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statistics for nursing a practical approach
Fundamentals Of Pharmacology : An Applied Approach For Nursing And Health 2nd Edition Shane Hunt - Solutions
Michelle Duponte develops stomatitis during phenytoin treatment. What action would you give for this condition? Provide rationales for your answer. (See Table 11.14 in Chapter 11 for assistance.)
Michelle Duponte, a 25-year-old patient, and her partner have decided they want to start a family.Michelle has been on phenytoin since her early teens for a seizure disorder. She would like to discontinue the phenytoin before getting pregnant. What points would need to be discussed with Ms Duponte
In hospital, one of the main ways of determining the effectiveness of antiseizure drug therapy is to document the incidence of and describe the patient’s seizures on a seizure chart. What information would be required on such a chart?
Compare and contrast the central spasmolytic actions of baclofen, diazepam and orphenadrine.
Outline the three major modes of action of spasmolytic drugs.
State four common adverse reactions associated with antiseizure drugs.
Describe the mechanisms of action of the following drugs/drug groups:(a) hydantoins;(b) carbamazepine;(c) benzodiazepines;(d) valproic acid;(e) gabapentin;(f ) oxcarbazepine.
For the following types of seizure, outline their major characteristics and classify them as either partial or generalised:(a) tonic–clonic;(b) psychomotor;(c) absence;(d) myoclonic.
Discuss why many patients cease therapy with the anticholinesterases used in Alzheimer’s disease.
Why are immunomodulating drugs useful in multiple sclerosis?
Discuss the role of the immune system in the aetiology of multiple sclerosis.
What factors are taken into account when treating multiple sclerosis with immunomodulating agents?
Describe the adverse effects that may lead to the cessation of therapy with the anticholinesterases used in Alzheimer’s disease.
Provide a rationale for the advice to take levodopa with food.
Mary Jones has been on a combination of levodopa and benserazide for Parkinson’s disease over the past 6 months. What evaluation would you make to determine whether there is any improvement in Mrs Jones’ condition?
Mary Jackson, a 75-year-old, has recently been diagnosed with Parkinson’s disease. She is taking levodopa and carbidopa for her condition. What patient education would you provide Ms Jackson about her medications?
Bromocriptine is a highly protein-bound drug (95 per cent protein-bound) and undergoes extensive liver metabolism. Would the dose be increased or decreased or remain the same in a patient with liver disease compared with a patient without liver disease? Why?
A 70-year-old patient with Parkinson’s disease is taking levodopa. Why would you advise the patient to avoid over-the-counter cough and cold preparations containing sympathomimetic decongestants?
Why, in the treatment and/or prevention of nausea and vomiting associated with apomorphine treatment of Parkinson’s disease, are the phenothiazines and antiemetics such as metoclopramide contraindicated?
Why, unlike with some monoamine oxidase inhibitor (MAOI) drugs, are dietary restrictions not necessary when using selegiline?
Would selegiline be useful in the treatment of depression?
Differentiate between hypokinesia, bradykinesia, akinesia and dyskinesia.
Explain the function of the decarboxylase inhibitor that is usually included with levodopa preparations.
Why is domperidone the preferred antiemetic in controlling the nausea and vomiting sometimes caused by antiparkinsonian drugs?
As significant therapeutic benefits of antidepressant therapy are not apparent for some weeks, compliance with treatment may be a problem. Outline some approaches that could be used to promote compliance with drug therapy.
Why would you advise a patient not to consume alcohol while on antidepressant therapy?
Peta McMuster is a 20-year-old woman with migraine who has sought treatment. She has been taking sumatriptan as a nasal spray to improve her condition. She recently became quite depressed and required treatment. Her doctor started her on therapy with the selective serotonin reuptake inhibitor
Your patient is taking tranylcypromine. What would you advise the patient about foods?
Theo Durr is a 35-year-old with rapid-cycling manic-depressive illness. He has not responded well to lithium therapy and is now receiving treatment with sodium valproate. What adverse effects should be monitored for during this therapy?
Mary Rogers, a 65-year-old patient, has manic depression, which is treated with lithium. After experiencing severe pain in her back, she decides to take some aspirin in an attempt to alleviate the pain. What is the problem with this combination?
Mark Dasmussen, a 50-year-old man, is newly diagnosed with depression. He complains of difficulty sleeping at night. What type of antidepressant would be suitable for Mr Dasmussen? Provide a rationale for your answer.
Why should the urinary output and neurological signs be monitored closely in a patient receiving lithium?
Which drugs/drug groups may form a part of the therapy in the following conditions?(a) obsessive–compulsive disorder;(b) mania;(c) severe depression;
Compare and contrast the general characteristics of the following drug groups:(a) the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs);(b) the non-selective monoamine oxidase inhibitors (MAOIs) and the reversible inhibitors of monoamine oxidase (RIMAs);(c)
State the mechanism of action of each of the following drug groups:(a) tricyclic antidepressants;(b) lithium carbonate;(c) non-selective monoamine oxidase inhibitors;(d) selective serotonin reuptake inhibitors;(e) noradrenaline–serotonin reuptake inhibitors.
State the proposed synaptic aberrations underlying the following conditions:(a) depression;(b) mania.
Define the following affective disorders:(a) reactive depression;(b) a panic disorder;(c) mania;(d) obsessive–compulsive behaviour;(e) bipolar affective disorder.
Benzodiazepines are highly protein-bound drugs. Would the drug dosage for patients with liver or renal disease be increased, decreased or remain unchanged? Why?
What non-drug measures would you recommend for Natalie Milakoviska, a 60-year-old widow whose husband has died recently and who has been experiencing difficulty getting to sleep?
Explain the benefit of using temazepam over nitrazepam to assist with sleep.
Explain why clonazepam and diazepam are useful in epilepsy.
Why should hypnotics be used for only a limited period of time to assist with sleep?
Why are anxiolytics useful in the treatment of individuals with alcohol problems?
What is a problem with abolishing REM sleep?
Differentiate between rapid-eye-movement (REM) and non-REM sleep.
What are the major problems associated with the use of paraldehyde?
Why has triazolam been withdrawn from clinical use in some countries?
What are the advantages of benzodiazepines over barbiturates?
Why are short-acting benzodiazepines more of a problem with addiction than long-acting benzodiazepines?
Differentiate between an anxiolytic and a hypnotic.
Cindy Nash is taking antipsychotic therapy and enjoys spending time in the sun. What instructions would you provide for Ms Nash when she goes outdoors?
A patient complains to you about severe tremor and rigidity following ingestion of fluphenazine tablets. What alternative medication is less likely to elicit these symptoms?
Barbara Lowe, who is newly diagnosed with schizophrenia, asks you about the possibility of taking alcohol with her antipsychotic medication. What would you say to Ms Lowe? Why?
During his visit to the psychiatric clinic, John Brown indicated his frustration in forgetting to take his oral promazine medication. What alternative formulation can you offer Mr Brown?
Joe Smith, a 35-year-old newly diagnosed schizophrenic, has been put on chlorpromazine to treat his condition. As his psychiatric nurse, what patient education would you give Mr Smith?
What conditions, other than antipsychotic drug use, can cause opisthotonos?
Promazine can cause an oculogyric crisis. Explain.
The drug chlorpromazine can cause extrapyramidal symptoms. What would one use to correct these symptoms? Why?
Flupenthixol may be administered intramuscularly to patients with schizophrenia. Why?
Explain the galactorrhoea that can occur during droperidol therapy.
Explain why amantadine would not be considered in the treatment of thiopropazate-induced parkinsonism.
Identify the receptor subtypes associated with the following transmitters:(a) dopamine;(b) glutamate;(c) GABA.
State which neurotransmitter(s) is/are involved in the following conditions:(a) parkinsonism;(b) depression;(c) aberrant behaviour;(d) stroke.
Which brain functions are thought to be associated with the following neurotransmitters?(a) GABA;(b) dopamine;(c) noradrenaline;(d) serotonin;(e) glutamate.
Which neurotransmitter(s) is/are involved in the control of the following functions?(a) mood;(b) behaviour;(c) skeletal muscle movement;(d) arousal;(e) emesis.
Identify the brain regions that participate in the control of the following functions:(a) consciousness;(b) motor control.
State the function(s) of the following brain regions:(a) thalamus;(b) cerebellum;(c) cerebrum;(d) medulla.
Outline the rationale for the development of drugs that affect the responses to the endothelins.
Outline the rationale for the development of drugs that affect nitric oxide levels.
For each of the following diseases, indicate whether nitric oxide and/or the endothelins have a role to play:(a) hypertension;(b) chronic inflammation;(c) diabetes mellitus;(d) renal failure.
For each of the following processes, indicate whether nitric oxide and/or the endothelins have a role and briefly outline that role:(a) inflammation;(b) airway responsiveness;(c) vascular responsiveness;(d) embryonic tissue development;(e) neurotransmission.
Explain how metoclopramide assists in the treatment of an acute migraine attack.
With reference to its adverse effects, explain why methysergide is not commonly prescribed for migraine prophylaxis.
What education can you offer a patient who wants to decrease the frequency of migraine attacks without resorting to drug therapy?
Explain how amitriptyline assists in preventing a migraine attack.
Mohamed Allaraz, a 65-year-old patient with angina, also suffers from severe migraine attacks.Why is sumatriptan an unsuitable form of treatment for his migraine condition?
The oral dose for sumatriptan is 100 mg and yet the subcutaneous dose is only 6 mg. Why?
Why should ‘drug holidays’ be given during methysergide therapy?
What two functions may the addition of caffeine serve in antimigraine preparations?
What is an advantage of rectal administration of antimigraine preparations?
Why is cyclizine, an antihistamine, included in some antimigraine preparations?
A 35-year-old mother with severe sinusitis often experiences difficulty sleeping at night because of her condition. What antihistamine preparation would you recommend for her to take at night?
Joe Guthrey, a 40-year-old lorry driver, suffers from severe allergic rhinitis. What antihistamine preparation would you recommend for him?
Cristina Vicario, a 70-year-old widow, has been prescribed doxylamine for insomnia and diazepam for anxiety following the death of her husband. What is the problem involved with this combination of drugs?
Explain why the following conditions cannot be treated with antihistamines:(a) common cold;(b) skin allergies and pruritus.
Alfred Adams is taking an antihistamine preparation for allergy-induced sinusitis. What patient education would you offer Mr Adams?
What are some other serious consequences of antihistamine use?
Antihistamines can lead to a rare condition known as tardive dyskinesia. Why?
Name as many indications for antihistamines as you can. (There are at least ten.)
Why are antihistamine nasal sprays of little use in nasal stuffiness due to the common cold?
State the limitations of peptides as drugs.
State four examples of peptide mediators and indicate their physiological roles.
Define the term ‘chemical modulation’ and provide an example.
Compare and contrast the characteristics of neurocrine, endocrine, paracrine and autocrine mediators.
As the theatre nurse, you are responsible for Christianne Van Dyke’s care during her rhinoplasty procedure. What observations would lead you to suspect that insufficient neostigmine was used to reverse the effects of atracurium, the non-depolarising neuromuscular blocking agent given for muscle
Boris Lebia is receiving bethanechol for urinary retention. He develops severe diarrhoea a couple of days after commencement of administration. With reference to bethanechol’s mechanism of action, explain how diarrhoea occurs.
What is the advantage of administering ipratropium inhalation for asthma, as opposed to using it systemically?
Soo Wong, a 65-year-old smoker, has been ordered nicotine patches as part of her quit-smoking programme. As Ms Wong’s clinical health educator, what would you tell her about the possible adverse effects of nicotine patches?
Ralph Salaman, who is about to undergo surgery, is given suxamethonium as part of the anaesthetic course of treatment. You are the nurse working in the operating theatre; what are the adverse effects of suxamethonium of which you should be aware?
Why is a depolarising agent usually chosen for administration before a non-depolarising agent?
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