exam 3 Flashcards
Lithium-indications
-manic episodes of bipolar disorder
Lithium- MOA
- alters cation transport in nerve and muscle
- may also influence re uptake of neuron transmitters
Lithium contraindications
- Hypersensitivity;
- Severe cardiovascular or renal disease;
- Dehydrated or debilitated patients;
- Sodium depletion;
- Brugada syndrome;
- Should be used only where therapy, including blood levels, may be closely monitored;
- Some products contain alcohol or tartrazine and should be avoided in patients with known hypersensitivity or intolerance;
- Lactation.
Lithium- Adverse reactions
- Seizures,
- fatigue,
- headache,
- impaired memory,
- ECG changes,
- abdominal pain,
- anorexia,
- bloating,
- diarrhea,
- nausea,
- polyuria,
- acneiform eruption, *hypothyroism,
- lukocytoisis,
- muscle weakness,
- tremors
Lithium- drug interactions
- Diuretics
- NSAIDS
- Ace inhibitors
- ARBs
- May prolong the action of neuromuscular blocking agents
- Hypothyroid effect
Lithium Toxicity
Toxicity
Therapeutic range: 1-1.5 mEq/L, > 1.5-2.5 mEq/L toxicity starts to occur
Lithium Toxicity Signs and Symptoms
Vomiting diarrhea slurred speech decreased coordination drowsiness muscle weakness twitching
Lithium implimentatin
do not crush or chew
administer with milk or food to minimize GI irritation
Lithium Pt teaching
-take as directed
-may cause dizzies or drowsiness
-drink 2000-3000 ml of fluid
avoid coffee and caffeine
-notify provider of fever -vomiting or diarrhea
-weight gain may occur
-notify provider of fainting, difficulty breathing or irregular pule
-regular lipid panels
Phenytoin MOA
- limits seizure propagationin by altering ion transport
- may also decrease synaptic transmission
- arrhythmic properties
phenytoin- indications
treatment of tonic-clonic seizuers and complex partial seizures
Phenytoin- contraindicated
hystory of hepatoxicity
-bradycardia, 2nd degree 3rd degree heart block
pregnancy
Phenytoin-Adverse reactions
Suicidal thoughts ataxia diplopia nystagmus hypotention acute hepatic failre gingival hyperplasia nausea steven-johnss syndrom toxic epidermal necrolysis agranulocitosis aplastic anema drug reaction with eosinophila and systemic symptoms
phenytoin drug interactions
amiodarone, benzoazepines, capeciitabine, chlodiazepoxide, cimetiding
phenytoin- assessment
- changes in behavior
- suicidal thoughts
- hypersensitivyt syndrome (fever, skin rash, lymphadnopahty
- development of rash
- toxic epidermis necrolysis
*monitor CBC, serum calcium, albumin, and hepatic functions
Phenytoin-pt teaching
- take medication as directed
- may cause drowsiness
- good dental hygiene
- ****Instruct patients that behavioral changes, skin rash, fever, sore throat, mouth ulcers, easy bruising, petechiae, unusual bleeding, abdominal pain, chills, pale stools, dark urine, jaundice, severe nausea or vomiting, drowsiness, slurred speech, unsteady gait, swollen glands, or persistent headache should be reported to health care professional immediately. Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur.
CarBAMazepine-Indications
Treatment of tonic-clonic, mixed and complex partial seizers
mgmtn of trigeminal neuralgia
acute manic or mixed episodes assoiciated with bipolar disorder
CarBamazepine- MOA
Decreases synaptic transmission in the CNS by affecting sodium channels in neurons.
CarBamazepine-contra indication
bone marrow suppression
within 14 days of MAO inhibitors
