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NUR 346 > Exam 1 Drugs > Flashcards

Exam 1 Drugs Flashcards

1
Q

Benzodiazepines

A

Anti-anxiety drug

Promote activity of GABA
decreased excitability ==> calming effect
sleeping inducing
anticonvulsant
muscle relaxant properties

controlled substance, addictive
used for insomnia, anti-anxiety, and alcohol withdrawal

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2
Q

List of Benzodiazepines - anxiety

A
  • ending in pam

Diazepam (Valium)
Clonazepam (Klonopin)
Alprazolam (Xanax)
Lorazepam (Ativan)

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3
Q

List of Benzodiazepines - insomnia

A
  • ending in pam, am

Flurazepam (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)

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4
Q

List of Benzodiazepines - alcohol withdrawal

A
  • ending in pam, xide

Chlordiazepoxide (Librium)
Diazepam (Valium)
Lorazepam (Ativan)

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5
Q

Short-Acting Sedative-Hypnotic Sleep Agents (“Z-hypnotics”)

A

Antianxiety and Hypnotic Drugs

Sedative effects without the anxiety, anticonvulsant, or muscle relaxant effects of other benzodiazepines.

Quick onset… take when ready to sleep

Short half lives (up to 8 hours)

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6
Q

List of Short-Acting Sedative-Hypnotic Sleep Agents (“Z-hypnotics”)

A
  • have Z in the beginning of the medication

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

Anti-anxiety and Hypnotic Drugs

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7
Q

Buspirone (BuSpar)

A

Anti-anxiety and Hypnotic - Melatonin Receptor Agonists

often better tolerated than benzos

Relieves anxiety with no sedative effect

No potential for addiction

Not a CNS depressant

thought to work as a partial serotonin agonist

SE: HA, dizziness, lightheadedness, nausea, insomnia

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8
Q

T/F

Many antidepressants have proven to be effective treatments for anxiety disorders.

A

TRUE

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9
Q

Tricyclic antidepressants (TCAs)

A

Antidepressant Drugs

Once was used as first line defense, however no longer

TCAs take longer to reach optimal dose, have many side effects, sedation, and MORE LETHAL IN OVERDOSE

Thought to act by blocking reuptake of norepinephrine or both norepinephrine and serotonin

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10
Q

Side effects of TCAs

A

Orthostatic hypotension (esp. with elderly), confusion, disturbed concentration; anti-cholinergic side effects including blurred vision, dry mouth, constipation, urinary retention

ER/MEDICAL FLOOR TIP: In overdose, may cause fatal arrhythmias, slows AV conduction (consider monitored bed, telemetry)

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11
Q

Side effects of TCAs

A

Orthostatic hypotension (esp. with elderly), confusion, disturbed concentration; anti-cholinergic side effects including blurred vision, dry mouth, constipation, urinary retention

ER/MEDICAL FLOOR TIP: In overdose, may cause fatal arrhythmias, slows AV conduction (consider monitored bed, telemetry)

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12
Q

Nursing Considerations for TCAs

A

suicidal precautions, sugarless lozenges for dry mouth, titrate down doses to avoid HA, Vertigo, wt. changes, avoid alcohol, sleeping pills, In bipolar patients, Tx with TCA’s may lead to hypomania or mania.

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13
Q

List of TCAs

A
  • end in ine

Amitriptyline (Elavil)
Imipramine (Tofranil)
Nortriptyline (Pamelor)

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14
Q

MAOIs

A

Antidepressant

drug that inhibits action of MAO by preventing destruction of monoamines… So synaptic level of neurotransmitters is increased and makes the antidepressant effects possible

If pt is taking this medication, must avoid tyramine rich foods (aged cheese, pickled or smoked fish, meats, wine) or risk hypertensive crisis

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15
Q

Side Effects of MAOIs

A

HTN crisis with consumption of high tyramine foods, photosensitivity, weight gain, sexual dysfunction

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16
Q

Nursing Considerations for MAOIs

A

Low tyramine diet
D/C 10 days prior to anesthesia
Monitor for urinary retention
Meds lower seizure threshold
Suicidal precautions

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17
Q

List MAOIs

A
  • end in ine or mine

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (EMSAM)
Tranylcypromine (Parnate

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18
Q

Tyramine Restrictive Food

A

Avocados
Strong or aged cheeses
Cured meats (salami, beef jerky)
Smoked or processed meats
Pickled or fermented foods
Soybean products
Sauces: soy sauce, shrimp sauce, fish sauce, miso, and teriyaki sauce
Snow peas & fava beans
Beer, red wine, sherry and liqueurs
Dried or overripe fruits (eg. Raisins, prunes, bananas, & avocados)
Meat tenderizers
Old or spoiled foods

**also found in some OTC meds

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19
Q

Major Side Effect of MAOIs

A

Hypertensive crisis (requiring emergency treatment)
Potentially causing a hemorrhagic stroke.

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20
Q

Why is MAOIs less commonly taken?

A

Due to restrictive diet

can cause hypertensive crisis that can require emergency treatment

interacts with many drugs

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21
Q

Adverse Drug Effect: Serotonin Syndrome

A

Can occur when multiple medications that alter serotonin metabolism are used together (MAOIs + SSRI, etc.)

Can be life-threatening

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22
Q

Adverse Drug Effect: Serotonin Syndrome Clinical Symptom Profile

A

Tachycardia
Sweating (diaphoresis)
Fever progressing to hyperthermia
Shivering, Tremor
Muscle rigidity (myoclonus)
Restlessness/Agitation/Delirium/Coma

**key: change in body temp

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23
Q

Selective serotonin reuptake inhibitors (SSRIs)

A

Antidepressant Drugs

Block reuptake and destruction of serotonin.

Less anticholinergic and sedating side effects

24
Q

Indications for use of SSRIs

A

Depression
Anxiety disorders
OCD
Obesity
Bulimia

25
Q

Nursing Considerations for SSRIs

A

Suicide precautions
Use in AM
Requires 4 weeks for full effect
monitor weight
Good mouth care

26
Q

What is the most common class prescribed for depressed mood?

A

SSRIs

27
Q

Side Effects of SSRIs

A

fluctuating weight
anticholinergic
sexual dysfunction

nausea, headache, painful menstruation, sexual dysfunction, insomnia, rash, taste changes, dry mouth, anxiety, tremor, dizziness, weight loss/gain

28
Q

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

A

Antidepressant

HTN is side effect in some pts with higher doses

Side effects include fewer anticholinergic effects.

29
Q

List Serotonin-norepinephrine reuptake inhibitors (SNRIs)

A
  • have “x” in their name

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)

30
Q

Mood Stabilizer - Lithium

A

“The Gold Standard”

Stabilizes depression and mania (bipolar disorder).
Narrows the therapeutic index.
Has a potential for toxicity.

31
Q

Mood Stabilizer - Lithium Toxic Effects

A

Toxic effects can include tremor, ataxia, confusion, convulsions, and N/V.
mechanism of action unknown. May act by affecting electrical conductivity in neurons bc it is a positively charged ion - Affects cardiac contraction - can lead to sinus bradycardia

Disturbances in fluid balance: polyuria, edema

** tremors, coma being KEY

32
Q

What does Lithium cause when taken long-term?

A

Long term use: hypothyroidism

33
Q

T/F

If pt is hyponatremic, can get lithium toxicity

A

TRUE

34
Q

How often do you draw blood to check for Lithium toxicity?

A

Initially weekly
then biweekly
followed by monthly

**blood is drawn often

35
Q

T/F

Lithium has a high therapeutic effect

A

FALSE

has a low therapeutic index… blood draws for effectiveness common

36
Q

Labs drawn for Lithium include

A

Lab: CBC, specifically WBC
Blood levels of Lithium, BUN, Creatinine

37
Q

Nursing consideration for Lithium

A

Lab: CBC, specifically WBC
Assessment of skin for rash
Education on potential weight gain

38
Q

Therapeutic blood level: Lithium

A

0.8 to 1.4 mEq/L

39
Q

Maintenance blood level: Lithium

A

0.4 to 1.3 mEq/L

40
Q

Toxic blood level: Lithium

A

1.5 mEq/L and above

41
Q

What can affect Lithium Levels

A

New blood pressure medication (most of them shift lithium levels)

NSAIDs (non-steroidal anti-inflammatories) can significantly shift Lithium Levels

The most obvious is over-taking Lithium or continuing to take Lithium while losing a lot of water due to the flu, diarrhea, vomiting or excessive exercise without replenishing fluid.

42
Q

Signs of Lithium Toxicity - Acute

A

Diarrhea; Nausea; Vomiting, Stomach Pains
Dizziness; Weakness
Confusion; Memory problems; Psychosis
Hand tremors; Muscle twitching; Ataxia (incoordination)
Nystagmus
Seizures; Coma; Kidney Failure

43
Q

Signs of Lithium Toxicity - Chronic

A

Tremors; Slurred Speech; Increase reflexes

44
Q

What to watch for in anticonvulsant drugs?

A

Watch for rash; may indicate Stevens-Johnson syndrome.

45
Q

Side Effect Profiles of Mood Stabilizers

A

Weight gain
Somnolence
Agranulocytosis
Thrombocytopenia
Hepatitis
Steven Johnson Syndrome- life threatening rash.

46
Q

Antipsychotic Drugs - First Generation

A

AKA conventional, typical or standard antipsychotic drugs

47
Q

Antipsychotic Drugs - First Generation Side Effects

A

extrapyramidal side effects
prolong QT interval
Parkinsons

**URGENT: if temperature is above 103F - they are having an extrapyramidal side effect

48
Q

What are extrapyramidal side effects?

A

Extrapyramidal side effects are a group of symptoms that can occur in people taking antipsychotic medications. 1 Symptoms of extrapyramidal effects include an inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements

49
Q

Second-Generation (Atypical) Antipsychotic Drugs

A

Produce fewer extrapyramidal side effects (EPS)

Target both the negative and positive symptoms

Predominantly D2 (dopamine) and 5-HT2A (serotonin) antagonists (blockers)

Often chosen as first-line treatment

50
Q

Second-Generation (Atypical) Antipsychotic Drugs Side Effects

A

Increase the risk of metabolic syndrome (increased weight, bs, triglycerides)
Insulin resistance

51
Q

List Second-Generation (Atypical) Antipsychotic Drugs

A
  • ending in one, hole, and pine

Clozapine (Clozaril)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Paliperidone (Invega)
Iloperidone (Fanapt)
Lurasidone (Latuda)
Asenapine (Saphris)

52
Q

Clozapine (Clozaril)

A

The first atypical antipsychotic

Highly effective in treating treatment-resistant schizophrenia

Has the least possibility of causing extrapyramidal side effects compared to traditional antipsychotics.

Requires regular blood monitoring for agranulocytosis

53
Q

Black Box Warning - Clozapine (Clozaril)

A

for agranulocytosis, seizures, myocarditis, for “other adverse cardiovascular and respiratory effects”, and for “increased mortality in elderly patients with dementia-related psychosis.“ ~ FDA

Additionally, it also often causes less serious side effects such as hypersalivation and weight gain.

54
Q

ADHD - Atomoxetine (Strattera)

A

Nonstimulant: labeled for 6+

increase attention, promote calmness

55
Q

Attention Deficit Hyperactivity Disorder (ADHD) Treatment

A

For short attention span, impulsivity, and overactivity

May inhibit overactive part of limbic system

NUR 346 (10 decks)

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