Lecture Week 4 - Neuro 2 and Musculoskeletal Flashcards by Isabel Ostroski

Benzodiazepines - therapeutic use

diazepam (Valium)
alprazolam (Xanax)

anxiety disorder and panic disorder

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benzodiazepines prototypes

diazepam (Valium)
alprazolam (Xanax)

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benzodiazepines - expected pharmacologic action

diazepam (Valium)
alprazolam (Xanax)

Enhance inhibitory effects of gamma-aminobutyric acid (GABA)

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benzodiazepines - adverse drug reactions

diazepam (Valium)
alprazolam (Xanax)

CNS depression
hypotension
tachycardia
respiratory distress
Tolerance and physical dependence

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benzodiazepine toxicity

diazepam (Valium)
alprazolam (Xanax)

sedation, hypotension, respiratory depression, cardiac arrest

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benzodiazepines contraindications

diazepam (Valium)
alprazolam (Xanax)

pregnancy
glaucoma

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benzodiazepines interactions

diazepam (Valium)
alprazolam (Xanax)

concurrent use of CNS depressants

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benzodiazepines - RN interventions

diazepam (Valium)
alprazolam (Xanax)

Monitor for withdrawal symptoms: insomnia, anxiety, tremors, diaphoresis, hypertension, seizures
Monitor for phlebitis - inflammation of vein
Assess/Monitor Falls
Regular Vital Signs
Do not stop abruptly
Assess CNS and Respiratory depression

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benzodiazepine antidote

flumazenil (Anexate, Romazicon)

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non-benzodiazepine anxiolytic prototype

buspirone (BuSpar)

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non-benzodiazepine anxiolytic - therapeutic use

buspirone (BuSpar)

Short term treatment of Generalized anxiety disorder (GAD)

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non-benzodiazepines anxiolytic - expected pharmacologic action

buspirone (BuSpar)

Binds to serotonin & dopamine receptors

agonistic action on dopamine

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non-benzodiazepine anxiolytic - adverse drug reactions

buspirone (BuSpar)

Paradoxical effects:
- insomnia
- anxiety
- restlessness
- headache
- dizziness.

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non-benzodiazepine anxiolytic contraindications

buspirone (BuSpar)

MAOI will cause hypertension
grapefruit juice, ketoconazole, erythromycin will increase blood levels

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non-benzodiazepine anxiolytic - RN interventions

buspirone (BuSpar)

monitor for paradoxical effects
monitor falls

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tricyclic antidepressants prototype and others

Amitriptyline (Elavil)

Imapramine (Torfranil)
Nortriptyline (Aventyl)

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tricyclic antidepressant expected pharmacologic action

Amitriptyline (Elavil)

Block norepinephrine reuptake pump & serotonin reuptake pump

boosts availability of serotonin, norepinephrine, acetylcholine, dopamine

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tricyclic antidepressant - therapeutic use

Amitriptyline (Elavil)

treats major depression

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tricyclic antidepressant - adverse drug reactions

Amitriptyline (Elavil)

Anticholinergic effects; sedation

abrupt discontinuation can cause withdrawal (anxiety, headache, muscle pain, nausea)

high risk for overdose (life threatening dysrhythmias, confusion, seizure)

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Tricyclic antidepressants contraindications

Amitriptyline (Elavil)

MAOIs
anticholinergics
CNS depressants
cardiac dysrhythmias
seizures
recent myocardial infarction

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Tricyclic antidepressants RN interventions

Amitriptyline (Elavil)

give at bedtime
orthostatic vital signs
monitor suicidal ideation
taper over 2 weeks
Patient has only 1 week supply at a time

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SSRI prototype and others

fluoxetine (Prozac)

Citalopram (Celexa)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)

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SSRI expected pharmacologic action

Fluoxetine (Prozac)

Block reuptake of serotonin

strengthened transmission of serotonin at serotonergic synapses

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SSRI therapeutic use

Fluoxetine (Prozac)

Depression
anxiety
OCD
bulimia nervosa
premenstrual dysphoric disorder

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SSRI adverse drug reactions Fluoxetine (Prozac)

Insomnia nervousness Sexual dysfunction Weight gain risk for GI bleeding Hyponatremia - low sodium risk for suicidal ideation Serotonin syndrome

SSRI contraindications/interactions Fluoxetine (Prozac)

MAOI St Johns Wort Ibuprofen can decrease glucose control in diabetic patients

SSRI RN interventions Fluoxetine (Prozac)

monitor for adverse effects - anxiety, insomnia, weight gain, decreased libido monitor sodium levels monitor for depression or suicidal ideation do not stop abruptly notify provider of persistent headaches

serotonin syndrome

Hypertensive crisis, hyperpyrexia, agitation can cause coma, muscle rigidity, seizure

SNRI prototype and others

venlafaxine (Effexor XR) duloxetine (Cymbalta)

SNRI expected pharmacologic action vanlafaxine (Effexor XR)

Block neuronal reuptake of serotonin AND norepinephrine increased amt of serotonin/norepinephrine available

SNRI therapeutic use vanlafaxine (Effexor XR)

Major depression social anxiety disorder generalized anxiety disorder (GAD)

SNRI adverse drug reactions vanlafaxine (Effexor XR)

similar to SSRI but sexual dysfunction less common can cause hypertension

SNRI contraindications and interactions vanlafaxine (Effexor XR)

MAOIs first gen antipsychotics ibuprofen

SNRI RN interventions vanlafaxine (Effexor XR)

take in morning monitor for insomnia, sexual dysfunction, weight gain monitor sodium monitor for depression or suicidal ideation monitor BP periodically

monoamine oxidase inhibitors expected pharmacologic action

blocks monoamine oxidase A and B

MAOI therapeutic use

Depression that hasn’t responded to other medications Depression in Bipolar

MAOI prototype and other

phenelzine (Nardil) isocarboxazid (Marplan)

MAOI adverse drug reactions

CNS stimulation GI: constipation, dry mouth, nausea, weight gain sexual dysfunction hypotension hypertensive crisis when eating foods that have tyramine (the food stuff: cheese, meat, yeast, chocolate, alcohol)

MAOI contraindications and interactions

renal failure or liver disease cardiac disease age over 60 SSRIs glaucoma

MAOI RN interventions

monitor vitals and BP give patient list of foods to avoid patient should report severe anxiety, insomnia, agitation

atypical antidepressant prototype

bupropion (Wellbutrin)

bupropion (Wellbutrin) expected pharmacologic action

Inhibits dopamine reuptake increases dopamine availability

bupropion (Wellbutrin) therapeutic use

depression, SAD adjunct to smoking cessation

adverse drug reactions of bupropion (Wellbutrin)

nausea and vomiting weight loss and appetite suppression seizures and CNS stimulation

contraindications for bupropion (Wellbutrin)

eating disorder history seizure disorder MAOI head trauma or CNS tumor

RN interventions wiith bupropion (Wellbutrin)

give in morning with food weigh weekly assess for increased depression/suicidal ideation

mood stabilizer prototype

lithium carbonate (Lithobid)

lithium carbonate expected pharmacologic action

Changes to transport of sodium ions in nerve cells and alters metabolism of catecholamines (fight or flight) in response to stress.

lithium carbonate therapeutic use

Controls acute mania and acute manic episodes assoc. w/bipolar disorder

lithium carbonate adverse drug reactions

GI distress fatigue confusion muscle weakness memory impairment fine hand tremors

lithium carbonate contraindications

pregnancy/lactation cardiac disorders dehydration hyponatremia renal insufficiency make sure to avoid NSAIDs

RN considerations for lithium carbonate

very narrow therapeutic range regular bloodwork 2-3 L fluid per day avoid caffeine consume sodium

first generation antipsychotics prototype

chlorpromazine

chlorpromazine expected pharmacologic action

Block several receptors: norepinephrine, acetylcholine, dopamine, histamine

chlorpromazine therapeutic use

suppress symptoms of schizophrenia and acute manic phase of BP

adverse drug reactions of chlorpromazine

extrapyramidal - abnormal muscle contraction inability to sit still dry mouth, dizziness, urinary retention liver failure

chlorpromazine contraindications

alcohol or CNS depressants SSRIs can cause serotonin syndrome hyponatremia pregnancy/lactation

second generation antipsychotic prototype

risperidone (Risperdal)

risperidone (Risperdal) expected pharmacologic action

Block receptors for dopamine and serotonin

risperidone (Risperdal) therapeutic use

schizophrenia and bipolar disorder

risperidone (Risperdal) contraindications

pregnancy/lactation parkinson's drugs older adults with dementia

nonbiological DMARDs prototype

methotrexate (Rheumatrexate)

methotrexate (Rheumatrexate) therapeutic use

decrease inflammation/joint damage

methotrexate (Rheumatrexate) expected pharmacologic action

immunosuppression

methotrexate (Rheumatrexate) adverse drug reactions

dizziness blurred vision nausea and vomiting decrease blood cells

methotrexate (Rheumatrexate) RN interventions and patient education

use contraceptives 2L per day call provider for jaundice, infection, SOB, bleeding

methotrexate (Rheumatrexate) contraindications

pregnancy/lactation peptic ulcer disease alcohol and liver disease reduce effectiveness by caffeine

biological DMARDs prototype

etanercept (Enbrel)

etanercept (Enbrel) therapeutic use

Decrease joint inflammation and subsequent damage

etanercept (Enbrel) EPA

Inactivates tumor necrosis factor (TNF)

etanercept (Enbrel) adverse drug reactions

immunosuppression pancytopenia - pan = all blood cells heart failure dizziness abdominal pain psoriasis

etanercept (Enbrel) contraindications

no live vaccines active infection hematologic malignancy