medications exam 2 Flashcards
antidepressant drug classes
SSRIs
SNRIs
tricyclic antidepressants (TCAs)
MAOIs
atypical antidepressants (smaller classes)
bupropion (wellbutrin)
mirtazapine (remeron)
trazadone (desyrel)
first line treatment for most depressive disorders, eating disorders, and anxiety disorders
SSRIs and SNRIs
why are MAOIs hardly used anymore?
dietary restrictions – food with tyramine
how are TCAs different from SSRIs or SNRIs?
carry more side effects and are more lethal in overdose
what should you ask about when giving antidepressants?
use of supplements like st. john’s wort
what should be assessed before giving TCAs and why?
suicidality – due to overdose potential
what is an important reminder for patients taking antidepressants?
take several weeks to work
there is a black box warning with children and young adults for increasing suicidal thoughts primarily with which antdepressants?
SSRIs and SNRIs
what causes serotonin syndrome?
too much serotonin resulting in CNS hyperactivity
7 symptoms of serotonin syndrome
hypertension
high fever
sweating
agitation
disorientation
myoclonus
hyperreflexia
examples of SSRIs
fluoxetine/prozac
paroxetine/paxil
sertraline/zoloft
fluvoxamine/luvox
escitalopram/lexapro
citalopram/celexa
3 common side effects of SSRIs and SNRIs
GI issues
headache
sexual dysfunction
what side effects are SOMETIMES experienced with SSRIs and SNRIs?
tiredness
alertness
what happens with abrupt withdrawal of SSRIs and SNRIs?
brain zaps
SSRI and SNRI black box warning
suicidal thoughts in kids and young adults
SNRIs examples
venlafaxine/effexor
duloxetine/cymbalta
desvenlafaxine/pristiq
what is an additional side effects of SNRIs?
hypertension
5 tricyclic antidepressant and MAOI side effects
sedation
weight gain
bP variations
dry mouth
constipation
TCA black box warning
suicidal thoughts in kids and adults – worry about overdose risk due to lethality of overdose
MAOI black box warning
hypertensive crisis – must avoid tyramine rich foods
3 side effects of Bupropoin/Wellbutrin
agitation
insomnia
decreased appetite
Mirtazapine/Remeron 2 side effects
significant sedation
weight gain
trazadone side effects
sedation
bupropion black box warning
lowers seizure threshold plus risk of suicidal thoughts in kids and young adults
mood stabilizers treat …
mood disorders – usually bipolar disorders
gold standard for bipolar disorder
lithium carbonate
most mood stabilizers require _____ regularly
bloodwork
which mood stabilizers require blood work?
lithium carbonate
divalproex sodium/valporic acid (Depakote)
carbamazepine/Tegretol
lithium patients need to be adequately ____ and eat adequate ___ in diet
hydrated; sodium
which mood stabilizers require monitoring of liver and education to avoid heavy alcohol usage and tylenol?
divaloprex sodium
cabamezapine
divalproex sodium and carbemazepine safety concern
liver
what is the safety concern with lamotrigine/lamictal
monitor for rash – stevens-johnsons syndrome is black box warning
mood stabilizer drug classes
lithium
anticonvulsants
6 side effects with lithium carbonate
GI issues
dry mouth
headache
metallic taste
dizziness
drowsiness
what is important to remember about lithium
narrow therapeutic range
therapeutic range of lithium
0.6-1.2mEq/L
what range of lithium can cause toxicity
1.5-2.0
what lithium value is considered severe toxicity?
2.0+
mild lithium toxicity <1.5 side effects
metallic taste
fine hand tremor (resting)
nausea
polyuria
polydipsia
diarrhea or loose stools
muscular weakness or fatigue
weight gain
edema
memory impairments
moderate lithium toxicity 1.5-2.5 side effects
severe diarrhea
dry mouth
N/V
mild to moderate ataxia
incoordination
dizziness, sluggishness, giddiness, vertigo
slurred speech
tinnitus
blurred vision
increasing tremor
muscle irritability or twitching
asymmetric deep tendon reflexes
increased muscle tone
severe lithium toxicity >2.5 side effects
cardiac arrhythmia
blackouts
nystagmus
coarse tremor
fasciculations
visual or tactile hallucinations
oliguria, renal failure
peripheral vascular collapse
confusion
seizures
coma and death
** think hyponatremia
6 side effects of anticonvulsants
GI issues
mood changes
fatigue
dizziness
drowsiness
rash – lamotrigine
what is the therapeutic level for Depakote
50-100 mcg/mL
what are the therapeutic levels for tegretol?
4-12 mg/L
what neurotransmitters do antipsychotics regulate
dopamine and sometimes serotonin
older antipsychotics
typical, only work on dopamine
newer antipsychotics
atypical, work on dopamine and serotonin
which antipsychotic requires blood monitoring
clozapine/clozaril
what signs should be reported when monitoring for tardive dyskinesia with antipsychotics?
unusual mouth movements like lip smacking or tongue protrusion
many antipsychotics cause _____
weight gain
what is a major concern to be aware of with antipsychotics
neurologic malignant syndrome (NMS)
what is NMS
caused by depleted dopamine due to antipsychotics, resulting in CNS hyperactivity
what are the 6 signs/symptoms of NMS?
hypertension
fever
sweating
agitation
disorientation
lead pipe muscle rigidity***
what is the safety concern/black box warning with clozapine/clozaril?
agranulocytosis
how should agranulocytosis be monitored with clozapine?
monitor for signs of infection and sickness like fever and monitor WBCs
what are the 6 side effects of antipsychotics?
EPS – more common with typicals
sedation
weight gain
risk of insulin resistance
constipation
dry mouth
what is the black box warning for antipsychotics
can increase risk of death in elderly dementia patients
tricyclic antidepressant examples
amitriptyline (elavil)
clomipramine (anafril)
doxepin (sinequan)
nortriptyline (pamelor)
imipramine (tofranil)
MAOI examples
phenelzine (nardil)
selegiline (eldepryl)
isocarboxazid (marplan)
rasagiline (azilect)
tranylcypromine (parnate)
anticonvulsant examples
Divalproex sodium/valporic acid (depakote)
lamotrigine (lamictal)
carbamazepine (tegretol)
oxcarbamazepine (trileptal)
levetiracetam (keppra)
topiramate (topamax)
typical antipsychotics examples
haloperidol (haldol)
chlorpromazine (thorazine)
pimozide (orap)
fluphenzaine (proxlin)
atypical antipsychotic examples
clozapine (clozaril)
risperidone (risperdal)
olanzapine (zyprexa)
aripiprazole (abilify)
ziprasidone (geodon)
lurasidone (latuda)
quetiapine (seroquel)
