Editing Pharmacology – RN Flashcards (section)

== Neurologic, Psychiatric, and Analgesic ==

;Distinguish serotonin syndrome from neuroleptic malignant syndrome.
:Serotonin syndrome has rapid onset within hours, with hyperreflexia, clonus, tremor, agitation, diaphoresis, and hyperthermia after serotonergic drug exposure. Neuroleptic malignant syndrome develops over days after dopamine antagonist exposure, with lead-pipe rigidity, hyporeflexia, high fever, altered mental status, autonomic instability, and elevated creatine kinase.

;Therapeutic lithium range and early toxicity findings?
:0.6 to 1.2 mEq/L, with toxicity above 1.5 mEq/L. Early findings are nausea, vomiting, diarrhea, fine tremor, and thirst; later findings are coarse tremor, ataxia, confusion, and seizures. Dehydration, sodium restriction, thiazides, NSAIDs, and ACE inhibitors all raise the level.

;Therapeutic phenytoin range and administration cautions?
:10 to 20 mcg/mL. Give intravenous phenytoin in normal saline only, never dextrose, and infuse slowly with cardiac monitoring because of hypotension and dysrhythmia risk. Toxicity presents as nystagmus, ataxia, and slurred speech. Chronic use causes gingival hyperplasia.

;What must a client on a monoamine oxidase inhibitor avoid, and why?
:Tyramine-rich foods such as aged cheese, cured or smoked meats, fermented soy products, tap beer, and overripe or fermented foods, because they can precipitate hypertensive crisis. A washout of about 2 weeks is required when switching to or from an SSRI.

;Antidotes to memorize for the analgesia and sedation family?
:Naloxone for opioids, noting its shorter duration than most opioids so repeat dosing may be needed; flumazenil for benzodiazepines, used cautiously because it can precipitate seizures in chronic users; and acetylcysteine for acetaminophen overdose.