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Pharm > ch 22/23 meds > Flashcards

ch 22/23 meds Flashcards

1
Q

chlorpromazine hydrochloride

A

aliphatic phenothiazine typical antipsychotic - strong sedative, lowers BP, may cause moderate EPS/ortho hypo

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2
Q

fluphenazine (Prolixin)

A

piperazine phenothiazine typical antipsychotic - produces more EPS symps than other phenos > dry mouth, urinary retention, agranulocytosis (life threat-labs every 3 mos).
tx symps of psychosis/schizo by blocking dopamine receptors.
inc other cns depressants.
photosensitivity, urinary retention, peripheral edema. observe ems AND nms. monitor glucose. 6wks for effect. no breastfeeding/smoking/abrupt stopping

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3
Q

thioridazine

A

piperdine phenothiazine typical antipsychotic drug - strong sedative, few eps, low to mod effect on BP and no antiemetic effect

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4
Q

haloperidol(Haldol)

A

butyrophenone nonphenothiazine typical antipsychotic - tx acute/chronic psychosis, children w/severe behavior/combative probs, suppresses narcotic withdrawal symps, schizo resistant to other drugs, tourette’s, dementia in older pts by altering effect of dopamine in cns(antipsy effect unk)

ci: narrow angle glaucoma, bone more dep
dfl: other cns dep, anticholinergics inc tox, LITHIUM, dec eff of PHENOBARBITAL, CARBAMEZAPINE, CAFFEINE
adv: urinary retention (life threat: laryngospasm, resp dep, NMS, agranulocytosis)
se: sedation, EPS, ortho hypo, headache, photosensitivity, dry mouth/eyes, blurry

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5
Q

aripiprazole(Abilify)

A

atypical antipsychotic - tx symps of psychosis, schizo by interfering w/ binding of dopamine to D2 and serotonin to 5-HT2
DFL: antidiabetic agents dec drug and inc hyperglycemia. SSRIs increase rsik for serotonin syndrome. hypotn risk. grapefruit juice. inc blood glucose.
life threat: SI, NMS, agranulocytosis, penias
NI: ortho hypo, give deep IM (irritate fat), non iv med, monitor eps/nms/urine retent, rise or fall in glucose
6wk eff. no smoking or baby

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6
Q

lorazepam(Ativan)

A

benzodiazepine anxiolytic - tx anxiety, status epi, preop sedative, substance withdrawal. potentiates gababy binding to specific benzo receptors, inhibiting GABA nt.
may lower BP/pulse. no driving/heavy machinery. no EToh/other cns dep. use nonpharma methods. 1-2 wks for eff. smoking will dec eff.

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7
Q

buspirone(BuSpar)

A

azapirone misc. anxiolytic - tx anxiety, anxiety related depression. binds to serotonin/dopamine receptors at 5-HT1A
pregnancy B, 1-2wks eff, same as lorazepam but less eff of sedation/physical/psychological dependence.
grapefruit max 8oz daily or half of one

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8
Q

fluoxetine(Prozac)

A

SSRI antidepressant - tx OCD, bulimia, depression, panic disorder, premenstrual dysphoric disorder (se of menstrual irreg), PTSD by blocking nerve fibers to increase serotonin in nerve cells.
prec: underweight and severe dep w/si.
BUN/Creat/liver enzymes.
watch for tardive dyskinesia, NMS, check if they stop taking from sex dysfx - give extra ed
take at bedtime. 1-2wks. take w/food. no pregnant/driving.

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9
Q

venlafaxine(Effexor)

A

serotonin norepinephrine reuptake inhibitor antidepressant - tx PTSD, panic disorder, dep, generalized/social anxiety dx by blocking nerve fibers to increase serotonin and NE in nerve cells

ci: siadh, children, MAOI, anticoag (incl asa)
prec: narrow angle glaucoma, Heart probs, kidneys only
se: cataract, gingivitis, hirsutism, alopecia, photosens, intraoc pressure, ejaculation dysfx. same nI and ed as prozac

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10
Q

trazodone(Desyrel)

A

atypical antidepressant - tx depression. no pregnancy C or other cns dep. no MAOIs within 14 days. monitor for sedation. take w food and at bedtime.

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11
Q

Lithium

A

mood stabilizer - tx manic episodes, bipolar psychosis by altering ion transport in muscle/nerve cells, increasing receptor sensitivity to serotonin.
prec: thyroid/seizure dx
dfl: increased levels w/thiazide diuretics, methyldopa, haloperidol, NSAIDs, antideps, carbamezapines, calcium channel blockers, spironolactone, ACE inhibitor, sodium bicarb, phenothiazines.
inc excretion w/theophylline, aminophylline. inc risk hyperglycemia IN DM. caffeine dec lithium. increased urine/blood glucose and protein. dec sodium.
ad rxn: incont, emia, uria
life thrat serotonin syndrome, NMS
se: metallic taste, dental caries
asses for electrolyte level and resulting arrhythm

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12
Q

fluphenazine(prolixin) and haloperidol(haldol) NI and PT ED

A

NI: monitor VS (ortho hypo), ensure pt takes med, observe for EPS and NMS, monitor urine output (retention), monitor serum glucose
8. Pt ed: take drug as ordered, won’t cure but will lessen symps, may take 6wks for effect, don’t take ETOH or other CNS depressants, get serial labs (monitor WBC every 3mos), no breastfeeding (effect on fetus unknown), no smoking (inc metabolism of some antipsy), don’t abruptly stop

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13
Q

flumanezil(Romazicon)

A

reversal agent for benzo OD

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14
Q

benzo short term withdrawal symps

A

agitation, nervous, insomnia, tremors, anorexia, muscle cramp, sweating

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15
Q

benzo long term withdrawal symps

A

paranoia, delirium, panic, HTN, stats epilepticus

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16
Q

theory of depression?

A

Common theory suggests insuff amt of brain monoamine NT (NE, serotonin, dopamine) causes it. Thought that dec level of serotonin permits depression, decreased levels of ne cause dep

17
Q

types of antipsychotics

A

d. Typical/Traditional antipsychotics:
i. Phenothiazines
1. Aliphatic
2. Piperazine
3. Piperdine
ii. Nonphenothiazines
1. Butyrophenones
2. Dibenzoxazepines
3. Dihydroindolones
4. Thioxanthes
e. atypical

18
Q

types of anxiolytics

A

barbiturates(not used anymore cause addictive)/benzos

19
Q

types of antidepressant agents

A
  1. tricyclic antidepressants
  2. selective serotonin reuptake inhibitors
  3. serotonin norepinephrine reuptake inhibitors
  4. atypical antidepressants(aka second gen)
  5. monoamine oxidase inhibitor
20
Q

tricyclic antidepressants

A

effective for major dep, cheaper than ssri. blocks uptake of NE and serotonin in brain. 2-4wk eff. no concurrent MAOI.

21
Q

is SSRI or TCA used more for dep?

A

SSRI

22
Q

ssri may interact with?

A

grapefruit juice

23
Q

ssri

A
  1. Block reuptake of serotonin in nerve terminal of CNS
  2. Don’t block uptake of dopamine or NE
  3. Don’t block cholinergic and alpha 1 adrenergic receptors
24
Q

atypical antidepressants

A
  1. Aka second gen
  2. Used for major depression, reactive depression, anxiety
  3. Affect 1-2 of the 3 NT (serotonin,NE, dopamine)
  4. Cannot take with MAOI, should not use w/in 14 day of MAOI
25
Q

atypical antidepressants

A
  1. Aka second gen
  2. Used for major depression, reactive depression, anxiety
  3. Affect 1-2 of the 3 NT (serotonin,NE, dopamine)
  4. Cannot take with MAOI, should not use w/in 14 day of MAOI
26
Q

monoamine oxidase inhibitors

A
  1. MAO inactivate NE, dopamine, epi and serotonin > cause inc in circulating levels
    non selective
    tx depression
27
Q

maoi forms

A

a. MAO-A: inactivate dopamine in brain

b. MAO-B: inactivate NE and serotonin

28
Q

are MAOIs choice drug?

A

as eff of tca, but higher risk of ad rxn – currently not antidep of choice, and are usually only prescribed if TCA or second gen drugs are ineffective
4. Many drug/food interactions can be fatal- tyramines

29
Q

tyramines

A

b. Tyramine foods have sympathomimetic like effects: cheese (cheddar, swiss, bleu), cream, yogurt, chocolate, coffee, bananas, raisins, green beans, liver, pickled food, sausage, soy, yeast, beer, red wines

30
Q

observe for what and teach what with MAOI?

A

s/s depression, further mood change, insomnia, hypoTN, hypertensive crisis (happens from d/f interaction)
no herbal products (interact). no tyramines. no pregnant. taper med. no MAOI 14 days. monitor BP. 1-2 wks eff. no other cns dep. no driving/machinery

31
Q

mood stabilizers

A

tx bipolar affective.

calm but can cause memory loss/confusion.

32
Q

front line drugs for bipolar

A

c. Lithium, valproic acid, lamotrigine, carbamezapine currently are front-line drugs for bipolar

33
Q

lithium levels

A 
therapeutic = 1 to 1.5meq/l
maintenance = 0.5 to 1.5
1.5-2 = persistent n/v, severe diarrhea, ataxia, blurry, tinnitus
2-3.5 = excessive dilute urine output, inc tremors, muscular irritability, psychomotor retardation, mental confusion
>3.5 = impaired consciousness, nsytagmus, seizure, coma, oliguria, anuria, cardiac dys, MI, CV collapse
34
Q

lithium pt ed

A

serial labs, educate on s/s of tox + when to call doc, notify if symps of dep persist or worsen, no driving until aware of how affected, adequate fluids 2—3L daily and 1-2 as maintenance, take w/food, effectiveness 1-2wks after start, consult doc for pregnant, avoid caffeine (can aggravate manic), no NSAIDs while taking lithium – may cause increase in levels

Pharm (20 decks)

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