E3 Medications Flashcards
Fluphenazine (Prolixin)
Blocks dopamine receptors in brain; typical antipsychotic (FGA)
Interactions: Alcohol (increased depression) Kava Kava (EPS)
Available in long acting IM for use when patient is stabilized on oral dose
Haloperidol (Haldol)
Blocks dopamine receptors in treatment of acute/chronic psychoses also used in dementia, schizophrenia, Tourette’s
SE: Similar to al FGA’s + EPS although less likely to cause sedation, hypotension, anticholinergics
Chlorpromazine (Thorazine)
Typical FGA used for schizophrenia, bipolar and other psychotic disorders
SE: orthostatic hypotension, anticholinergic effects, tardive dyskinesia, EKG changes (prolonged QT)
Thioridazine (Melleril)
High likelihood of EKG changes (prolong QT) so other FGAS should be tired first
SE: EPS, sedation, orthostatic hypotension, anticholinergic effects
Clozapine (Clozaril)
SGA used for severe schizophrenia that does not respond to other medications
Adverse: Agranulocytosis (fever, sore throat and mouth ulcers signs - reported immediately) + seizures
Interventions: Monitor WBC and neutrophil if ANC is below 1000 drug must be permanently discontinued
Olanzapine (Zyprexa)
SGA - Does not cause EPS
SE: weight gain, DM, duslipidemia, leukopenia/neutropenia
Nursing: WBC before starting and for multiple months after if ANC is less than 1000 stop medication and monitor for infection
Risperidone (Risperdal)
SGA - does not cause agranulocytosis
SE: low risk of EPS, weight gain, DM, dyslipidemia, agitation, fatigue, dizziness, orthostatic hypotension
Long acting IM available
Benzodiazepines
Immediate onset of action, can be used to treat anxiety - used on a schedule or PRN potential for dependence or abuse
SE: sedation, pt should avoid alcohol or other depressants
Ex: Chlordiazepoxide (Librium) Diazepam (Valium) Lorazepam (Ativan) Alprazolam (Xanax)
Buspirone (BuSpar)
Treats anxiety + depression
Effects in 2-4 weeks
SE: dizziness, headache, nausea, nervousness
Interacts with grapefruit juice (toxicity)
Phase 1 TB treatment
2 months, in regions without drug resistance
Isoniazid, rifampin, pyrazinamide, ethambutol
Phase 2 TB treatment
Minimum of 18 weeks
Isoniazid and rifampin are preferred
Generally 6-9 months of total treatment
Treatment for mutlidrug-resistant TB
Extended treatment time - 24 months, 2nd + 3rd line used. May need 5+ medications, extremely expensive 40-60% die
First line TB drugs
Isoniazid, rifampin, pyrazinamide, ethambutol, rifabutin, rifapentine
More effective than second line and less toxic
Second line drugs
cycloserione, ethionamide, caprdomycin, para-amino salicyclic acid, anminoglycosides (streptomycin, amikacin, kanamycin), quinolones (levofloxacin, moxifloxacin)
Less effective and more toxic
Bedaquiline
New treatment option for TB, does not interfere with metabolism of other medication, high mortality rate in trials
SE: prolonged QT + hepatotoxic
Isoniazid (INH)
Inhibits bacterial cell wall synthesis (prophylaxis and treatment of TB)
SE: gi distress, hepatotoxicity, blurred vision (photosensitivity) tinnitus, dizziness, peripheral neuropathy, psychotic behavior, seizures, blood dyscrasias, risk of hyperglycemia
Interaction: Increased risk of liver damage (alcohol, rifampin, rifabutin, rifapentine) increased phenytoin levels
Decreased absorption with antiacids
Teaching: complete regimen, sputum specimens early morning, pyridoxine (B6) to prevent neuropathy, frequent eye examinations, report (numbness, tingling, burning) teach about sun precautions and avoid antacids
Rifampin
Used with isoniazid to treat TB
Suppresses RNA synthesis
Tkae 1 hour before or 2 hours after meals
Red-orange discoloration of urine sweat and tears
Pt cannot wear soft contact lenses
Interactions: reduced effect of hormonal birth control
Rifapentine
May be taken with food
SE: Red orange discoloration of urine, sweat and tears (no soft contact lenses)
Interactions: reduced effect of hormonal BC
Rifabutin
Tb treatment - take with food to reduce GI upset, red/orange color body fluids
Uveitis - DC if eye pain
Interactions: reduced effect of BC
Pyrazinamide
Hepatotoxicity - monitor liver enzymes
Nongouty polyarthralgias (joint pain, NSAID treatment, hyperuricemia)
Ethambutol
Visual disturbances (visual acuity, color discrimination) Assess before and monthly, encourage pts to report symptoms and stop medication
SE: dizziness, confusion, hallucinations, joint pain
Valacyclovir HCL (Valtrex)
HSV-1, HSV-2 – acute outbreaks and/or chronic treatment
Herpes zoster (shingles)
Vericella (chicken pox)
Famciclovir (Famvir)
HSV, herpes zoster
Can decrease duration of shingles
HSV used for onset, recurrence, and prophylactically
Ganciclovir (Cytovene)
Systemic CMV treatment
Side effect: thrombocytopenia, nephrotoxicity, increased bilirubin
Hazardous – requires special training for handling
Serious side effects! Only used with immunocompromised!