Exam 2 drugs Flashcards
What is Lithium used for?
Acute mania/manic episodes, prevent mania/depression related to bipolar, decrease suicide incidence
Lithium effect on neurotransmitters
reduce dopamine and glutamate, increase GABA, change sodium ion transport
Lithium adverse reactions
L-levels-thyroid I-increased urination T-thirst/tremor H-hair loss/hypothyroidism I-impaired memory/interactions U-upset stomach M-muscle weakness S-skin conditions-dry skin, psoriasis
N/V, GI upset, hand tremors, polyuria, mild thirst, weight gain, hypotension, electrolyte imbalance, renal toxicity, goiter, hypothyroidism
Lithium toxicity
narrow therapeutic range. 1.0-1.5 initial treatment. Maintenance 0.6-1.2
Early toxicity indications: 1.5-2.0 mEq/L confusion, sedation, poor coordination, coarse tremors, GI distress, N/V/D; hold med and inform provider
Advanced: 2.0-2.5 mEq/L extreme polyuria, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension, stupor leading to coma, possible death-respiratory complications; give emetic, gastric lavage, meds to increase excretion
Severe greater than 2.5 mEq/L manifestations rapidly progress coma and death. Need hemodialysis at this point.
Lithium contraindications/precautions
teratogenic, renal insufficiency, cardiac disorders, dehydration, low salt diets, diabetes, seizures disorders, SI
Lithium interactions
diuretics, NSAIDs, ACE inhibitors-CAN CAUSE LITHIUM TOXICITY
Remember “AND” (ACE, NSAIDs, Diuretics)
anticholinergics=abdominal pain
Patient education-Lithium
take with food/milk, s/s hypothyroidism and lithium toxicity, 2-3 L fluids daily, avoid low sodium diets, sweating, vomiting, diarrhea can increase lithium levels
What is carbamazepine used for?
seizures, mood stabilizer for bipolar
Carbamazepine mechanism of action?
inhibit influx of sodium through sodium channels=decreased discharge neurons around areas of increased activity
Carbamazepine therapeutic level?
4-12 mcg/mL
Carbamazepine adverse reactions?
visual disturbances, headache, ataxia, nystagmus, blurred vision, fluid retention, photosensitivity (usually subsides), SIADH, bone marrow suppression, leukopenia, anemia, thrombocytopenia, Stevens-Johnson syndrome
Carbamazepine interactions
OTC and prescription drugs may increase or decrease drug levels, contraceptives, warfarin
Carbamazepine patient education
take with food, no grapefruit, monitor for rashes, s/s HF due to fluid retention (decreased urine output, SOB, edema), sun protection, need alternate birth control, report all meds and supplements
Valproic acid use:
mania associated with bipolar
off brand use for agitation and behaviors r/t dementia
Valproic acid effect on neurotransmitters:
increase GABA, might inhibit glutamate (exact mechanism unknown), inhibits influx of sodium through sodium channels=decreased discharge neurons around areas of increased activity
Valproic acid therapeutic level
50-120 mcg/mL
Valproic acid adverse reactions
GI upset, weight gain, thrombocytopenia, bone marrow suppression (low RBC, platelets=increased bleeding, bruising, hematuria), hyperammonemia, liver toxicity, anorexia, jaundice, nausea, abdominal pain, pancreatitis, vomiting, confusion, decreased LOC, increased serum amylase
Valproic acid contraindications/precautions
teratogenic, liver dz, hyperammonemia, pancreatitis
Valproic acid interactions
phenytoin, phenobarbital, topiramate (other anticonvulsants)
First Gen Antipsychotics and Use
Chlorpromazine and Haloperidol
Suppress positive symptoms of schizophrenia
First Gen Antipsychotics effect on neurotransmitters
Suppresses the release of dopamine
Blocks receptors for: norepinephrine, acetylcholine, dopamine, and histamine
First Gen Antipsychotics adverse reactions
Extrapyramidal effects (EPS)
Acute dystonia (hours to days)
Tardive dyskinesia (months to years)
Akathisia (days to weeks)
Pseudoparkinsonism-weeks to months, usually resolves
Anticholinergic, gynecomastia, galactorrhea, weight gain, sexual dysfunction, menstrual irregularities, liver impairment, cataracts
Agranulocytosis
Neuroleptic malignant syndrome (NMS) – medical emergency
Severe dysrhythmias, seizures, sedation
First Gen Antipsychotics Contraindications/Precautions
ETOH withdrawal, bone marrow suppression, CNS depression, pregnancy or lactation
Glaucoma, diabetes, HTN
Cardiac, liver, thyroid disorders
First Gen Antipsychotics Interactions
CNS depressants, antacids and antidiarrheals
Decreases levels of anticonvulsants– measure serum levels
Meds for bipolar disorders!
Especially valproic acid (Depakote)
Second Gen Antipsychotics and Use
risperidone, olanzapine, quetiapine
Use: Treat schizophrenia, bipolar disorder, irritability d/t autism
Second Gen Antipsychotics effect on neurotransmitters
Block dopamine and serotonin receptors
Second Gen Antipsychotics adverse effects
Extrapyramidal effects (EPS) at high doses
Metabolic side effects: weight gain, dyslipidemia, impaired glucose regulation, diabetes
Anticholinergic effects, drowsiness, insomnia, dizziness, gynecomastia, galactorrhea
Second Gen Antipsychotics Contraindications/precautions
CNS disorders, cardiac concerns, cerebrovascular accidents, hypotension, seizure disorders, kids and older adults
Second Gen Antipsychotics Interactions
antihypertensives, anticonvulsants
Benztropine use
Used for muscle spasms, bronchospasm
Treat side effects associated with antipsychotics
Pseudoparkinsonism, acute dystonia
does NOT treat tardive dyskinesia
Anticholinergic (antimuscarinic), blocks histamine receptors and antagonizes (blocks) acetylcholine
Benztropine interactions
histamines and other anticholinergics
Aripiprazole
3rd gen antipsychotic, lowest risk for side effects, extrapyramidals, metabolic, anticholinergic effects
Clozapine
First developed second gen
highest risk of fatal agranulocytosis, more adverse effects than other second gen
high risk weight gain, diabetes, dyslipidemia
requires special license to prescribe
Benzodiazepines and use
Diazepam and Lorazepam ‘lam or pam’ endings
Short term GAD and panic disorder
Benzodiazepine effect on neurotransmitters
Increase effect of GABA, risk for addiction
Benzodiazepine adverse reactions:
CNS depression, dizziness, drowsiness, lethargy, hypotension, tachycardia, respiratory depression
Benzodiazepine contraindication/precaution
teratogenic, conditions/meds that increase CNS depressant effect, patients prone to addiction
Benzodiazepine interactions
Respiratory depression when combined with other CNS depressants (alcohol, opioids other benzos), kava kava, chamomile, valerian, Cimetidine, smoking decreases effect of benzos
Benzodiazepine Monitoring/Intervention
fall risk, sedation, paradoxical rxn older adults, tolerance/dependence, taper to avoid withdrawal, vital signs, memory assessment, if giving through IV give slowly
Keep IV Flumazenil nearby,
Buspirone use
Short acting for anxiety, GAD
Buspirone effect on neurotransmitters
agonist for serotonin and dopamine
Buspirone adverse effects
insomnia, anxiety, restlessness, GI upset, nausea, headache, dizziness, lightheaded
Buspirone contraindications
liver or kidney insufficiency
Buspirone patient education
Must take daily-takes several weeks to reach therapeutic levels
Buspirone interactions
MAOI’s within 2 weeks=HTN crisis, erythromycin, grapefruit juice, ketoconazole
