NUR 243 Exam 4 Practice Questions and Complete Solutions
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Course
NUR 243
Institution
NUR 243
Tolerance - Decreased response occurring during the course of prolonged drug use - a larger dose is required to produce the same response that could be produced with smaller amounts (prolonged use)
Tonic-clonic seizures - "grand-mal" - Neuronal spreads throughout both hemispheres - Major convulsio...
NUR 243 Exam 4 Practice Questions and
Complete Solutions
Tolerance ✅- Decreased response occurring during the course of prolonged drug use
- a larger dose is required to produce the same response that could be produced with
smaller amounts (prolonged use)
Tonic-clonic seizures ✅- "grand-mal"
- Neuronal spreads throughout both hemispheres
- Major convulsions (period of muscle rigidity(tonic phase) + synchronous muscle
jerks(clonic phase)
- Often cause urination, no defecation.
- Impairment of consciousness + followed by CNS depression ("postictal state")
- Seizure persists <90 seconds
Gamma-aminobutyric acid (GABA) ✅Neurotransmitter that reduces activity across the
synaptic cleft and thus inhibits a range of behaviors and emotions, especially
generalized anxiety.
Epilepsy ✅- group of chronic neurologic disorders → recurrent seizures; due to
excessive neuronal excitability
Gingival hyperplasia ✅- adverse effect of phenytoin
- overgrowth of gum tissue
Seizure ✅- Brief episode of abnormal electrical activity in nerve cells of the brain
- Hyperexcitability of Neurons called a Focus
- Result is alterations in:
*Consciousness
*Motor Activity
*Sensations
Benzodiazepines: therapeutic uses ✅- Anxiety
- Insomnia: decrease latency time to falling asleep, reduce awakenings, increase total
sleeping time
- Seizure disorders
- Muscle spasm
- Alcohol withdrawal
- Perioperative applications
*safer than general CNS depressants and low risk for abuse
,*oral - no effect on heart/blood vessels
*IV - produces profound hypotension and cardiac arrest
- respiratory system:
*weak respiratory depressant except when combined w/other CNS depressant
*Worsen hypoventilation + hypoxemia in COPD
*Exacerbate apneic episodes in OSA
- induces muscle relaxation
Benzodiazepines: MOA ✅- Potentiate actions of GABA (inhibitory neurotransmitter)
*Binds to GABA receptor-chloride channel complex
- Intensify effects of GABA; not a GABA agonist
*There is a limit to how much CNS depression benzodiazepines can produce --> safer
than barbituates
Benzodiazepines: pharmacokinetics ✅- High lipid soluble ; readily cross BBB
- Well absorbed PO
Benzodiazepines: drug interactions ✅- do not induce hepatic drug-metabolizing
enzymes --> does not accelerate metabolism of other drugs
- can be dangerous in combo w other CNS depressants --> resp depression, coma,
death
Benzodiazepines: nur implications ✅- Administer with food if gastric upset occurs
- Swallow sustained-release intact
- Do not increase dose / discontinue without consulting HCP
Benzodiazepines: acute toxicity ✅-PO: rarely cause serious toxicity
*drowsiness, lethargy, confusion
- IV: can cause severe toxicity
*profound hypotension, resp arrest, cardiac arrest
Benzodiazepines: acute toxicity treatment ✅- Treatment with flumazenil
*Competitive benzodiazepine receptor antagonist
*Reverses the sedative effects of benzodiazepines but may not reverse respiratory
depression
, *Approved for benzodiazepine overdose and for reversing the effects of
benzodiazepines after general anesthesia
**adverse effect: precipitation of seizures
Benzodiazepines: tolerance ✅- No tolerance develops to anxiolytic effects
- Low tolerance to hypnotic effects
- Significant tolerance to antiseizure effects
- Pt tolerant to barbiturates, alcohol, other CNS depressants show cross-tolerance to
benzodiazepines
Benzodiazepines: physical dependence and withdrawal ✅- incidence of substantial
dependence is low
- D/C after short term at therapeutic dose: anxiety, insomnia, sweating, tremors,
dizziness
- D/C after long term at high dose: panic, paranoia, delirium, hypertension, muscle
twitches, outright convulsions
- monitor pt for 3 weeks after drug D/C
Benzodiazepine-like drug: Zolpidem [Ambien] ✅- Sedative-hypnotic
- Most widely used hypnotic
- Short-term management of insomnia
- rapid onset
- extended release used for ppl who have difficulty maintaining sleep
- Long term use: No apparent tolerance or increase in adverse effects
Benzodiazepine-like drug: Zolpidem [Ambien]: action ✅- Binds to benzodiazepine
receptor site on GABA receptor-chloride channel complex
- Reduce sleep latency + awakenings
- Prolong sleep duration
Benzodiazepine-like drug: Zolpidem [Ambien]: adverse effects ✅- Daytime drowsiness
and dizziness
- Sleep driving, sleep related complex behaviors
- Small risk of anaphylaxis + angioedema
Benzodiazepine-like drug: Ramelteon: Melatonin Agonist ✅- Brand name: Rozerem
- Relatively new hypnotic
- Not a controlled substance
- Activation of melatonin receptors
- Approved for chronic insomnia: *Difficulty with sleep onset but not with sleep
maintenance
- Rapid onset (about 30 minutes) and short duration
Benzodiazepine-like drug: Ramelteon: Melatonin Agonist: adverse effects ✅- well
tolerated
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