Meds exam 2 Flashcards by Casey Goss

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.

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

Lamotrigine (Lamictal)

class, use

Anticonvulsent, esp in peds, used in BPD and Mania

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

SSRIs

SE/AE

Common Side Effects: suicide ideation, nausea, insomnia, dry mouth, HA, sexual dysfunction
Adverse Side Effects: serotonin syndrome, Agitation, diaphoresis

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

TCAs

SE/AE

Common Side Effects: drowsiness, dry mouth, sexual problems
Adverse Side Effects: anticholinergic effects, delirium

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

MAOIs

SE/AE

Common Side Effects: runny nose, itching, skin rash
Adverse Side Effects: hypertensive crisis

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Serotonin syndrome

s/s

Confusion, muscle rigidity, diaphoresis, increased HR, fluctuating BP

How well did you know this?

Not at all

Perfectly

Serotonin syndrome

nursing imp

vitals, reorient, when was the last med? hold all meds, talk to provider about what you see

How well did you know this?

Not at all

Perfectly

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