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pharm 140 > CNS drugs 2 > Flashcards

CNS drugs 2 Flashcards

1
Q

antipsychotics

chlorpromazine (thorazine) indications

A

schizophrenia
manic phase of bipolar disorder
nausea/vomiting

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2
Q

antipsychotics

chlorpromazine (thorazine) administration

A

IV, IM, PO

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3
Q

antipsychotics

chlorpromazine (thorazine) action

A

blocks post synaptic dopamine receptors in the brain

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4
Q

antipsychotics

chlorpromazine (thorazine) contraindications

A

hypersensitivity
alcohol withdrawal
bone marrow suppression
thyroid, cardiac, liver, respiratory disorders

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5
Q

antipsychotics

chlorpromazine (thorazine) adverse effects

A 
tardive dyskinesia, akathisia
constipation, urinary retention
tachycardia, arrhythmia
rash, photosensitivity
blurred vision, dry mouth
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6
Q 
antipsychotics 
chlorpromazine (thorazine) interactions
A

CNS depressants: increased sedation
antacids/antidiarrheals: space 2 hrs (poor absorption)
antiseizure drugs: decreased blood levels of antiseizure drugs

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7
Q 
antipsychotics 
chlorpromazine (thorazine) interventions
A 
give beta blocker if tachycardic
acute dystonia: give IV diphenhydramine 
give IV dantrolene if hyperthermic
keep client recumbent for 30 min following IV dose
monitor vitals, ECG, potassium
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8
Q

antipsychotics

chlorpromazine (thorazine) pt teaching

A 
take with food to prevent GI effects
notify provider of involuntary movements
urinate before dose
use sun protection
report sudden fever immediately
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9
Q

mood stabilizers (lithium) pregnancy category

A

category D (teratogenic)

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10
Q

mood stabilizers (lithium) indications

A

mania, especially in bipolar disorder

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11
Q

mood stabilizers (lithium) action

A

alters sodium transport in nerve and muscle cells

inhibits release of norepinepherine and dopamine, but not serotonin

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12
Q

mood stabilizers (lithium) contraindications

A 
pregnancy/lactation
renal insufficiency
decreased serum sodium levels
angioedema 2/2 ACE inhibitors
seizure disorders
suicidal ideation
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13
Q

mood stabilizers (lithium) adverse effects

A

muscle weakness, goiter, hypothyroidism
drowsiness, headache, confusion
polyuria, GI distress
toxicity! narrow therapeutic range

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14
Q

mood stabilizers (lithium) toxicity s/s

A 
nausea
fine tremor progressing to coarse tremor
seizures
coma
death
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15
Q

mood stabilizers (lithium) interactions

A

NSAIDs (except aspirin), tetracyclines, diuretics: increased risk for toxicity
phenothiazine antipsychotics (Haldol): increased risk for dyskinesias, urinary retention
ACE inhibitors: may increase lithium levels and cause toxicity
antiarrhythmics: risk of arrhythmias

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16
Q

mood stabilizers (lithium) nursing dx

A

excess fluid volume r/t urinary retention 2/2 drug therapy

risk for poisoning r/t lithium toxicity

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17
Q

mood stabilizers (lithium) interventions

A

monitor I&O, weight, thyroid studies, renal studies, glucose levels, electrolyte levels
check lithium level 2x weekly for first 2 months, then every month as needed
report low urine specific gravity, which may indicate diabetes insipidus

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18
Q

mood stabilizers (lithium) pt education

A

take with water, food to minimize GI upset
narrow therapeutic window; recognize s/s toxicity/OD
carry medical identification at all times

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19
Q

seizure disorder

A

loss of consciousness with muscle twitching and mild alterations in consciousness with repetitive blinking

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20
Q

epilepsy

A

a brain disorder with particular patterns of seizures

treated with anticonvulsants

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21
Q

3 ways anti-epileptic drugs work

A
  1. decreasing the rate at which sodium flows into the cell
  2. inhibiting calcium flow into the cell through specific channels
  3. increasing the effect of the neurotransmitter GABA
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22
Q

focus

A

a group of neurons exhibits coordinated, high-frequency discharge
caused by trauma, tumor, hypoxia, genetics
can spread to other areas of the brain and cause seizure activity

23
Q

seizures may result from

A
  1. low levels of GABA

2. high levels of glutamate

24
Q

drugs that potentiate GABA action

A

barbiturates

benzodiazepines

25
Q

drugs that suppress sodium influx into cells

A

dilantin

depakote

26
Q

drugs that suppress calcium influx into cells

A

succinimides

27
Q

phenytoin (dilantin) pregnancy category

A

category D (teratogenic)

28
Q

phenytoin (dilantin) indications

A

partial seizures

tonic-clonic seizures

29
Q

phenytoin (dilantin) administration

A

PO, IV

30
Q

phenytoin (dilantin) action

A

may stabilize neuronal membranes and limit seizure activity either by increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses

31
Q

phenytoin (dilantin) contraindications

A 
pregnancy
bradycardia or heart block
allergy to hydantoins
seizures 2/2 hypoglycemia
renal/hepatic disease
alcohol use disorder
respiratory dysfunction
32
Q

phenytoin (dilantin) adverse effects

A 
drowsiness
bradycardia, shock
blurred vision, thickening of facial features
gingival hyperplasia
agranulocytosis
toxic hepatitis
lupus, osteomalacia
33
Q

phenytoin (dilantin) interactions

A

oral contraceptives, acetaminophen, corticosteroids: decreased effectiveness
diazepam, isoniazid, valproic acid: increased levels of phenytoin
warfarin, lithium
phenobarbital, carbamazepine: can decrease phenytoin levels

34
Q

phenytoin (dilantin) interventions

A 
taper gradually to avoid w/d
monitor for rash and d/c
monitor CBC, BMP, hepatic panel, phenytoin level
monitor for cardiac toxicity giving IV
maintain seizure precautions
vitamin D and calcium supplements
35
Q

phenytoin (dilantin) pt education

A

regular dental checkups and good dental hygiene with soft toothbrush
notify if rash occurs
do not stop taking abruptly

36
Q

valproic acid (depakote) indications

A

all seizure types
bipolar disorder
migraine headache

37
Q

valproic acid (depakote) action

A

unknown; thought to modulate inhibitory ntx GABA

38
Q

valproic acid (depakote) pregnancy category

A

category D (teratogenic)

give folic acid if pregnancy occurs to prevent neural tube defects

39
Q

valproic acid (depakote) contraindications

A 
renal/hepatic impairment
other anticonvulsants
thrombocytopenia
hyperammonemia
pregnancy
40
Q

valproic acid (depakote) adverse effects

A 
hepatotoxicity
birth defects
pancreatitis
headache, ataxia
blurred vision, tinnitus
infection
41
Q

valproic acid (depakote) nursing interventions

A

monitor bleeding time, platelet count
give with food
monitor blood ammonia levels, serum amylase, LFTs
ensure client takes lowest effective dose

42
Q

valproic acid (depakote) pt education

A

report bleeding, bruising, rash, decreased LOC, jaundice, anorexia
take with food
inform provider if plan to become pregnant
do not mix oral syrup with carbonated drinks

43
Q

valproic acid (depakote) black box warning

A

abdominal pain, n/v, and anorexia may be symptoms of pancreatitis that requires immediate medical evaluation

44
Q

carbamazepine (tegretol) indications

A

partial seizures
tonic-clonic seizures
mood stabilizer in bipolar disorder
reduces pain of trigeminal neuralgia

45
Q

carbamazepine (tegretol) administration

A

PO

46
Q

carbamazepine (tegretol) action

A

thought to stabilize neuronal membranes and limit seizure activity by either increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses

47
Q

carbamazepine (tegretol) pregnancy category

A

category D (teratogenic)

48
Q

carbamazepine (tegretol) contraindications

A 
pregnancy
absence/myoclonic seizures
hematologic disorders
HF
hepatic impairment
MAOIs in past 2 weeks
hypersensitivity to TCAs
49
Q

carbamazepine (tegretol) adverse effects

A 
visual disturbance, headache, ataxia, seizure exacerbation
decreased blood cell production
skin rash (stevens-johnson syndrome)
photosensitivity
albuminuria, glycosuria
50
Q

carbamazepine (tegretol) interactions

A

grapefruit juice: increases plasma levels
erythromycin, isoniazid, antiretrovirals, valproic acid, verapamil, loratidine, MAOIs: increased plasma levels
phenytoin, barbiturates, rifampin, theophylline: decreased plasma levels
lithium levels increased
oral contraceptives, anticoagulant effects decrease

51
Q

carbamazepine (tegretol) may cause a false ______

A

false negative pregnancy test

52
Q

carbamazepine (tegretol) interventions

A

gradually increase dose to prevent CNS effects
give as much of dose at bedtime as possible to minimize daytime side effects
monitor CBC, WBC counts
monitor for skin rash

53
Q

carbamazepine (tegretol) pt education

A

sun protection
CNS effects should decrease
report fever, rash, sore throat, bruising
take with meals to reduce GI distress

pharm 140 (18 decks)

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