ATI section 11: Medications for the Nervous System Flashcards

1
Q

Antianxiety Medications

A

-lam, pam, Buspirone, Chlordiazepoxide

-Therapeutic Use
Generalized anxiety disorder and panic disorder
Insomnia
Alcohol withdrawal
Induction of anesthesia

-Precautions/Interventions
Diazepam and buspirone are used with caution in clients who have substance use disorder and liver disease
Buspirone is contraindicated for clients taking MAOIs

-Side/Adverse Effects
CNS depression
Paradoxical response (insomnia, excitation, euphoria)
Withdrawal symptoms (not with Buspirone)
Risk of abuse and potential overdose

-Nursing Interventions and Client Education
Monitor vital signs
Instruct clients to avoid alcohol
Treat overdose with flumazenil (Romazicon)

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2
Q

Antidepressant Classes

SSRI

A

-oxetine, Escitalopram, Fluvoxamine, Sertraline

-Precautions/Interactions
Avoid alcohol
Do not discontinue abruptly
Monitor for serotonin syndrome (agitation, confusion, hallucinations) within first 72 hr

-Side/Adverse Effects
Weight gain
Sexual dysfunction
Fatigue
Drowsiness
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3
Q

Antidepressant Classes

Tricyclic

A

-ine, Doxepin

-Precautions/Interactions
Do not administer with MAOIs or St John’s wort
Must avoid alcohol
Contraindicated for clients with seizure disorder

-Side/Adverse Effects
Anticholinergic effects
Sedation
Toxicity
Decreased seizure threshold
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4
Q

Antidepressant Classes

MAOI

A

-Isocarboxazid, Tranylcypromine, Phenelzine

-Precautions/Interactions
Avoid foods containing tyramine
Antihypertensives have additive hypotensive effect
Contraindicated with SSRIs, tricyclics, heart failure, CVA, renal insufficiency

-Side/Adverse Effects
CNS stimulation
Orthostatic hypotension
Hypertensive crisis with intake of tyramine, SSRIs, and tricyclics

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5
Q

Antidepressant Classes

A
  • Nursing Interventions and Client Education
    Assess client for suicide risk
    Instruct client to take on daily basis and never miss a dose
    Instruct client about therapeutic effects and time of onset
    Instruct client to avoid discontinuing drug abruptly
    Instruct client to take SSRIs in the morning to minimize sleep disturbances
    Provide clients taking MAOIs a list of foods containing tyramine
    Advise clients to avoid taking other medications without consulting a provider
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6
Q

Bipolar Disorder Medications

A

-Lithium Carbonate

-Therapeutic Use
Bipolar disorder
Alcohol use disorder
Bulimia
Schizophrenia

-Precautions/Interactions
Use cautiously in clients who have renal dysfunction, heart disease, hyponatremia, and dehydration
NSAIDs will increase lithium levels
Monitor serum sodium levels

-Side/Adverse Effects
GI distress
Fine hand tremors
Polyuria
Weight gain
Renal toxicity

-Nursing Interventions and Client Education
Monitor therapeutic levels
Monitor serum sodium levels
Instruct clients that therapeutic effects begin in 7-14 days
Doses must be administered 2-3 times daily per prescriber
Provide nutritional counseling to include food sources for sodium
Administer with food to decrease GI distress

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7
Q

Antipsychotic Medications

A
  • Conventional: azine, Haloperidol, Thiothixene
    -Atypical (less severe side/adverse effects)
    Aripiazole, apine, done
-Therapeutic Use
Acute and chronic psychosis
Schizophrenia
Manic phase of bipolar disorders
Tourette's syndrome
Delusional and schizoaffective disorders
Dementia

-Precautions/Interactions
Contraindicated for clients who have severe depression, Parkinson’s disease, prolactin-dependent cancer, and severe hypotension
Use caution in clients who have glaucoma, paralytic ileus, prostate enlargement, or seizure disorder

-Side/Adverse Effects
Sedation
Extrapyramidal effects (administer benzatropine)
Anticholinergic effects
Agranulocytosis
Neuroleptic malignant syndrome
Seizures (may require increased dose of anti seizure medications)

-Nursing Interventions and Client Education
Monitor for side effects within 5 hr-5 days of administration
Advise client of potential side effects
Monitor CBC
Encourage fluids
Stop medication for signs of neuroleptic malignant syndrome

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8
Q

Attention Deficit Hyperactive Disorder Medications

Stimulants

A

-amphetamine, Methylphenidate

-Side effects
Mood changes
Insomnia
Anxiety

-Nursing Interventions and Client Education
Administer in early morning
Do not abruptly discontinue
Monitor for signs of abuse, agitation

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9
Q

Attention Deficit Hyperactive Disorder Medications

Nonstimulants

A

-Atomoxetine, Guanfacine

-Side effects
GI upset
Constipation
Fatigue

-Nursing Interventions and Client Education
Take medication daily
Do not crush or chew
Instruct client to immediately report worsening of anxiety, agitation
Do not take with MAOIs

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10
Q

Sedative/Hypnotic Medications

A

-Eszopiclone, Temazepam, Zolpidem tartrate

-Therapeutic Use
Short term insomnia
Difficulty falling or staying asleep

-Precautions/Interactions
Use cautiously in clients who have severe mental depression
Avoid combined use with alcohol and medications that depress CNS function

-Side/Adverse Effects
Dry mouth
Decreased libido
Respiratory depression

-Nursing Interventions and Client Education
Instruct client to take immediately before bedtime because medication has abrupt onset of sleep
Instruct client to avoid alcohol
Warn client and caregivers of potential for sleep activities without recall; notify prescriber immediately

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11
Q

Abstinence Maintenance Medications

Disulfiram

A

-Therapeutic Use
Adjunct to maintain sobriety in tx of alcohol use disorder

-Precautions/Interactions
INH will increase risk of adverse CNS effects for clients taking disulfiram
Ingestion of large amounts of alcohol may cause respiratory depression, arrhythmias, and cardiac arrest
Adjust medication doses of warfarin and phenytoin

-Side/Adverse effects
Drowsiness
Headache
Metallic taste

Nursing Interventions and Client Education

  • Must wait 12hr between time of last alcohol intake and starting medication
  • Instruct client that consumption of alcohol while taking disulfiram will result in flushing, throbbing in head and neck, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion
  • Instruct client that undesirable effects last 30 min- several hrs when alcohol is consumed
  • Instruct client the effects of disulfiram may stay in the body for weeks after therapy is discontinued
  • Instruct client that therapy may last months-years
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12
Q

Abstinence Maintenance Medications

Methadone

A

-Therapeutic Use
Prevents withdrawal symptoms in clients who were addicted to opiate drugs

-Precautions/Interactions
Do not use in clients who have severe asthma, chronic respiratory disease, or hx of head injury

-Side/Adverse effects
Sedation
Respiratory depression
Paradoxical CNS excitation

Nursing Interventions and Client Education

  • Monitor clients for signs of drug tolerance and psychological dependence
  • Monitor pancreatic enzymes because medication may cause biliary spasms
  • Instruct client that methadone must be slowly reduced to produce detoxification
  • Client must be monitored through tx center
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13
Q

Chronic Neurological Disorders

Cholinesterase Inhibitors

A

-Neostigmine, onium

-Therapeutic Use
Myasthenia gravis

-Precautions/Interactions
Do not administer if systolic BP less than 90 mm Hg

-Side/Adverse Effects
Slow HR
Chest pain, weak pulse, increased sweating, and dizziness
Client feeling like he or she might pass out
Weak or shallow breathing
Urinating more than usual 
Seizures
Trouble swallowing

-Nursing Interventions and Client Education
Dose must be individualized
Instruct client to keep individual diary to record side effects
Advise client to wear medical alert bracelet
Monitor for cholinergic crisis

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14
Q

Chronic Neurological Disorders

Anti-Parkinson’s

A

-Benztropine, dopa

-Therapeutic Use
Parkinson’s disease

-Precautions/Interactions
Do not use levodopa within 2 weeks of MAOI use
Pyridoxine (vitamin B6) decreases effects of levodopa
Bentropine is contraindicated in clients who have narrow-angle glaucoma
Must discontinue 6-8 hrs before anesthesia

-Side/Adverse Effects
Muscle twitching (especially eyelid spasms
Headache
Dizziness
Dark urine
Agitation

Nursing Interventions and Client Education

  • Instruct family members to assist with medication regimen
  • Instruct client to notify prescriber if sudden loss of the medication effects occurs
  • Instruct client that maximum therapeutic effects may take 4-6 weeks
  • Monitor closely for signs of adverse reactions
  • Instruct client to avoid high-protein meals and snacks
  • Keep medication away from heat, light, and moisture. If pills become darkened, they have lost potency and must be discarded
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15
Q

Chronic Neurological Disorders

Antiseizure

A

-Carbamzepine, Gabapentin, Phenobarbital, Phenytoin, Valproic acid

-Therapeutic Use
Prevent and/or control seizure activity

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16
Q

Carbamazepine

A

-Precautions/Interactions
Contraindicated in clients who have bone marrow suppression or bleeding disorders

-Side/Adverse Effects
Anemia, leukopenia, Steven-Johnson syndrome

17
Q

Gabapentin

A

-Precautions/Interactions
Do not abruptly discontinue

-Side/Adverse Effects
Dizziness, ataxia, somnolence, hypertension, bruising

18
Q

Phenobarbital

A

-Precautions/Interactions
Contraindicated in hx of substance use disorder

-Side/Adverse Effects
Drowsiness, hypotension, respiratory depression

19
Q

Phenytoin

A

-Precautions/Interactions
Causes increased excretion of digoxin, warfarin, oral contraceptives

-Side/Adverse Effects
Gingival hypertrophy, diplopia, drowsiness, hirsutism

20
Q

Valproic acid

A

-Precautions/Interactions
Contraindicated in liver disease, pregnancy

-Side/Adverse Effects
Hepatotoxicity, teratogenic effects, pancreatitis

21
Q

Antiseizure Medications

Nursing Interventions and Client Education

A
  • Monitor for therapeutic effects
  • Monitor clients taking phenytoin for toxic effects, including serum levels for toxicity
  • Instruct clients regarding the importance of compliance; medication is tx, not a cure
  • Individualize tx regimen
  • Instruct client regarding side/adverse effects
  • Medication therapy for status epilepticus: IV phenytoin and diazepam
22
Q

Ophthalmologic Medications (Antiglaucoma)

A

-olol, Pilocarpine

-Precautions/Interactions
Use caution in clients taking oral BBs or calcium channel blockers

-Side/Adverse Effects
Blurred vision
Photophobia
Dry eyes
May have systemic effects of beta blockers

Nursing Interventions and Client Education
-Instruct client to use sterile technique when handling applicator portion of the container
-Hold gentle pressure on the nasolacrimal duct for 30-60 seconds immediately after instilling drops
Monitor pulse rate/rhythm for clients taking oral beta or calcium channel blocker