barbituates, CNS stimulants, ADHD, insomnia, yadayadayada Flashcards
What are the two barbiturates used for epilepsy?
Phenobarbital, Primidone
Why do barbiturates have a high abuse potential?
They cause tolerance and dependence by mimicking GABA.
What are the CNS effects of barbiturates?
Drowsiness, sedation, depression, confusion, anxiety.
What are signs of barbiturate toxicity?
Nystagmus, ataxia, respiratory depression, coma, pinpoint pupils, hypotension, death.
How should barbiturate toxicity be managed?
Monitor vital signs, provide oxygen, and ventilatory support.
What vitamins do barbiturates decrease?
Vitamin K and D (affect clotting).
How do barbiturates affect warfarin?
Decrease its effects (monitor INR, calcium, and vitamin D).
What are the CNS effects of phenytoin (hydantoin)?
Nystagmus, sedation, ataxia, diplopia, cognitive impairment.
What oral side effect is associated with phenytoin?
Gingival hyperplasia (overgrowth of gums).
How can gingival hyperplasia be managed?
Good dental hygiene, flossing, folic acid supplementation.
What cardiovascular effects does IV phenytoin cause?
Dysrhythmias, hypotension.
What endocrine effects does phenytoin have?
Facial coarsening, hirsutism, interferes with vitamin D metabolism.
How does phenytoin affect newborns?
Interferes with vitamin K clotting factors.
What are the CNS effects of carbamazepine?
Nystagmus, diplopia, ataxia, headache.
What blood dyscrasias can carbamazepine cause?
Leukopenia, anemia, thrombocytopenia.
What are signs of blood dyscrasias?
Bruising, bleeding gums, sore throat, fever, pallor, weakness, infection.
What is a major fluid-related adverse effect of carbamazepine?
Hypo-osmolarity (edema, decreased UOP, HTN).
What skin conditions are associated with carbamazepine?
Rash, Stevens-Johnson Syndrome (SJS), photosensitivity.
What are the adverse effects of valproic acid?
GI issues, hepatotoxicity, pancreatitis, thrombocytopenia, hyperammonemia (CNS effects).
What CNS effects does lamotrigine cause?
Dizziness, somnolence, aphasia, diplopia, blurred vision, headache, nausea/vomiting, depression.
What serious CNS infection is associated with lamotrigine?
Aseptic meningitis (headache, fever, stiff neck, nausea/vomiting, rash, photophobia).
What are the skin effects of lamotrigine?
Rash, Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN).
What are the CNS effects of levetiracetam?
Dizziness, asthenia, agitation, anxiety, depression, suicidal ideation.
What CNS effects does topiramate cause?
Somnolence, dizziness, ataxia, nervousness, diplopia, confusion, impaired cognitive function.
What metabolic effect does topiramate cause?
Metabolic acidosis.
What eye condition is associated with topiramate?
Angle-closure glaucoma.
What CNS effects does oxcarbazepine cause?
Dizziness, drowsiness, diplopia, nystagmus, headache, nausea/vomiting, ataxia.
What endocrine disorder can oxcarbazepine cause?
Hypothyroidism (lethargy, cold intolerance, dry skin, brittle hair, constipation).
What serious hypersensitivity reaction is associated with oxcarbazepine?
Multiorgan hypersensitivity (fever, rash ± lymphadenopathy, hepatorenal syndrome, hematologic abnormalities).
Why do gabapentin and pregabalin have abuse potential?
Due to their CNS effects (somnolence, dizziness, ataxia, fatigue, nystagmus, peripheral edema).
What weight-related side effect does pregabalin cause?
Weight gain.
What is the main nursing consideration for antiepileptic therapy?
Monitor therapeutic plasma levels to assess effectiveness.
Why should antiepileptics never be stopped suddenly?
Risk of withdrawal seizures.
What are the CNS effects of CNS stimulants?
Insomnia, restlessness.
When should CNS stimulants be given?
In the morning before school.
What effect do CNS stimulants have on appetite?
Decreased appetite, weight loss, growth suppression.
What cardiovascular effects do CNS stimulants cause?
Dysrhythmias, chest pain, hypertension.
What psychiatric effects do CNS stimulants cause?
Hallucinations, paranoia.
What happens if CNS stimulants are stopped suddenly?
Tolerance & withdrawal symptoms (headache, nausea/vomiting, muscle weakness, depression).
What are signs of CNS stimulant toxicity?
Dizziness, palpitations, hypertension, hallucinations, seizures.
What substances interact with CNS stimulants?
MAOIs, caffeine, phenytoin, warfarin, phenobarbital, OTC cold/decongestants.
What are the adverse effects of atomoxetine?
Appetite suppression, weight loss, growth suppression, GI issues, suicidal ideation, hepatotoxicity, seizures.
What are the adverse effects of alpha-2 adrenergic agonists (guanfacine, clonidine)?
Sedation, drowsiness, fatigue, hypotension, bradycardia, weight gain.
What should be avoided when taking alpha-2 adrenergic agonists?
CNS depressants, antihypertensives, high-fat foods.
What is the goal of insomnia treatment with medication?
Use drugs for 2-3 weeks max.
What are the “Z-drugs” used for insomnia?
Zolpidem, Zaleplon, Eszopiclone.
What are the adverse effects of “Z-drugs”?
Daytime sleepiness, lightheadedness, headache.
What are the risks of “Z-drugs” in pregnancy?
Neonatal respiratory depression.
What is the melatonin agonist used for insomnia?
Ramelteon.
What hormonal effects can ramelteon cause?
Amenorrhea, decreased libido, infertility, galactorrhea.
What contraindications exist for ramelteon?
Severe liver disease, depression, sleep apnea, COPD.
What are the orexin antagonists used for insomnia?
Suvorexant, Lemborexant, Daridorexant.
What psychiatric effects can orexin antagonists cause?
Hallucinations, sleep paralysis, vivid/disturbing perceptions.
