Lecture Week 4 - Neuro 2 and Musculoskeletal Flashcards
Benzodiazepines - therapeutic use
diazepam (Valium)
alprazolam (Xanax)
anxiety disorder and panic disorder
benzodiazepines prototypes
diazepam (Valium)
alprazolam (Xanax)
benzodiazepines - expected pharmacologic action
diazepam (Valium)
alprazolam (Xanax)
Enhance inhibitory effects of gamma-aminobutyric acid (GABA)
benzodiazepines - adverse drug reactions
diazepam (Valium)
alprazolam (Xanax)
CNS depression
hypotension
tachycardia
respiratory distress
Tolerance and physical dependence
benzodiazepine toxicity
diazepam (Valium)
alprazolam (Xanax)
sedation, hypotension, respiratory depression, cardiac arrest
benzodiazepines contraindications
diazepam (Valium)
alprazolam (Xanax)
pregnancy
glaucoma
benzodiazepines interactions
diazepam (Valium)
alprazolam (Xanax)
concurrent use of CNS depressants
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
benzodiazepine antidote
flumazenil (Anexate, Romazicon)
non-benzodiazepine anxiolytic prototype
buspirone (BuSpar)
non-benzodiazepine anxiolytic - therapeutic use
buspirone (BuSpar)
Short term treatment of Generalized anxiety disorder (GAD)
non-benzodiazepines anxiolytic - expected pharmacologic action
buspirone (BuSpar)
Binds to serotonin & dopamine receptors
agonistic action on dopamine
non-benzodiazepine anxiolytic - adverse drug reactions
buspirone (BuSpar)
Paradoxical effects:
- insomnia
- anxiety
- restlessness
- headache
- dizziness.
non-benzodiazepine anxiolytic contraindications
buspirone (BuSpar)
MAOI will cause hypertension
grapefruit juice, ketoconazole, erythromycin will increase blood levels
non-benzodiazepine anxiolytic - RN interventions
buspirone (BuSpar)
monitor for paradoxical effects
monitor falls
tricyclic antidepressants prototype and others
Amitriptyline (Elavil)
Imapramine (Torfranil)
Nortriptyline (Aventyl)
tricyclic antidepressant expected pharmacologic action
Amitriptyline (Elavil)
Block norepinephrine reuptake pump & serotonin reuptake pump
boosts availability of serotonin, norepinephrine, acetylcholine, dopamine
tricyclic antidepressant - therapeutic use
Amitriptyline (Elavil)
treats major depression
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)
Tricyclic antidepressants contraindications
Amitriptyline (Elavil)
MAOIs
anticholinergics
CNS depressants
cardiac dysrhythmias
seizures
recent myocardial infarction
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
SSRI prototype and others
fluoxetine (Prozac)
Citalopram (Celexa)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)
SSRI expected pharmacologic action
Fluoxetine (Prozac)
Block reuptake of serotonin
strengthened transmission of serotonin at serotonergic synapses
SSRI therapeutic use
Fluoxetine (Prozac)
Depression
anxiety
OCD
bulimia nervosa
premenstrual dysphoric disorder
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
