal symptoms

4. Caution: those with glaucoma

5. Nursing: promethazine IV: risk of severe tissue injury

1. moa: decrease stimulation of the ctz zone by blocking dopamine

2. SE: drowsiness, amenorrhea, hypotension, motor restlessness, dystonia

3. Black box warning:

1. monitor for signs of dehydration, VS, intake/output, and bowel sounds

2. avoid in patients with glaucoma

3. oral hygiene

4. no alcohol

5. pregnancy: some meds avoid in first trimester: speak to physician

6. avoid driving due to drowsiness

1. infrequent bowel movements

2. causes:

3. symptoms: bloating, feeling sluggish, abd pain

1. promote soft stool

2. stimulate peristalsis

3. abuse from chronic use common in older adults

4. cause of constipation

5. prevent laxative dependence

1. Psyllium (metamucil) and methylcellulose (citrucel)

2. absorb water, increase fecal bulk and increase peristalsis

3. No laxative dependence

4. Not systemically absorbed

5. Nursing: drink 8 oz of fluid w/ fiber, monitor i/o, bowel sounds, don't swallow dry form or inhale, mix 8-10oz water and drink immediately

1. increase absorption of water in the stool

2. commonly prescribed post op

3. increase fluids

4. soft stool after several days

5. hold for diarrhea

1. Stimulant laxatives

2. increase peristalsis by irritating sensory nerve endings

3. quicker result

4. se: nausea, abdominal cramping, fluid and electrolyte imbalance

5. nursing: increasing fluids, avoid overuse, advise exercise, high fiber foods.

1. loose and watery stool

2. acute and chronic

3. causes

4. symptoms

5. se:

1. opioids

2. binds to gut wall opioid receptors to inhibit peristalsis

3. Lomotil: CNS depression

4. Contra: bacteria-induced diarrhea (c. diff)

5. Caution: children

1. Bismuth subsalicylate (Pepto-Bismol): diarrhea

2. Activated charcoal: poisoning and diarrhea, by mouth or ng tube, efficacy depend on how quickly its given

1. assess food and drug intake, recent travel

2. Assess vital signs and bowel sounds

3. Note the frequency of bowel movements

4. monitor fluid and electrolyte status

5. drink clear liquids, avoid fried foods and milk

6. monitor for CNS depression

1. stomach contents move up into the esophagus

2. Can damage the esophagus, pharynx, or respiratory tract

3. Symptoms: chest pain/heart burn, dysphagia

4. Causes: obesity and pregnancy, food high in fat, salt, and spice. Caffeine and alcohol, smoking.

1. open sore in the stomach or duodenum

2. symptoms: abdominal pain, burning or gnawing, n/v, burping, loss of appetite, weight loss, full after small amounts, black tarry stools

3. Causes: helicobacter pylori bacteria (h. pylori), NSAIDs

1. Gram-negative bacillus

2. can lead to peptic ulcer

3. diagnostics - urea breath test

4. multiple antibacterial agents

5. combination therapy (triple therapy): metronidazole, omeprazole, clarithromycin

1. Histamine h2 antagonists

2. proton pump inhibitors (ppi)

3. mucosal protectants

4. antacids

5. prostaglandin e analog

6. antibiotics

1. Histamine H2 antagonists

2. MoA: block h2 receptors parietal cells of stomach

3. TE: decreases stomach acid and increases pH of stomach

4. SE: impotence, gynecomastia, reduced lbidio, headache, dizziness

5. Drug interactions: increase warfarin levels, increase phenytoin (for seizures), overstimulates the heart, lungs and cns when taking with theopylline.

1. OTC taken 30 minutes before eating or drinking foods that cause heart burn.

2. See if physician if taking OTC longer than 2 weeks

3. No antacids within 1 hr of administration

4. Avoid food and drink that irritate the GI tract

5. smoking cessation

6. eat foods rich in b12

7. monitor liver enzymes

1. proton pump inhibitors (ppi)

2. Moa: inhibits the atpase enzyme system

3. SE: bone loss (long-term use), low magnesium

4. Drug interactions: increases levels of warfarin, phenytoin and diazepam (valium)

1. Take it before the first meal of the day

2. food reduces absorption

3. consume adequate amounts of calcium and vit D

4. Long-term use recommends physician visits for bone density testing

5. Monitor magnesium levels and liver enzymes

6. Short-term treatment (4-8 weeks)

1. mucosal protectant

2. indication: active duodenal ulcers

3. moa: covers the ulcer site and protects it from stomach acid

4. se: constipation

5. drug interactions: decrease levels of warfarin, phenytoin, theophylline, digoxin, tetracycline (antibiotic) and diazepam (valium), antaacids reduce effects

1. Pain assessment

2. Take on empty stomach and not with other medication

3. Avoid gastric irritating foods and liquids

4. Will alter the absorption of some medications

5. Take 2 hours after potential medications that interact

6. Constipation prevention: increase fluids, fiber, increase activity

1. Antacids

2. indication: relieves heartburn, acid indigestion, peptic ulcers and GERD

3. MoA: neutralize gastric acid

4. SE: constipation (aluminum and calcium), diarrhea (magnesium)

1. interferes with drug absorption

2. take 1-2 hours before or after other medications

3. take with full glass of water

4. teach to monitor for signs of gi bleed, report abdominal pain and severe diarrhea.

5. chew thoroughly, don't swallow

6. Aluminum hydroxide may speckle stools white

7. Don't take with milk or vitamin D.

antibacterial / antimicrobial - substances that inhibit bacterial growth

2. sensitive - certain bacteria is sensitive to antibiotic

3. resistant - bacteria resistant to antibiotic

4. nosocomial infection- acquired in a health care facility

5. narrow-spectrum - targets certain bacteria

6. broad-spectrum - targets lots of bacteria

7. prophylaxis - prevention of infection

8. bacteriostatic - stops growth of bacteria

9. bactericidal - kills bacteria

Negative - 3 layer cell wall, harder to kill

1. consider: the host, where is the infection, what are the symptoms, what are the likely bacteria, what drugs are the likely bacteria killed by, what are the adverse effects

1. culture and sensitivity (c and s) - cultures treated with different antibiotics to see what will be effective.

2. peak- lab draws, in between peak and trough is TE range. peak 2-3 hrs after generally, OD past peak

3. trough- low point, not effective below trough, draw 10-15 minutes before

1. allergy or hypersensitivity

2. diarrhea

3. superinfection: clostridium difficile diarrhea, stomatitis (mouth ulcers), vaginitis (discharge, itching), hairy black tongue

4. Organ toxicity: kidney and liver function

1. no alcohol

2. allergy

3. alternate form of birth control

4. concurrent medication

5. culture prior to dosing

6. take full course

7. monitor kidney and liver function

1. inhibit of cell wall synthesis

2. alternation of membrane permeability

3. inhibition of protein synthesis

4. inhibition of synthesis of bacterial rna and dna

5. interference with cellular metabolism

6. bactericidal or bacteriostatic

1. most end in -cillin

2. weaken and destroy bacterial cell wall

3. Broad spectrum antibiotic

4. PO, IM, IV, liquid, chewable forms

5. protype: amoxicillin (amoxil), amoxcillin/clavulanic (augmentin)

6. SE: n/v, diarrhea, superinfections

7. allergies to cillins have been fatal

8. contra: hypersensitivity

9. caution: renal impairment

1. decrease effectiveness of oral contraceptives

2. do not give with an aminoglycoside (reduces effectivness)

3. increase fluids

4. allergy: wear a medic alert bracelet

5. take with food

6. screen for allergy, have been fatal

1. Starts with ceph or cef-

2. inhibition of cell wall synthesis

3. broad spectrum / five generations, cover more bacteria with each generation

4. PO, IV, IM

5. Prototype: cephalexin (keflex), first generation, skin infections, staph and strep

6. SE: nausea, diarrhea, superinfection

7. Caution: renal failure, cross sensitivity pcn allergy

1. Assess for allergy to PCN

2. increase fluids

3. take with food

4. monitor liver and kidney function

5. assess for bleeding (cefotan)

6. give iv over 30 mins

1. Weakens and destroys the cell wall

2. PO and IV

3. treats MRSA and C diff (PO version)

4. monitor serum levels with IV / trough levels

5. SE: ototoxicity, nephrotoxicity, hypotension

6. Rapid IV infusion: red man syndrome

7. Monitor for infusion related reactions

8. Caution with IV monitor for infiltration

9. Vancomycin resistant enterococci infections (VREF)

1. contains -cyc- in the name

2. Inhibits protein synthesis

3. Broad spectrum

4. PO, IV, IM, topical and liquid

5. Prototype: doxycycline

6. SE: n/v, diarrhea, abdominal pain, hepatoxicity, photosensitivity, nephrotoxicity, superinfection

7. Contra: infants, children, pregnant women, discoloration of teeth can be permanent for children < 8 and developing fetus, suppression of long-bone growth in premature infants, teratogenic

1. Store tetracyclines away from light and extreme heat

2. Advise use of sun block and protective clothing while taking

3. Take 1 hr before or 2 hr after meals

4. can be taking with nondairy food if GI upset occurs

5. do not take with Ca containing foods, antacids, iron or zinc

6. use additional method of contraception

7. shake solution before administration

8. avoid in children under 8 due to bone and teeth development.

1. Ends in -mycin

2. Inhibit protein synthesis

3. Broad spectrum

4. PO, IV< OT ointment, IM is too painful

5. Prototype: erythromycin and azithromycin (Zithromax)

6. SE: n/v, diarrhea, abdominal pain, dysrhythmias (rare), ototoxicity, hepatotoxicity, superinfections

7. Contraindications: cardiac abnormalities

1. Monitor liver function for hepatotoxicity long term use

2. GI disturbances can take with food

3. Screen for cardiac abnormalities/prolonged QT interval

4. S/s of ototoxicity

5. take 1 hr before or 2 hrs after meal with 8 oz of water

6. Increase levels of: monitor pt/inr for pts on warfarin, digoxin, theophylline

1. Inhibit protein synthesis

2. Narrow spectrum (gram +)

3. IM, IV, IT, OT, nebulizer and topical

4. Prototype: gentamicin

5. SE: black box warning ototoxicity and nephrotoxicity

6. Contra: pregnancy (teratogenic)

7. Caution: previous hearing loss, presence of tinnitus, vertigo, renal disorders, dehydration

1. Monitor peak and trough levels

2. Monitor i/o

3. Monitor labs for renal function

4. Patient teaching: report signs of ototoxicity, report signs of decreased urine output

1. Ends in -floxacin

2. Inhibit synthesis of bacterial DNA

3. Broad spectrum

4. PO, IV

5. Prototype: ciprofloxacin (cipro) and levofloxacin (levaquin)

6. Black box warning: tendonitis, tendon rupture, peripheral neuropathy, cns effects

7. SE: cns symptoms, n/v, diarrhea, photosensitivity

8. Contraindications: under 18

1. decrease caffeine use

2. report tendon pain

3. sun exposure

4. antacids, iron, dairy and sucralfate 2 hours after or 6 hours before

5. Drug interactions: increase warfarin levels, increased hypoglycemia with antidiabetic medication.

1. Bacteriostatic: inhibits bacteral synthesis of folic acid

2. Broad spectrum

3. PO, OT, topical, liquid

4. Prototype: Trimethoprim-sulfamethoxazole (bactrim, septra)

5. SE: n/v, pancytopenia, crystalluria, photosensitivity, exfoliative dermatitis, anorexia, stevens-johnson syndrome, superinfections

6. contraindication: infants, pregnancy or breastfeeding.

1. Interactions: warfarin, oral hypoglycemics, ace inhibitors, spironolactone and digoxin

2. Increase fluids 1200 mL daily

3. Measure I/O

4. Take one hour before or 2 hrs after with a full glass of water

5. With food for nausea

6. Pancytopenia: obtain baseline CBC, report s/s

1. Assess for hx of allergy

2. Obtain Culture and Sensitivity (CS) before start of anti biotics

3. monitor for s/s of superinfections

4. teach patient to take entire course of antibiotics

1. monitor superinfections

2. evaluate renal/liver functions

3. diarrhea-take yogurt

4. inform provider prior to taking other medications

5. cultures prior to initial dose

6. alcohol is out. ask about allergy

7. take full course

8. evaluate cultures

1. causes - frequent antibiotic use, transfer of genetic instruction

2. types- mrsa, vref

1. Nystatin (myostatin) - suspension, cream, ointment, powder; candida (oral or vaginal), swish and spit or swish and swallow

2. Fluconazole (diflucan): po or iv, candidasis, oral esophageal, systemic, vaginal

3. monitor liver enzymes

4. se: nausea, vomiting, darrhea

1. wake you up

2. drug categories: amphetamines- dextroamphetamine/amphetamine (adderall); methyphenidate (ritalin); non-amphetamines-modafinil (provigil)

1. adhd/hyperactivity in children

2. narcolepsy

3. reversal of respiratory distress after anesthesia

4. increase mental alertness

5. conduct disorders

6. migraines

7. weight loss, increase metabolic rate

1. common neurodevelopment disorder diagnosed in childhood and lasts into adulthood

2. can't concentrate for extending periods of time

3. difficulty controlling impulsive behaviors

4. overly active

5. treatment: combination behavior thearpy and meds

1. stimulate release of norepinephrine and dopamine

2. te: euphoria, increased alertness, decreased fatigue, and prolonged wakefulness, decreases brains percetion of hunger, VS increase

3. schedule 2: high potential for abuse, tolerance and dependance

4. black box warning for abuse and dependence

1. se: cns inc, cardiovascular, gi (decrease appetite, dry mouth), toxicity, withdrawal if stopped abruptly

2. contras: cardiovascular disease, htn, history of drug abuse, maoi within 14 days, glaucoma

1. administer on regular schedule, dose to allow for sleep

2. monitor weight (height and weight for children)

3. take before meals

4. avoid other stimulants (caffeine)

5. do not stop abruptly, taper dose

6. avoid alcohol consumption

7. educate on potentials for abuse

8. monitor VS and mental status

9. advise families to seek behavioral counseling for children

1. amphetamine

2. indication: adhd, narcolepsy

3. IR, SR

4. Do not crush or chew

1. methylphenidate

2. indication: adhd and narcolepsy

3. sr, transdermal patch

4. capsules may be opened and sprinkled on food (apple sauce)

5. take 30-45 mins before meal

6. contra: motor tics, tourette's syndrome

1. drug cats of cns depressants: barbiturates, benzodiazepines

2. enhance the inhibitory effects of neurotransmitter GABA

1. te use is dose dependent: sedative /hypnotic

2. po, im, iv

3. long acting (6-12 hrs): phenobarbital, control seizures

4. short acting (2-4 hrs): secobarbital (seconal), procedural sedation, sleep induction

5. se: hang over (long acting), respiratory depression, cns depression

6. NC: monitor vs, resuscitation equipment on hand

1. medical emergency

2. S/s: respiratory depression, pinpoint pupils, coma, hypotension, hypothermia

3. treatment: gastric lavage, hemodialysis, fluid replacement, maintain body heat, maintain heat

4. NO SPECIFIC ANTIDOTE

1. TE: anxiety panic attacks, insomnia, seizures, conscious sedation, alchohol withdrawl, pre op relief

2. end in -lam and -pam

3. diazepam (valium), alprazolam( xanax), midazolam (versed), lorazepam (ativan)

4. commonly prescribed

5. se: dizziness, impaired recall of events, sedation, paradoxical confusion, and anxiety hypotension, bradycardia, respiratory depression

1. contra: children, pregnancy, breast feeding, renal or hepatic dysfunction, mental health disorders, si, respiratory disorder or neuromuscular disorders

2. benzodiazepines are teratogenic

3. do not use concurrently with alcohol and opioids

4. overdose: over sedation, slurred speech, impaired mental status, diminished stability/reflexes, respiratory depression, hypotension, bradycardia.

5. Antidote: flumazenil (romazicon) IV (benzodiazepine anatagonist)

1. short term use to prevent dependence and tolerance

2. lower dose for older adults

3. monitor VS

4. avoid alcohol

5. do not drive

6. change positions slowly to prevent falls

7. don't stop abruptly

8. store in safe a secure area

1. Non-benzodiazepine

2. te: anxiety and sleep

3. se: hangover side effects, gi upset, headache dizziness, paradoxical effects (insomnia, anxiety restlessness), abnormal thinking and behaviors

4. less sedation and no interaction with other CNS agents

5. no risk for dependence or abuse

6. contra: hypersensitivity, kidney or liver dysfunction, caution in elderly

7. nursing interventions, fall precautions, caution with driving, urinate before sleep, caution in older adults, take only immediately before bed

1. general anesthetics: depress cns, loss of pain sensation, loss of consciousness, barbiturates, benzodiazepines, opioids

2. local: blocks pain at site, small area,, sutures dental nerve blocks, epidural spinal, prevents conduction of nerve impulse, lidocaine

1. topical: cream, relieves pain, itching, sore throat, sunburns

2. infiltration: anesthetic injected directly into tissue

3. field block

4. nerve block: epidural