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NUR 210 Pharm > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Non-Benzodiazepines: Zolpidem
Use:

A

Drug of choice for insomnia

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2
Q

Non-Benzodiazepines: Zolpidem
SEs/ADRs, Interactions:

A
  1. SEs/ADRs
    o Common: headache, drowsiness, dizziness, anxiety, abnormal dreams, hangover effect (residual sedation, you will still feel sleepy after waking up)
    o Sleep-related behaviors-engaging in activities in your sleep and not being aware of them. Ex/ driving, walking, talking on phone, cooking etc.
    o Suicidal thoughts
    o Hallucinations
  2. Interactions- no alcohol, CNS depressants
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3
Q

Non-Benzodiazepines: Zolpidem
Contradictions:

A

o Sleep apnea (breathing repeatedly stops and starts)
o Severe respiratory impairment
o Hepatic/renal impairment
o BEERS: avoid in patients over 65 yrs. old

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4
Q

Non-Benzodiazepines: Zolpidem
Administration:

A

Tablet- IR (immediate release) or ER (extended-release), SL (sublingual), best taken on an empty stomach at bedtime, used short term, only when you can get a full night’s sleep.

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5
Q

IV Anesthetics: Midazolam
Indications:

A

Conscious sedation for minor surgery or procedures. The patient will be sedated and relaxed but still conscious/responsive.

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6
Q

IV Anesthetics: Midazolam
ADRs:

A

o Impaired airway reflexes (can’t cough or gag, swallow),
o Hypotension, respiratory, and CV (cardiovascular) depression.

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7
Q

IV Anesthetics: Midazolam
Contradictions:

A

o Allergy
o Unstable cardiorespiratory function
o Non-fasting state (risk for aspiration)

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8
Q

Local Anesthetics: Lidocaine
MOA, Uses, Administration:

A
  1. MOA: numbs the skin
    o Onset is rapid and provides a long duration of action.
  2. Uses: minor surgeries/procedures (dental, IV start, suturing)
  3. Administration: infiltration (dermal injection)
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9
Q

Spinal and Epidural Anesthesia
Uses:

A

o Spinal: total joint replacement
o Epidural: childbirth

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10
Q

Spinal and Epidural Anesthesia
SEs/ADRs:

A

o Postural headache (occurs 1%- 1/100)
o Vital sign changes: hypotension, respiration depression
o Infection ex/ meningitis
o Bleeding

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11
Q

Spinal and Epidural Anesthesia

A
  1. Spinal (intrathecal)- single shot
    o Short-acting, regional anesthesia (short, quick, and powerful)
    o Drug injected around spinal column (subarachnoid space), quick onset less than 5 min.

o Epidural: between dura and vertebral wall, takes about 30 mins for onset, longer acting and lasting regional anesthesia.

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12
Q

Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
MOA, Uses:

A
  1. MOA: inhibit COX 1 and 2–> decrease prostaglandin synthesis–> decrease inflammation
  2. Uses:
    o analgesics (meds that relive pain)
    o antipyretics (meds that reduces fever)
    o inhibit platelet aggregation,
    o aspirin- MI (heart attack)/stroke prevention
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13
Q

Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
SEs/ADRs:

A

o GI bleeding
o renal insufficiency/failure
o increased blood pressureCV (cardiovascular) complications
o tinnitus
o Reye’s syndrome in children (aspirin)
o thrombocytopenia.
o DO NOT GIVE ASPIRIN IF UNDER 18 YRS OLD

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14
Q

Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
Interactions, Caution:

A
  1. Interactions:
    o other NSAIDs
    o 4 G’s (garlic, ginseng, ginkgo Biloba, green tea)- increased bleeding
  2. Caution: best not to take 2 days before or 1st 2 days of menstrual cycle due to increase bleeding
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15
Q

Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
Contraindications:

A

o Renal failure
o Hypertension
o DO NOT GIVE ASPIRIN IF UNDER 18 YRS OLD – due to increased risk of Reyes syndrome- associated with the use of aspirin during febrile illness (flu, chicken pox, URI (upper respiratory infection))

Reyes syndrome:
etiology- cause unknown, linked to brain swelling and liver damage.
symptoms: vomiting, lethargy, delirium, personality changes, seizures.

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16
Q

COX 2 selective NSAID: Celecoxib
MOA, Uses:

A
  1. MOA: selectively blocks COX 2, fewer GI side effects
  2. Uses:
    o Arthritis
    o Acute pain
    o Dysmenorrhea (pain associated with menstruation)
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17
Q

COX 2 selective NSAID: Celecoxib
ADRs:

A

o Associated with increased risk of serious adverse CV (cardiovascular) events
o MI (heart attack)
o CVA
o New onset hypertension
o Events (fewer than traditional NSAIDs)
o Hepatitis
o Acute kidney injury

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18
Q

COX 2 selective NSAID: Celecoxib
Contraindications, Interactions:

A
  1. Contradictions: history of heart disease
  2. Interactions:
    o ACE inhibitors
    o Anticoagulants
    o SNRIs – antidepressants
    o Lithium
    o Ginkgo biloba -increased bleeding
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19
Q

Gout and its Patho

A

Gout: due to accumulation of uric acid crystals into joints and other body tissuesinflammation

Patho:
o uric acid under secretion by kidneys
o overproduction of uric acid
o exogenous (high purine (meats and alcohol) diet)
male predominance, great toe (1st attack)

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20
Q

Gout treatment: Allopurinol

A

preferred urate-lowering drug

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21
Q

Gout treatment: Allopurinol
MOA, Use:

A
  1. MOA: lowers production of uric acid
  2. Use: gout prevention- treatment of chronic gout
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22
Q

Gout treatment: Allopurinol
SEs/ADRs:

A

o Hepatotoxicity
o Hypersensitivity reactions
o Stevens Johnsons Syndrome – blisters and peels reaction
o GI: nausea/vomiting
o Renal: renal failure
o CNS: drowsiness

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23
Q

Gout treatment: Allopurinol
Caution, Monitoring, Interactions:

A
  1. Caution: decrease dose or withdraw drug for renal impairment
  2. Monitoring: LFTs, renal function (BUN and Creatinine) periodically
  3. Interactions:
    o thiazide/loop diuretics
    o warfarin (allopurinol increases anticoagulant effect)
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24
Q

Acetaminophen

A

non-opioid analgesics; NOT an NSAID, no anti-inflammatory action or anti-platelet.

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25
Q

Acetaminophen
MOA, Uses:

A
  1. MOA: unknown……. Theories?
    o Might weakly inhibit prostaglandin.
    o Activate the cannabinoid system.
    o Increase serotonin levels in the brain, which helps modulate pain.
  2. Uses: reduce pain and fever
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26
Q

Acetaminophen
Administration:

A

Oral form can be taken with or without food. MAX: 4 gm daily from all sources. Lower for the elderly or for hepatic impairment (2-3 gm daily)

o do not self-medicate with acetaminophen for more than 10 days. -Pg 299

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27
Q

Acetaminophen
ADRs, Cautions:

A
  1. ADRs:
    o liver toxicity
    o monitor LFTs.
    o signs and symptoms of hepatotoxicity
  2. Cautions: Use with caution in patients with hepatic impairments
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28
Q

Acetaminophen
Interactions:

A

o increase the effect with caffeine.
o avoid alcohol while taking acetaminophen.
o decrease the effect with oral contraceptives,
o Antacids (1-2 hrs. apart from other drugs)
o may interact with potentially hepatic toxic herbs: echinacea and kava.

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29
Q

Acetaminophen Overdose

A

Antidote: N-acetylcysteine ~ used in patients at increased risk of liver failure.

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30
Q

Opioid analgesics

A

“Mu” agonists- morphine like drugs

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31
Q

Opioid analgesics
MOA, Uses:

A
  1. MOA: binds to opiate receptors in CNS–>decrease pain perception and suppresses cough center in the brain.
  2. Uses:
    o Decrease moderate to severe pain.
    o Antitussive (cold medication- prevent/relieve cough)
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32
Q

Opioid analgesics
Administration, SEs/ADRs:

A
  1. Administration: varies
  2. SE/ADRs:
    o Constipation
    o Nausea and vomiting
    o Urinary retention – dec sensation of bladder fullness
    o Itching
    o Sedation
    o Orthostatic hypotension
    o Bradycardia
    o Respiratory depression
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33
Q

Opioid analgesics
Signs of OD(overdose), reversal agent:

A
  1. Signs of OD (overdose): Pinpoint pupils- pg. 302
  2. Reversal Agent: Naloxone
    o Only lasts about 20 minutes; repeat dosing may be needed.
    o IV, IM, SQ, intranasal
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34
Q

Opioid analgesics
Interactions:

A

o Increased effects of alcohol
o Sedatives
o Antipsychotics
o Muscle relaxers
o St. John’s Wort may decrease drug effects.

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35
Q

PCA “Patient Controlled Analgesics”

A

o Gives pt control over pain management.
o Usually morphine, hydromorphone, or fentanyl

  1. High Alert: requires 2 nurse verification.
  2. Only the patient can push the button.
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36
Q

“Triptans- medications used for headaches:” -Sumatriptan
MOA, Uses:

A
  1. MOA: serotonin agonist- induce vasoconstriction of extracranial arteries
  2. Uses:
    Migraine, headache
    P Pulsative quality
    O One day duration
    U Unilateral direction
    N Nausea/vomiting
    D Disabling intensity

Cluster, headache
Excruciating pain is generally situated around one eye.
“Lancinating pain”
No non-headache symptoms
Lasts 5 min-3 hrs.
Other symptoms on affected side

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37
Q

“Triptans- medications used for headaches:” -Sumatriptan
Administration, SEs/ADRs:

A
  1. Administration: oral, SQ, intranasal
  2. SE/ADRs: pg. 310
    o Dizziness
    o Drowsiness
    o Flushing
    o Blurred vision
    o Pruritis (itchy skin)
    o Hypotension
    o Hypertensive crisis
    o Angina (chest pain)
    o Bradycardia
    o Tachycardia
    o Thrombus
    o Seizures
    o Hearing loss (2 triptans)
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38
Q

“Triptans- medications used for headaches:” -Sumatriptan
Contradictions:

A

o Uncontrolled hypertension
o History of stroke
o MI (heart attack)
o CAD (coronary artery disease)

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39
Q

“Triptans- medications used for headaches:” -Sumatriptan
Interactions:

A

o SSRIs
o St. John’s Wort – combination may lead to serotonin syndrome: too much serotonin stimulating basal ganglia–> tachycardia, hyperthermia, agitation, tremors, muscle rigidity….

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40
Q

CNS stimulant indications

A

Indications include treatment of ADHD, reduce narcolepsy, appetite control. Ex/methyl phenolate

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41
Q

ADHD

A

Characterized by inattentiveness, hyperactivity, and/or impulsivity that results in difficulty functioning in at least two settings (home/school). Symptoms must be present over 6 months.

Stimulants play a prominent role in therapy.

o Why?
Thought is that there’s a deficiency of dopamine. Dopamine increases focus/concentration.

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42
Q

Narcolepsy

A

A disorder of REM sleep in which the patient will complain of excessive daytime sleepiness, often accompanied by sleep attacks and sudden loss of muscle tone (cataplexy).

Diagnosis: symptoms present greater than 3 months.

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43
Q

Stimulant- Methylphenidate

A

a CNS stimulant

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44
Q

Stimulant- Methylphenidate
MOA, Use:

A
  1. MOA: increased levels of catecholamines (dopamine and norepinephrine). Dopamine and norepinephrine increase focus and wakefulness.
  2. Use: treatment of ADHD, management of narcolepsy
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45
Q

Stimulant- Methylphenidate
SEs/ADRs:

A

o Tachycardia
o Anxiety
o Headache
o Sweating
o Insomnia
o Weight loss (monitor 2x/week)
o Increased risk of stroke
o MI (heart attack)
o Arrhythmias
o Hypertension -contraindicated in clients with cardiac abnormalities.
o Psychotic symptoms -hallucinations, delusions, mania.

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46
Q

Stimulant- Methylphenidate
Administration, Interactions:

A
  1. Administration:
    o Give 30-45 mins before breakfast/lunch, this helps increase absorption.
    o DO NOT take it in the evening.
  2. Interactions:
    o MAOIs
    o Antihistamines
    o Haloperidol
    o Caffeine
    o Dec effects of antihypertensives
    o AVOID CAFFINE & ALCOHOL
47
Q

Seizure

A

Characterized by abnormal electrical activity in the brain. Epilepsy is a chronic condition of recurrent seizures.

Characteristics: depends on type

Underlying cause may be idiopathic, or provoked by stroke, infection, metabolic causes, drugs and alcohol.

48
Q

Anti-seizure drugs- how do they work?

A
  1. Decrease excitatory neurotransmitters.
  2. Increase inhibitory neurotransmitters.
49
Q

Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
MOA, Use, Therapeutic level:

A
  1. MOA: decrease excitation, enhance inhibition
  2. Use: Prevent seizures- especially tonic-clonic
  3. Therapeutic level: 10-20 mcg/ml
50
Q

Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
SEs/ADRs:

A

o Hyperglycemia
o Headache
o Dizziness
o Confusion
o Gum hyperplasia (overgrowth)
o Thrombocytopenia (low levels of platelets)
o Leukopenia (low levels of WBCs)
o Hepatic injury
o Stevens Johnson Syndrome
o Teratogenicfetal malformations
o Suicidal ideation
o Depression

51
Q

Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
Precautions:

A

o Impairs Vit D metabolism–>decrease absorption of calcium–>increased risk of osteoporosis–>increased risk fractures.
o DO NOT STOP SUDDENLY status epilepticus.
o Impairs folic acid absorption.

52
Q

Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
Administration, Interactions:

A
  1. Administration: capsules, suspension, IV infusion no more than 50 mg/min
  2. Typical Scenario:
    Pt seizing- give benzo, then follow up with 1 gm of IV phenytoin to prevent seizure recurrence.
  3. Interactions:
    o dec effect of anticoagulants
    o dec efficiency of OCPs (birth control)
53
Q

Anticonvulsants/Anti-seizure-Valproid Acid
MOA, Uses:

A
  1. MOA: dec excitation
  2. Uses:
    o Seizures (any type except absence)
    o Broad spectrum, very effective
54
Q

Anticonvulsants/Anti-seizure- Valproid Acid
SEs/ADRs:

A

o CNS depression
o Sedation
o Respiratory depression
o Hepatoxicity

55
Q

Anticonvulsants/Anti-seizure- Valproid Acid
Valproid acid and pregnancy:

A

HIGHLY teratogenic! Exposure in utero is associated with major malformations. AVOID in pregnancy.

56
Q

Anticonvulsants/Anti-seizure- Valproid Acid
Monitoring:

A

o Therapeutic level: 50-125 mcg/ml
o Risk for hepatotoxicity
- base line LFTs before starting and at frequent intervals thereafter, especially during the 1st six months.

57
Q

Anticonvulsants/Anti-seizure- Valproid Acid
Precautions. Interactions:

A
  1. Precautions: DO NOT SUDDENLY STOP TAKING! will lead to status epilepticus
  2. Interactions: CNS depressants
58
Q

Anticonvulsants/Anti-seizure-
Benzodiazepines:

A

“BB”- benzos break seizures. Ex/ diazepam, lorazepam, midazolam.

59
Q

Anticonvulsants/Anti-seizure-
Benzodiazepines:
Uses, Administration:

A
  1. Uses:
    o Acute seizures
    o Status epilepticus
  2. Administration: give slowly to avoid respiratory depression
    o Lorazepam IV
    o Diazepam IV/PR (parenteral route)
    o Midazolam IV, IM, intranasal
60
Q

Anticonvulsants/Anti-seizure-
Phenobarbital

A

Barbiturate-oldest anti-seizure drugs, use is limited because of its sedating effects.

61
Q

Anticonvulsants/Anti-seizure-
Phenobarbital
MOA, Uses:

A
  1. MOA: decrease excitation
  2. Uses: still first line agent in children and neonates, status epilepticus in adults
62
Q

Anticonvulsants/Anti-seizure-
Phenobarbital
SEs, ADRs:

A
  1. SEs: CNS depression, sedation
  2. ADRs:
    o Apnea
    o Hyperventilation
    o Hypotension
    o Bradycardia
    o Coma
63
Q

Anticonvulsants/Anti-seizure-
Phenobarbital
Monitor: Therapeutic level

A

10-40 mcg/mL, over 40 lethal range

64
Q

Anticonvulsants/Anti-seizure-
Phenobarbital
Precaution, Interactions:

A
  1. Precaution: cannot be abruptly discontinue, taper to avoid withdrawal
  2. Interactions: decrease efficacy of OCPs, corticosteroids, theophylline, CNS depressants
65
Q

Psychosis

A

Broadly defined as loss of contact with reality, increased risk of harm to self and others.

 Etiology: too much dopamine
 Causes:
o Feature of psychiatric disorders
o Substance abuse
o Underlying medical disease

66
Q

Schizophrenia

A

A psychiatric disorder involving chronic or recurrent psychosis.

 Onset of illness: adolescence or early adulthood

 Positive symptoms: reality distortion symptoms such as hallucinations or delusions.

 Negative “deficit” symptoms:
o Decreased expressiveness
o Apathy
o Lack of energy
o Cognitive impairment:
* Attention
* Memory
* Learning
* Reasoning is affected.

67
Q

EPS (Parkinson-type movements)-

A

most significant ADR of antipsychotics, particularly typicals (Haloperidol).

o Etiology: due to blockage of dopamine–>Parkinson’s type symptoms:
* Tremors
* Masked facies
* Rigidity
* Shuffling gait
* Dystonia (muscle spasms)
* Akathisia (restlessness)
* Tardive dyskinesia (irreversible- involuntary movements of face and jaw)

68
Q

EPS (Parkinson-type movements)
Treatment:

A
  • Anticholinergics
  • Diphenhydramine
  • Benztropine
  • Switch to atypical
69
Q

NMS (neuroleptic malignant syndrome)

A

Potentially lethal
MEDICAL EMERGENCY
Directly caused by antipsychotics

Cause: unknown? Dopamine receptor

Blockade–>destabilization of sympathetic nervous system

70
Q

NMS (neuroleptic malignant syndrome)
Signs and Symptoms:

A

o MS (mental status) changes
o Muscle rigidity
o Increased fever -over 40 C
o Severe hypo/hypertension
o Seizure activity
o Tachycardia
o Tachypnea

71
Q

NMS (neuroleptic malignant syndrome)
Treatment:

A

o Immediate withdrawal of antipsychotic
o Hydration
o Cool blankets
o Benzos if seizure develops.

72
Q

Antipsychotic: Haloperidol

A

typical antipsychotic

73
Q

Antipsychotic: Haloperidol
Uses:

A

o Psychotic disorder
o Acute agitation
o Movement disorders:
* Huntington’s disease–>attacks areas of the brain that control voluntary movement.
* Tourette’s syndrome–>tics/twitches

74
Q

Antipsychotic: Haloperidol
SEs:

A

o Drowsiness
o Headache
o Photosensitivity
o Urinary retention
o Sexual dysfunction
o Orthostatic hypotension

75
Q

Antipsychotic: Haloperidol
ADRs:

A

o EPS (Parkinson-type movements- twitches, jerks, twisting or writhing movements) and
o NMS (neuroleptic malignant syndrome- a life-threatening idiosyncratic reaction to antipsychotic drugs)

76
Q

Antipsychotic-Atypicals~Aripiprazole

A

Used for long term treatment of psychosis, also used for depressive symptoms.

77
Q

Antipsychotic-
Atypicals~Aripiprazole
MOA, teaching

A
  1. MOA: block dopamine and serotonin.
  2. Teach pt that initial improvement may be seen in 1-2 weeks but takes 4-6 weeks to achieve full effect.
78
Q

Antipsychotic- Atypicals~Aripiprazole
Uses:

A

o Bipolar disorder
o Major depressive disorder
o Schizophrenia
o Tourette’s
o Autistic disorder

79
Q

Antipsychotic- Atypicals~Aripiprazole
SEs:

A

o Restlessness or sedation
o Hyperglycemia
o Dyslipidemia (abnormal cholesterol)
o Photosensitivity
o Sexual disfunction
o Weight gain

80
Q

Antipsychotic- Atypicals~Aripiprazole
ADRs:

A

o Low possibility of EPS/NMS
o Hematologic abnormalities:
o Neutropenia
- Recommendations: check CBC frequency within first few months of therapy
- Teach pt to report signs and symptoms of infection.

81
Q

Anti-depressant groups

A

o Selective serotonin reuptake inhibitors (SSRIs)
o Serotonin-norepinephrine reuptake inhibitors (SNRIs)
o Tricyclic antidepressants (TCAs)
o Monoamine oxidase inhibitors (MAOIs)

82
Q

Anti-depressants and mood stabilizers theory

A

Theory- due to abnormal levels of serotonin, norepinephrine, and dopamine.

83
Q

Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine

A

1st line therapy for depressive symptoms/anxiety disorders.

84
Q

Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
MOA:

A

Increase availability of serotonin

85
Q

Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
Uses:

A

o Depression
o Bipolar 2 disorder
o Dysthythia (persistent depression)
o Anxiety disorders
o Bulimia

86
Q

Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
SEs:

A

o Sedation
o Sexual dysfunction
o Diarrhea

87
Q

Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
ADRs:

A

o Hyponatremia
o Seizures
o Suicidal ideation

88
Q

Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
Contradictions:

A

o Allergy
o Hypersensitivity

89
Q

Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
Interactions:

A

o Triptans
o MAOIs
o St. John’s Wort

90
Q

Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
MOA:

A

Increases levels of serotonin and norepinephrine

91
Q

Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
Uses:

A

o Depression
o Anxiety
o Chronic pain

92
Q

Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
SEs:

A

o Nausea
o Sweating
o Loss of appetite
o Drowsiness or insomnia
o ED (erectile dysfunction)

93
Q

Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
ADRs:

A

o Hypertension or orthostatic hypotension
o Suicide ideation (adolescence- early 20s)
o Seizures
o NMS (rare) pg. 271

94
Q

Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
Contraindications/ Interactions:

A

o Hypersensitivity
o MAOIs
o Linezolid

95
Q

Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline

A

Original therapy for depression long ago. Fallen out of favor. HIGH MORTALITY IN OVERDOSE.

96
Q

Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
MOA:

A

Similar to SNRIs, increased serotonin and norepinephrine

97
Q

Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
Uses:

A

o Depression
o Bedwetting
o OCD (obsessive compulsive disorder)
o Fibromyalgia
o Neuropathic pain

98
Q

Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
SEs:

A

o Sedation
o Postural hypotension (common)
o Urinary retention
o Dry mouth
o Weight gain

99
Q

Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
ADRs:

A

o Seizures
o Respiratory depression
o Arrhythmias

100
Q

Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
Precautions, Interactions:

A
  1. Precautions:
    o Use with caution in pts with a history of cardiovascular disease.
  2. Interactions:
    o MAOIs
    o CNS depressants
101
Q

Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine

A

RARELY USED for depression due to risk of hypertensive crisis (a sudden, severe increase in blood pressure 180/120 or greater) when taken with tyramine rich foods and certain medication (stimulant meds). -used when nothing else works.

102
Q

Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
Action:

A

o MAO -degrades serotonin, norepinephrine and dopamine.
o MAOIs – prevent breakdown of these neurotransmitters.

103
Q

Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
Uses:

A

o Depression
o Parkinson’s disease (caused by not enough serotonin)

104
Q

Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
SEs:

A

o Dizziness
o Drowsiness
o Headache
o Dry mouth
o Constipation
o Weight gain
o Sexual side effects

105
Q

Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
ADRs:

A

o Hypertensive crisis resulting from drug and food interactions.
- MAO normally breakdown tyramine (sympathomimetic-raises heart rate, blood pressure)

106
Q

Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
Interactions:

A

Foods that contain tyramine–
Aged (Swiss, parmesan, blue cheese) and fermented (sauerkraut, yogurt, soy sauce, no Asian food)
Processed meats (salami, pepperoni)
Pickled foods (kimchi)
Alcohol

Drugs–
CNS stimulants
Sympathomimetics
Cold medications
Other antidepressants

Drug-Herb pg 271–
Ginseng
Ephedra
St. Johns Worts
Brewer’s yeast (makes beer)
Anise

107
Q

Mood stabilizer- Lithium

A

1st drug of choice for any of the bipolar disorders.

108
Q

Mood stabilizer- Lithium
MOA:

A

o Decrease dopamine (dec excitation)
o Inc serotonin (happy hormone)
o Dec norepinephrine (stress hormone)
o Therapeutic effect: mood stabilization

109
Q

Mood stabilizer- Lithium
Uses:

A

o Mania with bipolar disorder
o Mood stabilizer

110
Q

Mood stabilizer- Lithium
SEs:

A

o GI upset
o Muscle weakness
o Tremors
o Memory loss
o Confusion
o Weight changes
o Polyuria
o Dehydration

111
Q

Mood stabilizer- Lithium
ADRs:

A

o Hypotension
o Dysrhythmias
o Seizures
o Hyponatremia
o Nephrotoxicity

112
Q

Mood stabilizer- Lithium
Contraindications:

A

o HIGLY TERATOGENIC – do not use during pregnancy.
o Keep drug levels below 1.5 meq/L

113
Q

Mood stabilizer- Lithium
Interactions:

A

o NSAIDs
o Haldol increases lithium levels.

114
Q

Mood stabilizer- Lithium
Pt teaching:

A

o Stay hydrated. Maintain a high level of hydration- 2-3 L/day initially, 1-2 L/day maintenance.
Dehydration–>lithium toxicity
o Drinking alcohol is not recommended.
o Take with food to decrease GI upset.
o Wear medical alert bracelet.

NUR 210 Pharm (4 decks)

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