Exam 4 Module 7 Drug Purpose Flashcards
Properties of anxiolytics
- Prevent tension or fear
- Sedatives
- Hypnotics (sleep and minor tranquilizing)
Risk for addiction/dependence and sedation higher than benzos
Barbiturates
phenobarbital (Luminal) indications
relief of s/sx of anxiety, sedation, insomnia, treatment of seizures
phenobarbital (Luminal) adverse effects
- CNS depression
- bradycardia, hypotension, syncope, hypoventilation
- hypersensitivity
Flumazenil (Romazecon)
Used to treat acute withdrawal syndrome
Benzodiazepines
- Prevent anxiety without causing much sedation
- less likely to cause physical dependence
Acute withdrawal syndrome
Caused by abrupt cessation of drug
Causes nausea, headache, malaise, vertigo, and nightmares
Diazepam (Valium) indications
- Anxiety disorders
- Alcohol withdrawal
- hyperexcitability
- Agitation
- Preop relief of anxiety and tension
Diazepam (Valium) adverse effects
- sedation, drowsiness, depression, lethargy, blurred vision, apathy, mild paradoxical reactions
- HTN, hypotension, arrhytmias, respiratory difficulty
- urinary retention, loss of libido
- withdrawal
Antidote for diazepam
flumazenil
action of tricyclic antidepressants
- prevents reuptake of 5HT and NE
- exact mechanism in decreasing depression unknown
uses of Imipramine (Tofranil)
- relief of depression
- sedative effect for anxiety
- might be effective in treating anuresis in children >6 years old
- being investigated for treating chronic pain
side effects of TCAs
- anticholinergic effects
- sleep disturbances and decreased libildo
nursing process for TCAs
- abrupt cessation causes withdrawal syndrome
- administer at bedtime
interactions with TCAs
- oral anticoagulants lead to higher serum levels of the anticoagulant and increase risk of bleeding
- sympathomimetics or clonidine: risk for HTN and arrhythmias
- MAOIs- lead to severe hyperpyretic crisis with severe convusions, HTN episodes and eath
- all drugs should be carefully considered when given with TCAs
MAOIs (monoamine oxidase inhibitors) actions
irreversibly inhibit MAOs
side effects of MAOIs
- more fatal than other antidepressants r/t accumulation of NE in the synaptic cleft
- HTN crisis: occipital headache, palpitations, neck stiffness, N/V, sweating, dilated pupils, photophonia, tachy, angina… may progress to intracranial bleeding and fatal stroke
- liver toxicity
- mania, hyperreflexia, tremors, confusion, insomnia, agitation, blurred vision
contraindications for MAOIs
- insuline, oral antidiabetic agents: additive hypoglycemic effects (monitor closely)
- TCAs: can result in life threatening hypertensive crisis
- SSRIs: serotonin syndrome… never give at same time
MAOI diet
-avoid tyramine-containing foods: chocolate, aged foods like cheese, wine, meats
treatment for hypertensive crisis
Phentolamine (Regitine) or another adrenergic blocker
actions of SSRIs (selective serotonin reuptake inhibitors)
blocks the reuptake of serotonin with little or no effect on NE
adverse effects of SSRIs
- not as many adverse effects so its a good first-choice drug
- effects are related to increase of 5HT levels
- mild GI and GU
- Resp: cough, upper resp infections, pharyngitis
- CNS: headache, drowsiness, insomnia, anxiety, tremor, seizures (rare)
nursing priorities with pts starting SSRIs
suicide precautions
action of typical antipsychotics
-block dopamine receptors preventing the stimulation of the post-synaptic neurons by dopamine; also suppress the RAS, limiting the stimuli coming into the brain
side effects of antipsychotics
- anticholinergic, antihistamine, alpha-adrenergic blocking effects all related to blocking of dopamine receptor sites
- sedation, tremors, EPS, pseudo-parkinsonism, dystonia, akethesia, tardif dyskonisia, NMS
nursing process for typical antipsychotics
- don’t crush or chew sustained-release capsules
- monitor for glucose intolerance
- acute withdrawal syndrome
- ice and hrd candies for dry mouth
- void before taking if urinary retention is a problem
actions of atypical antipsychotics
block both dopamine and serotonin receptors, helping to alleviate some of the unpleasant neurological effects found in typical
actions of antimanic drugs (lithium)
alters Na+ transport in nerve and muscle cells, inhibits release of NE and dopamine, but not serotonin, from from stimulated neurons; increases the interneuronal stores of NE and dopamine slightly and decreases interneuronal content of second messengers (may allow it to selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state
contraindications of lithium
hyponatremia
s/s: lethargy, slurred speech, muscle weakness, fine tremor, polyuria (renal toxicity), n/v and diarrhea
nursing considerations for lithium
- hold if serum lithium is too high or Na+ is too low
- narrow therapeutic range
- lots of CNS effects
actions and uses of CNS stimulants
- tricks the brain, gives them stimulation that allows them to think in a rational, calm manner
- used for ADD and narcolepsy
actions of phenytoin (Dilantin)
stabilize nerve membranes throughout the CNS directly by influencing ionic channels in the cell membrane thereby decreasing the excitability and hyperexcitability to stimulation
dilantin therapeutic level
10-20 mcg/ml
expected side effects of dilantin
teeth staining and hypertrophy of the gums
actions of succinamides
suppress the normal electrical activity in the brain that is associated with absense seizures
actions of GABA modulators
stabilize nerve membranes:
- directly by altering Na+ and Ca+ channels
- indirectly by increasing activity of GABA (inhibitory transmitter) thereby decreasing excessive activity
side effects of valproic acid (Depakene)
- BBW for increased suicidality
- can be directly toxic to bone marrow and liver
therapeutic level of carbamazepine (tegretol)
4-12 mcg/ml
side effects of carbamazepine (Tegretol)
suicide, SJS (look for skin issues)
actions of levodopa (Dopar)
treats movement disorders
-crosses the BBB because dopamine normally can’t, so meds have to be used to stimulate existing dopamine in the brain
antidote for EPS from neuroleptics
benztropine (Cogentin)
actions and uses of baclophen (Lioresol)
- work in the CNS to interfere with the reflexes that care causing spasm (spasmolytics)
- used for spasms/ tension
antidote to morphine overdose
naloxone (Narcan)
actions of Ergots
block adrenergic and serotonin receptor sites in the brain to cause a constriction of cranial vessels and decrease in cranial artery pulsations and decrease in hyperfusion of the basilar artery
big side effect of Ergots
pulselessness, parasthesias, muscle pain
drug interactions of Ergots
beta blockers (risk for peripheral ischemia and gangrene
succinylcholine (Anectine) actions
attaches to the acetylcholine receptor site on the muscle cell causing a prolonged depolarization of the muscle
antidote for succinylcholine (Anectine)
a cholinesterase inhibitor
