NURS 133 Gabapentin and Atropine

jasmine's version from 2016-05-17 02:44

Section 1

Question Answer
Gabapentin Anti-convulsant; Anti-epileptic; Analgesic adjuncts; Mood stabilizers; Used in adults to treat nerve pain, restless legs syndrome (RLS), treat seizures in adults and children who are at least 3 years of age; Partial seizures (adjunct treatment) (immediate release only); Post-herpetic neuralgia; Restless legs syndrome (Horizant only); Unlabeled use: Neuropathic pain; Prevention of migraine headache; Bipolar disorder; Anxiety; Diabetic peripheral neuropathy
Gabapentin actions Not known; May affect transport of amino acids across and stabilize neuronal membranes
Gabapentin therapeutic uses Decreased incidence of seizures; Decreased post-herpetic pain; Decreased leg restlessness
Elimination/Excretion of Gabapentin Eliminated mostly by renal excretion of unchanged drug
Adverse/Side Effects of Gabapentin Suicidal thoughts, confusion, depression, dizziness, drowsiness; Rhabdomyolysis; Ataxia; Multi-organ hypersensitivity reactions
Contraindications of Gabapentin Hypersensitivity
Drug/Food interactions of Gabapentin Antacids may decrease absorption of gabapentin; Increase risk of CNS depression with other CNS depressants, including alcohol, anti-histamines, opioids, and sedative/hypnotics; Morphine increase gabapentin levels and may increase risk of toxicity, dosage adjustments may be required; Kava-kava, valerian, or chamomile can increase CNS depression
Medication administration of Gabapentin PO
Nursing interventions of Gabapentin Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression; Seizures: Assess location, duration, and characteristics of seizures activity; Post-herpetic neuralgia and neuropathic pain: Assess location, characteristics, and intensity of pain periodically during therapy; Migraine prophylaxis: Monitor frequency and intensity of pain on pain scale; Restless leg syndrome: Assess frequency and intensity of restless leg syndrome prior to and periodically during therapy; Lab test considerations: May cause false-positive readings when testing for urinary protein with Ames N-Multistix SG dipstick test-use sulfosalicylic acid precipitation procedure; May cause leukopenia
Client education of Gabapentin Instruct patient to take medication as directed; Advise patient not to take gabapentin within 2 hours of an antacid; Caution patient to avoid driving or activities requiring alertness until response to medication is known; Seizure patients should not resume driving until physician gives clearance based on control of seizure disorder; Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking; or other unusual changes in behavior or mood occur; Advise female patient to notify health care professional if pregnancy is planned or suspected or is breast feeding; Advise patient to carry identification describing disease process and medication regimen at all times
Evaluation/Desired outcomes of Gabapentin Decreased frequency of or cessation of seizures; Decreased post-herpetic neuralgia pain; Decreased intensity of neuropathic pain; Decreased frequency of migraine headaches; Increased mood stability; Decreased effects of restless leg syndrome
Potential nursing diagnoses of Gabapentin Risk for injury (side effects); Chronic pain (indications); Ineffective coping (indications)

Section 2

Question Answer
Atropine Anti-arrhythmics; Anti-cholinergics; Anti-muscarinics; IM: Given pre-operatively to decrease oral and respiratory secretions; IV: Treatment of sinus bradycardia and heart block; Reversal of adverse muscarinic effects of anti-cholinesterase agents (neostigmine, physostigmine, or pyridostigmine); IM, IV: Treatment of anti-cholinesterase (organophosphate pesticide) poisoning; Inhaln: Treatment of exercise-induced bronchospasm
Atropine actions Inhibits the action of acetylcholine at post-ganglionic sites located in: Smooth muscle, secretory glands, CNS (anti-muscarinic activity); Low does decrease: Sweating, salivation, respiratory secretions; Intermediate doses result in: Mydriasis (pupillary dilation), Cycloplegia (loss of visual accommodation), increased heart rate; GI and GU tract mobility are decreased at larger doses
Atropine therapeutic uses Increased heart rate; Decreased GI and respiratory secretions; Reversal of muscarinic effects; May have a spasmolytic action on the biliary and genitourinary tracts
Elimination/Excretion of Atropine Mostly metabolized by the liver; 30-50 percent excreted unchanged by the kidneys
Adverse/Side Effects of Atropine Drowsiness; Blurred vision; Tachycardia; Dry mouth; Urinary hesitancy
Contraindications of Atropine Hypersensitivity; Angle-closure glaucoma; Acute hemorrhage; Tachycardia secondary to cardiac insufficiency or thyrotoxicosis; Obstructive disease of the GI tract
Drug/Food interactions of Atropine Increase anti-cholinergic effects with other anti-cholinergics, including anti-histamines, tricyclic anti-depressants, quinidine, and disopyramide; Anti-cholinergics may alter the absorption of other orally administered drugs by slowing motility of the GI tract; Antacids decrease absorption of anti-cholinergics; May increase GI mucosal lesions in patients taking oral potassium chloride tablets; may alter response to beta-blockers
Medication administration of Atropine IM; IV; Subcut; Inhaln
Nursing interventions of Atropine Asses vital signs and ECG tracings frequently during IV drug therapy; Monitor intake and output ratios in elderly or surgical patients due to atropine may cause urinary retention; Assess patients routinely for abdominal distention and auscultate for bowel sounds-if constipation becomes a problem, increasing fluids and adding bulk to the diet may help alleviate; If overdose occurs, physostigmine is the antidote
What is the antidote for Atropine overdose? Physostigmine
Client education of AtropineCaution patients to avoid driving or other activities requiring alertness until response to medication is known; Instruct patient that oral rinses, sugarless gum or candy, and frequent oral hygiene may help relieve dry mouth; Caution patients that atropine impairs heat regulation-strenuous activity in a hot environment may cause heat stroke; Pedi: Instruct parents or caregivers that medication may cause fever and to notify health care professional before administering to a febrile child; Geri: Inform male patients with benign prostate hyperplasia that atropine may cause urinary hesitancy and retention-changes in urinary stream should be reported to health care professional
Evaluation/Desired outcomes of Atropine Increase in heart rate; Dryness of mouth; Reversal of muscarinic effects
Potential nursing diagnoses of Atropine Decreased cardiac output (indications); Impaired oral mucous membrane (side effects); Constipation (side effects)