Meds exam 2 Flashcards
Lithium
(Category, intended actions)
Drug Category: Mood stabilizers
What other frequently prescribed medications are in this category? Carbamazepine, risperidone
Intended Action (s): resolve symptoms of mania (hyperactivity, pressured speech, poor judgment), decreased incident of mood swings, etc.
Lithium
(SE & AE)
Common Side Effects: fatigue, HA, impaired memory, EKG changes, hypothyroidism, abdominal pain, N/V, leukocytosis, muscle weakness, tremors, polydypsia, polyuria
Adverse Side Effects: seizures, serotonin syndrome
Lithium
(nursing implications, teaching priorities)
Patient Teaching Priorities: changes in sodium will alter the elimination of lithium. Increased sodium intake will increase the renal excretion of lithium.
Nursing Implications: very narrow therapeutic range (0.6-1.2), monitor levels closely and teach patient they will need to get blood work periodically. Look for lithium toxicity (vomiting, diarrhea, slurred speech, lightheadedness, decreased coordination, drowsiness, muscle weakness, tremors, seizures). Stop drug administration if toxicity. Worried also about potassium levels with the salt intake. Not having enough sodium can lead to increased reuptake of lithium→ toxicity. Prelithium workup → cardiac and renal status. Adequate sodium and fluid intake. Teach pt to wear sunscreen
Depakote
(Category, intended actions)
Drug Category: Valproate, anticonvulsant
What other frequently prescribed medications are in this category: carbamazepine, Lamotrigine, Phenytoin
Intended Action(s): increase levels of GABA, → decrease manic episodes
Depakote
SE/AE
Common Side Effects: agitation, dizziness, HA, insomnia, sedation, abdominal pain, diarrhea, N/V, tremors, thrombocytopenia
Adverse Side Effects: suicidal thoughts, hepatotoxicity, pancreatitis, hypothermia, hyperammonemia, agranulocytosis, aplastic anemia
Depakote
nurse impl, pt ed
Patient Teaching Priorities: abrupt withdrawal of drug may lead to seizures
Nursing Implication: assess for suicidal tendencies, restrict amount of drug available to pt. Looks for s/s of DRESS (drug reaction with eosinophilia and systemic symptoms) (fever, rash, lymphadenopathy, myocarditis, etc.) monitor hepatic function and serum ammonia levels. Discontinue therapy if hyperammonemia occurs.
Valproic acid/tegratol
category, action
Drug Category: Anticonvulsant, mood stabilizer
What other frequently prescribed medications are in this category? (Gabapentin), Valproic acid, (Phenytoin)
Intended Action (s): prevention of seizures, relief of neuralgia pain, decreased mania and depressive symptoms.
Valproic acid/tegratol
SE/AE
Common Side Effects: Suicidal thoughts ataxia, drowsiness fatigue. Hepatotoxicity, pancreatitis. Agranulocytosis, anemia, thrombocytopenia.
Adverse Side Effects: blood cell abnormalities, could result in bone marrow depression
Valproic acid/tegratol
nurse imp, pt ed
Patient Teaching Priorities: take doses around the clock as directed and take missed doses ASAP but not right before the next dose. Discontinue gradually to prevent seizures. Avoid grapefruit and grapefruit juice during therapy. Report changes in skin, behavior, rash, sore throat, suicidal thoughts, etc.
Nursing Implications: for bipolar: assess mental status and cognitive abilities before and during therapy. Monitor labs for the first 2 months.
Lamotrigine (Lamictal)
class, use
Anticonvulsent, esp in peds, used in BPD and Mania
Lamotrigine/Lamictal
SE, AE, caution
Significant AE: Stevens Johnson syndrome, hold and call provider if rash
Common SE
weight changes
sedation
upset stomach
Caution in hepatic and renal impairment
SSRIs
drugs, uses
Example drug: Zoloft
generic and trade: Sertraline
What other frequently prescribed medications are in this category? Include 2-3 examples: Fluoxetine (Prozac), Citalopam (Celexa), Escitalopam (lexapro), Fluvoxamine (Luvox)
SSRIs
SE/AE
Common Side Effects: suicide ideation, nausea, insomnia, dry mouth, HA, sexual dysfunction
Adverse Side Effects: serotonin syndrome, Agitation, diaphoresis
SSRIs
nurse imp, pt ed
Patient Teaching Priorities: Take at same time every morning
Nursing Implication: Teach patient that effects may take 4-6 weeks to take effect, report SI
TCAs
meds, uses
Name (generic and trade): clomipramine (anafranil) (first med for OCD)
What other frequently prescribed medications are in this category? Include 2-3 examples: Amitriptyline (Elavil), Imipramine (Trofanil), Noritryptaline (pamelor), Doxepin (sinequan)
Intended Action(s): depression, OCD, migraines, smoking cessation
TCAs
SE/AE
Common Side Effects: drowsiness, dry mouth, sexual problems
Adverse Side Effects: anticholinergic effects, delirium
TCAs
nurse imp, pt ed
Patient Teaching Priorities: TCA’s are sedative so take before bed
Nursing Implications: monitor for suicide ideation and orthostatic hypotension, high suicide effectiveness, high cost
MAOIs
drugs, uses
Example drug: Selegiline
generic and trade: edepryl, emsam
What other frequently prescribed medications are in this category? Include 2-3 examples: phenelzine (nardil), tranylcypromine (parnate), isocarboxazid (Marplan), Moclobemide (Manerix, RIMA)
Intended Action(s): depression, panic, social anxiety
MAOIs
SE/AE
Common Side Effects: runny nose, itching, skin rash
Adverse Side Effects: hypertensive crisis
MAOIs
nurse imp, pt ed
Patient Teaching Priorities: warn patients about signs of hypertensive crisis (headache, shortness of breath, headache, changes in vision), avoid eating tyramine (aged cheese, avocados, chinese food)
Nursing Implication: Monitor blood pressure
Serotonin syndrome
s/s
Confusion, muscle rigidity, diaphoresis, increased HR, fluctuating BP
Serotonin syndrome
nursing imp
vitals, reorient, when was the last med? hold all meds, talk to provider about what you see
Hypertensive crisis
from MAOIs, especially when taken with other antidepressants, pseudoephedrine, amphetamines, cocaine cyclobenzaprine (Flexeril), dopamine, methyldopa, levodopa, epinephrine, buspirone (Buspar) or if the patient has tyramine
Benzos
drugs, uses
What other frequently prescribed medications are in this category? Chlordiazepoxide (Librium), Diazepam (Valium), Clonazepam (Klonopin), Alprazolam (Xanax), Chlorazepate (Tranxene), Midazolam (Virsed)
Lorazepam (Ativan) – short half-life, intermediate onset
Diazepam (Valium) – long half-life, fast acting
Intended Action(s): Depress CNS by potentiating GABA, resulting in sedation, decreased anxiety, and decreased seizures (Used during ECT), short term in alc withdrawl
Benzos
SE/AE
Common Side Effects: Dizziness, drowsiness, lethargy, forgetfulness, confusion, constipation, feelings of detachment, irritability, hostility,
Adverse Side Effects: Respiratory depression, cardiac arrest (rapid IV usage), tolerance, physical dependence, rebound anxiety.
Benzos
nursing imp, pt ed
Patient Teaching Priorities: This is a medication for short term use, and the dosage must be decreased gradually to minimize withdrawal symptoms (tremors, nausea, vomiting, abdominal, agitation, tremors, seizures and muscle cramps)
Nursing Implications: Flumazenil (Romazicon) is antidote if overdose, evaluate for too much CNS depression or potential for abuse.
Clonidine
use, category
Treats physical symptoms associated with anxiety like tremors/diaphoresis/hypertension, also used for ADHD, can be used in withdrawl to help with symptoms
Category: Non-benzo anxiolytics, alpha 2 receptor agonist
Clonidine
SE, nursing imp
Side effects: palpations, tachycardia, bradycardia, constipation, dry mouth sedation, rebound syndrome (increase in anxiety)
Check BP, monitor for hypotension, falls precaution, watch for rebound hypertension
Disulfiram (antabuse)
use, SE, pt ed, nuring imp
alc deterant
SE: Rash, acne, HA, taste changes impotence
Cannot drink with med, start with flushing, increased heart rate, headache, can progress to life threatening rxn, so they even need to check things like mouthwash for alcohol
monitor liver function
Acomprosate (campral)
prevents reengaging with alc
SE: GI upset, myalgia, arthritis, HA, dry mouth
poor compliance
monitor kidney function
Naltrexone
opioid antagonist, helps them stay away from substance, can be long acting/given monthly
SE: N, HA, Dysphoria, elevated liver enzymes
Monitor liver enzymes
injection site reactions
Buprenorphine
opiod substitute
partial opioid agonist/antagonist
SE: N/V, constipation, dry mouth
can cause precipitated withdrawal
watch for sedation and respiratory depression
Methadone
synthetic opioid agonist
SE: N/V/C, dry mouth, sexual dysfunction, menstrual irregularities, weight gain, prolonged QT
Watch for sedation, respiratory depression
* Drug interactions
* Get baseline EKG
Naltrexone (Revia, Vivitrol)
opioid antagonist
SE: N, HA, dysphoria, elevated liver enzymes
monitor liver enzymes
injection site rxns
Haloperidol/Haldol
d, traditional antipsychotic
Fluphenazine/prolixin
d, traditional antipsychotic
chlorpromazine/thorazine
antipsychotic
decanote
long acting dosing version, d
risperidone
d, atypical antipsychotics
Clozapine
atypical antipsychotics (AE)
olanzapine/zyprexa
d, atypical antipsychotics
Ziprasidone/geodon
atypical antipsychotics
aripiprazole/abilify
d, atypical antipsychotics
Quetiapine/seroquel
atypical antipsychotics
Side effect of antipsychotics
EPS – tardive dykinesia, acute dystonia, akathesia (restlessness), pseudoparkinsonism, anticholinergic effects (especially hypotension)
blurred vision, dry mouth, sedation
weight gain
orthostatic hypotension
lowers seizure threshold
neuroleptic malignant syndrome → mental status change, rigidity, fever, diaphoresis, hypertension
agranulocytosis, more with atypicals → cold/flu-like symtoms
photosensitivity
cardiac arrhythmias
Nursing things to be aware of with antipsychotics
be aware of fevers or increased HR
look at available PRNs like cogentin or benadryl for side effects
Valbenazine (Ingrezza) SE: balance problems, HA, anticholinergic effects / AE: QT prolongation, somnolence, Parkinson’s S&S
teach pt to wear sunscreen especially with traditional antipsychotics
for agranulocytosis or NMS discontinue med and treat symptoms
monitor glucose, lipids and cholesterol periodically
monitor for agranulocytosis
use abnormal involuntary movement scale
importance of adherence
daytrana
patch, methylphenidate, psychostimulants
adderall, vyvanse
amphetamine, psychostimulants
psychostimulants
AE
tics/stereotypical movements
anxiety
insomnia
rebound headaches
psychostimulants
nursing implications
assess weight/height, may need to take breaks
potential for abuse by others
Traditional vs atypical antipsychotics
Tradionals are more rapid acting and sedating, but have more side effects. Atypicals are cheaper with less side effects
Aricept/donepezil
for dementia
increases Ach for mild-moderate disease
Rivastigmine/exelon
dementia, patch, concern of them taking it off,
memantine/Namenda
dementia, moderate to severe, slow degeneration
Namzaric (donepezil + memantine)
dementia, ER
