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Medications / Conditions Flashcards

1
Q

Name 6 SSRI’s

A 
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)
Vilazodone (Viibryd)
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2
Q

Common side effects of SSRI’s?

A

Nausea
vomiting or diarrhea
Headache
Dry mouth
Drowsiness
Insomnia
Nervousness
Agitation or restlessness
Dizziness
Sexual problems
Impact on appetite, leading to weight loss or weight gain

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3
Q

What is serotonin syndrome?

A

Rarely, an antidepressant can cause high levels of serotonin to accumulate in your body. Serotonin syndrome most often occurs when two medications that raise the level of serotonin are combined. These include, for example, other antidepressants, certain pain or headache medications, and the herbal supplement St. John’s wort.

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4
Q

Symptoms of Serotonin syndrome?

A

Anxiety, agitation, restlessness
High fever, sweating
Confusion
Tremors, lack of coordination
Major changes in blood pressure
Rapid heart rate.

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5
Q

What is Lithium?

A

mood stabilizers for manic episodes of bipolar I disorder (treatment, maintenance, prophylaxis).
Prevents/decreases incidence of acute manic episodes.

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6
Q

How does Lithium work?

A

reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission

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7
Q

Side effects of Lithium?

A

S: SEIZURES
A: Arrhythmias
M: Metallic taste, dry mouth

H: Hypo / hyper thyroidism, hypotension
I: Irritability
T: Toxicity, renal, tremors
S: Sedation

D: Dizziness, drowsiness,
A: Abdominal pain / symptoms
B: Blurred vision

L: low sodium (hypoatremia) leukocytosis
O: PsychOmotor Retardation
W: Weight gain

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8
Q

Theraputic range of Lithium?

A

A safe blood level of lithium is 0.6 and 1.2 milliequivalents per liter (mEq/L). Lithium toxicity can happen when this level reaches 1.5 mEq/L or higher.

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9
Q

Signs/ Symptoms of Lithium Toxicity?

A

S: Slurred speech / seizure
H: high fever
A: Agitation
E: Eyes movements uncontrollable

T: Twitching / uncoordinated
O: lOw blood pressure
X: kidney failure
I: increased (rapid) heartrate
C: Confusion, coma, delirium or death

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10
Q

What to advice patients about regarding Lithium Toxicity?

A

Loosing water and salt can effect the absorption of lithium, risk for toxic levels. Advise to drink 2000–3000 mL fluid each day and eat a diet with consistent and moderate sodium intake. Excessive amounts of coffee, tea, and cola should be avoided because of diuretic effect.

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11
Q

What to monitor in Lithium Toxicity?

A

Blood pressure, blood lithium levels, signs of kidney failure, hyperthermia

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12
Q

Treatment of Lithium Toxicity?

A

Treatment may include activated charcoal if you took other substances as well, kidney dialysis in severe cases, or whole bowel irrigation

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13
Q

What medications can lead to lithium toxicity?

A

Medications that can lead to dehydration or make your kidneys not work as well as normal:
including diuretics,
ACE inhibitors, and NSAIDs like aspirin, Motrin/Advil (ibuprofen), and Aleve (naproxen)

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14
Q

What is Divalproex (Epival) used for

A

Manic episodes
Prevention of migraine headache
Anticonvulsant

.

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15
Q

Action of Divalproex?

A

Action: Increase levels of GABA, an inhibitory neurotransmitter in the CNS.

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16
Q

Side effects of divalproex?

A

D: DRESS
I: Insomnia
V: Visual disturbances
A: Abonminal symptoms and pain
L: Leukopenia (low WBC)
P: Pancreatitis
R: Rash
O: HepatOtOxicity, HypOthermia
E: Edema
X: SUICIDAL THOUGHTS, agitation

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17
Q

What is DRESS?

A

A severe adverse drug reaction that includes the symptoms of
skin rash
fever
swelling of lymph nodes
inflammation of the liver, lung , and heart.

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18
Q

Signs and symptoms of narcotic overdose?

A

Face is clammy to touch and has lost color
Blue lips and fingertips
Non-responsive to his/her name or a firm sternum rub using the knuckles
Slow or erratic breathing, or no breathing at all
Deep snoring or a gurgling sound (i.e. what would be described as a “death rattle”)
Heartbeat is slow or has stopped

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19
Q

Dose of Naloxone?

A

0.4 mg/mL
A second dose of 0.4 mg/mL is sometimes needed if the first dose does not reverse the overdose and restore breathing.

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20
Q

What drugs cause Extrapyramidal symptoms?

A

caused by dopamine blockade or depletion
Antipsychotic Medication
Certain non-antipsychotic agents: antidepressants, lithium, various anticonvulsants
(clozapine, risperidone, olanzapine, quetiapine, paliperidone, abilify)

21
Q

What are Extrapyramidal symptoms?

A

Caused by dopamine blockade or depletion in the basal ganglia.

B-Bradykinesia (slowness of movement)
A: Akathisia - motor restlessness
D: Dystonia - spasms and muscle contractions

P: Parkinsonism- rigidity, tremor
T: Tardive dyskinesia (irregular, jerky movements)

22
Q

Just gave insulin and your patient is refusing to eat what do you do

A

Explain to the patient the importance of eating especially after having insulin. Read the chart to see if this has happened before and if there was an intervention. Have another staff with good rapport talk to them. Encourage the patient to have juice at least.

23
Q

What are some early signs of hypoglycemia?

A

Think hangry.

Shakiness, Dizziness, Sweating, Hunger, Irritability or moodiness, Anxiety or nervousness, Headache

24
Q

What are some severe signs of hypoglycemia?

A

Clumsiness or jerky movements, Muscle weakness, Difficulty speaking or slurred speech, Blurry or double vision, Drowsiness, Confusion, Convulsions or seizures, Unconsciousness, Death

25
Q

How does alcohol effect insulin?

A

Alcohol consumption increases insulin secretion, which leads to low blood sugar

26
Q

What is clozapine?

A

Antipsychotic
Schizophrenia unresponsive to or intolerant of standard therapy with other antipsychotics (treatment refractory).
To reduce recurrent suicidal behavior in schizophrenic patients.

27
Q

Action of clozapine?

A
  • Binds to dopamine receptors in the CNS.
  • Also has anticholinergic blocking activity.
  • Produces fewer extrapyramidal reactions and less tardive dyskinesia than standard antipsychotics but carries high risk of hematologic abnormalities.
28
Q

What are Typical antipsychotics (1st generation)?

Risks?

A

High risk for EPS and tardive dyskinesia, and weight gain

Examples: Haldol, Loxapine, Chlorpromazine

29
Q

What are Atypical antipsychotics?

A

Fewer side effects, lower risk of EPS, mood stabilizing effect, higher risk metabolic syndrome and weight gain.

Olanzapine, risperidone, papiperidone, Seroquel

30
Q

What are 3rd generation antipsychotics effects?

A

Minimal EPS, higher risk of akathisia - is a movement disorder- feeling of inner restlessness and inability to stay still

abilify

31
Q

How to treat EPS?

A

Use anticholinergic agents:
Procyclidine, benztropine (Cogentin), diphenhydramine (Benadryl), and trihexyphenidyl (Artane).

32
Q

What is tardive dyskinesia?

A

Tardive dyskinesia is a side effect of antipsychotic medications.

33
Q

How does tardive dyskinesia present?

A
  • Movements of the mouth (Lip smacking, frowning)
  • Rapid body movements of arms, legs, trunk
  • Disfigured facial features (drooping)
  • Rapid blinking
  • Difficult breathing, swallowing, speaking
34
Q

What are some examples of Typical (1st) antipsychotics?

A

Haldol
flupenthixol
chlorpromazine

35
Q

What are some examples of Atypical (2nd) antipsychotics?

A

Aripiprazole (ambilify)
Lurasidone
olanzapine
Clozapine

36
Q

What is neuroleptic malignant syndrome?

A

Neuroleptic malignant syndrome (NMS) is a rare reaction to antipsychotic drugs.
It affects the nervous system and causes symptoms like a high fever and muscle stiffness.

37
Q

How does Neuroleptic malignant syndrome present?

A 
Muscular rigidity (typically, “lead pipe” rigidity)
Hyperthermia (temperature >38°C)
Diaphoresis.
Pallor.
Dysphagia
Shortness of breath
Tremor.
Incontinence.
38
Q

How to treat NMS?

A

Muscle relaxant, such as dantrolene (Dantrium)
Parkinson’s disease drugs that make your body produce more dopamine, such as amantadine (Symmetrel) or bromocriptine (Parlodel)

39
Q

How to treat serotonin syndrome?

A

Benzodiazepine medicines, such as diazepam (Valium) or lorazepam (Ativan) to decrease agitation, seizure-like movements, and muscle stiffness.
Cyproheptadine (Periactin), a drug that blocks serotonin production.

40
Q

What is the SAVE ME acronym?

A

Stimulate- shake the person
Airway- assess airway
Ventilate- 1 breath every 5 seconds
Evaluate- are they breathing on thier own?
Medication- administer naloxone (ampoule)
Evaluate- again (if nothing happens in 5 min, administer another dose)

41
Q

What is clozapine used for?

A

Treatment resistant schizophrenia
Works on positive and negative symptoms
Rarely has EPS or NMS
Can be very sedating

42
Q

What are risks of Clozapine?

A

Metabolic syndrome- weight gain, high lipids, high glucose
This leads to diabeties and cardiac issues
High risk of agranulocytosis (Low WBC)-blood work
High risk of myocarditis and myopathy (Highest in first 4 weeks)- why we do vital signs
-Watching for decreased bp and increased HR

43
Q

Name the Medication rights

A

right patient (use at least two patient identifiers)
right medication
right dose
right time and frequency
right route
right reason
right documentation
right to refuse

44
Q

Name side effects of Risperidone

A

Drowsiness, dizziness, lightheadedness, drooling, nausea, weight gain, or tiredness
Has potential to raise blood sugar.
Cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels. These effects, along with diabetes, may increase your risk for developing heart disease.
Can rarely cause NMS or TD

45
Q

What psychotropic medications need blood monitoring?

A

Lithium, clozapine, epival, carbamazepine

46
Q

How is clozapine monitored?

A

Baseline blood tests should check white cell count, troponins, CRP.
We monitor with color status. Green, yellow and red.
Green means they can continue treatment as usual, yellow indicated that abnormalities are showing leukocyte and absolute neutrophil counts and there is need to use caution, if patient is on red status, clozapine needs to be discontinued.

47
Q

What are the signs of overdose

A

Signs of an overdose include:
Face is clammy to touch and has lost color
Blue lips and fingertips
Non-responsive to his/her name or a firm sternum rub using the knuckles
Slow or erratic breathing, or no breathing at all
Deep snoring or a gurgling sound (i.e. what would be described as a “death rattle”)
Heartbeat is slow or has stopped

48
Q

Patient states they are allergic to Haldol because their neck gets sore. What do you do?

A

EPS- give cogentin and reassure patients it is not an allergy but instead a side effect of antipsychotics. Give cogentin.

49
Q

What medications are held the night before ECT?

A

zopiclone, benzodiazepines, Epival

Interview (8 decks)

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