Midterm Meds Flashcards
What are pharmacologic treatments for depression?
ketamine
antidepressants
- SSRIs
- SNRIs
- Trazodone
- TCAs
- MAOIs
- Bupropion
What is a priority when giving antidepressants?
safety!
black box warning
- increased risk of suicide in first few weeks, check on pt often
What are examples of SSRIs?
citalopram
escitalopram
fluoxetine
paroxetine
sertraline
What are SSRIs used for?
tx for:
- depression with anxiety
- panic disorder
- PTSD
- OCD
- bulimia
How long will it take to see the effects of SSRIs?
2-3 weeks
Is it possible to overdose on SSRIs?
no
Are SSRIs tolerable?
yes
What are the side effects of SSRIs and SNRIs?
sleep disturbance
sexual dysfunction (decreased libido)
tension headaches
reduced appetite
hyponatremia
rash/SJS
What are the symptoms of SSRIs?
increased bleeding
serotonin syndrome (SHIVERS A)
- Shivering
- hyperreflexia
- increased temp
- Vital sign instability
- encephalopathy (mental status changes)
- restlessness
- sweating
- abdominal pain
What are examples of SNRIs
venlafaxine
desvenlafaxine
duloxetine
levomilnacipran
What are SNRIs used for?
major depressive disorder
anxiety disorder
What are the side effects of SNRIs?
serotonin syndrome
hyponatremia
What is trazodone used for?
adjunct for depression
insomnia
What are the adverse effects of trazodone?
sedation
priapism (painful erect penis)
What are examples of TCAs (tricyclics)?
amitriptyline
doxepin
imipramine
nortriptyline
How long does it take for TCAs to take effect?
4-8 weeks for full effect
What are TCAs used for?
stimulating
- target lethargy and fatigue
sedating
- target agitation or restlessness
What are the side effects of TCAs?
orthostatic hypotension
anticholinergic
sedation
increased appetite
dysrhythmias
MI
heat block
Describe the anticholinergic side effects of TCAs
- dry mouth
- blurred vision
- tachycardia
- constipation
- urinary retention
- esophageal reflux
- photophobia
- sexual dysfunction
Which side effects of TCAs are considered a medical emergency?
constipation
urinary retention
What are safety precautions for TCAs?
it is cardiotoxic
pt can overdose
What are the contraindications of TCAs?
recent MI
narrow-angle glaucoma
benign prostatic
hypertrophy
seizures
pregnancy
What are examples of MAOIs?
phenelzine
tranylcypromine
isocarboxazid
selegiline
What can MAOIs cause?
hypertensive crisis (over 180/100)
- blurry vision
- chest pain
- tachycardia
- SOB
- diaphoresis
- anxiety
- mental status change
- confusion
- N/V
How long will a pt need to be off of SSRIs in order to take MAOIs?
for 5 weeks and then take MAOI
What should a pt avoid if taking MAOIs? Why?
tyramine foods
it will cause HTN crisis
What are examples of tyramine foods?
avocados
figs
deli meats
cheese
yeast extract
beer
protein supplements
shrimp paste
soy sauce
red wine
What are the contraindications for MAOIs?
cardiovascular disease
HTN, CHF
liver disease
headaches
surgery
What is bupropion used for?
depression
prevention of seasonal depression
mainly for:
- smoking cessation
What are the adverse effects of bupropion?
appetite suppression
seizures
Who should not be given bupropion? Why?
pt with eating disorder
it causes appetite suppression
What is ketamine used for?
anesthetic
targets suicidal ideation
What are the side effects of ketamine?
increased HR/BP
dissociation
How long does ketamine last for?
fades within 1-3 days
What are pharmacological therapies for anxiety?
antidepressant
antihistamine
anticonvulsant
antipsychotic
buspirone
benzodiazepine
What antidepressants are given for anxiety?
SSRIs
SNRIs
Will a patient suddenly stop antidepressants? Why?
No
b/c there is a high risk of suicide, the medication will have to be tapered down
Describe antidepressants for anxiety
start with low doses
long term tx
What are examples of benzodiazepines?
lorazepam
clonazepam
Describe benzodiazepines for anxiety
short term tx
tolerance develops
withdrawal symptoms
addiction
Should higher doses of benzodiazepines be given? Why?
no
b/c tolerance/addiction develops and it can lead to an overdose
(withdrawal symptoms develop)
What are examples of antihistamines?
diphenhydramine
hydroxyzine
What are antihistamines used for in regard to anxiety?
good for those w/ substance use disorder
sedating
How long will a pt be on antihistamines for anxiety?
short term use only
Describe buspirone
non-addictive
long-term tx
2-4 weeks to be effective
risk for serotonin syndrome
Who should not be given buspirone? Why?
older adults
can develop delirium
What are examples of anticonvulsants for anxiety?
valproic acid
gabapentin
pregabalin
What are anticonvulsants used for in regard to anxiety?
generalized anxiety dis.
social anxiety
panic attacks
adjunct medication
What are pharmacological therapies for bipolar disorders?
mood stabilizers
anticonvulsants
anxiolytics
second-generation antipsychotics
ECT
What medication is a mood stabilizer?
lithium
What is lithium effective in treatment for?
first line of tx
antisuicidal effects
acute mania
acute bipolar depression
prevention of manic/depressive episodes
What are safety precautions with lithium?
cautious with diuretics
do not give with NSAIDs
How long does lithium take for a full effect?
3-6 weeks
What is a therapeutic level for lithium?
0.5-1.2 mEq/L
What are expected side effects of lithium?
fine hand tremors
polyuria, mild thirst
nausea
weight gain
sedation
acne
What are early signs of lithium toxicity? What is the range?
N/V/D
slurred speech
muscle weakness
early toxicity: 1.2-1.5 mEq/L
What are advanced signs of lithium toxicity? What is the range?
coarse hand tremor
GI upset
mental confusion
muscle hyperirritability
EEG changes
incoordination
toxic: 1.5-2 mEq/L
What are signs of severe lithium toxicity? What is the range?
HTN
ataxia
serious EEG changes
blurred vision
renal failure
clonic movements/seizures
stupor
coma
death
toxic: above 2 mEq/L
What are the long term side effects of using lithium?
hypothyroidism goiter
kidney dysfunction
What are examples of anticonvulsants?
valproic acid
depakote
divalproex
valproate
carbamazepine
lamotrigine
What are anticonvulsants effective in treatment of?
bipolar mania
hypomania
mixed states
rapid cycling
If a patient is taking lithium and they are not responding well, what can they take?
anticonvulsants
If a patient has kidney issues and bipolar disorders, what can they take?
anticonvulsants
What are the expected side effects of anticonvulsants?
GI pain
tremors
sedation
hair loss
weight gain
blood dyscrasias
hepatotoxicity
pancreatitis
What are the signs of toxicity with anticonvulsants? What is the therapeutic range?
ataxia
confusion
somnolence
coma
85-125 ug/mL
What is carbamazepine effective in treatment for?
rapid cycling
mixed states
acute mania
prevents relapse of mania
What should a nurse monitor for a patient taking carbamazepine?
monitor blood levels for the first 8 weeks of tx weekly
What are the expected side effects of carbamazepine?
hepatic disease
blood dyscrasias
fluid overload
hyponatremia
SJS (rash)
What are signs of toxicity with carbamazepine? What is the therapeutic range?
fatigue
nausea
diplopia
blurred vision
ataxia
4-12 mcg/mL
What is lamotrigine effective in treatment of?
bipolar depression
acute and maintenance
What are serious side effects of lamotrigine?
SJS
aseptic meningitis
can lower effectiveness of birth control
What are examples of anxiolytics?
benzodiazepines
- clonazepam
- lorazepam
What are anxiolytics used for?
adjunct medication
acute mania
psychomotor agitation
calms pt
What are second generation antipsychotics effective in treatment of?
acute mania
bipolar depression
prevent relapse of mania and depression
What is the pharmacological therapy for schizophrenia?
first generation antipsychotics
Describe first generation antipsychotics
traditional dopamine antagonist
used less frequently
minimal impact on - symptoms
side effects experienced more
What are examples of first generation antipsychotics?
chlorpromazine
loxapine
fluphenazine
haloperidol
What side effects that are experienced with first generation antipsychotics?
extrapyramidal symptoms
- acute dystonia
- tardive dyskinesia
- akathisia
- pseudoparkinsonism
What are the expected side effects of antipsychotics?
sedation
orthostatic hypotension
lowered seizure threshold
increased prolactin
- sexual dysfunction
- galactorrhea
- amenorrhea
- gynecomastia
What are serious adverse effect of antipsychotics?
prolonged QT interval
anticholinergic toxicity
neuroleptic malignant syndrome
metabolic syndrome
- weight gain
- HTN
- diabetes
- dyslipidemia
What are examples of second/third generation antipsychotics?
aripiprazole
clozapine
lurasidone
olanzipine
quetiapine
risperidone
What are the side effects of second/third generation antipsychotics?
same as first generation, but not as bad
Describe clozapine
last resort
side effects are severe/common
high risk of myocarditis and seizures
What are examples of CNS depressants?
alcohol
benzodiazepines
barbiturates
What are examples of medications for alcohol withdrawal?
benzodiazepines
barbiturates
anticonvulsants
vitamins
What are examples of vitamins for alcohol withdrawal?
folic acid (folate)
thiamine (B1)
cyanocobalamin (B12)
Why would barbiturates be used for alcohol withdrawal?
only if pt is not responding to benzodiazepines
Why would anticonvulsants be used for alcohol withdrawal?
for seizures and to decrease anxiety
What are examples of medications for alcohol sobriety?
disulfiram (antabuse)
naltrexone
acamprosate
What should a patient know if they are taking medications for alcohol sobriety?
avoid any and all alcohol
What are examples of opiates?
heroin
oxycodone
fentanyl
What are examples of medications for opioid overdose?
naloxone
nalmefene
What should be done with naloxone?
administer every few hours until all opioids are out of system
What is important to know about nalmefene?
not used as often
withdrawals last longer with RX
What are examples of medications for opioid withdrawal?
methadone
clonidine
buprenorphine
Why is methadone used for opioid withdrawal?
replaces opioid bc it is a long-acting opioid (pt doesn’t feel high)
- pt can then taper off
or
- pt can be on it for life
What is the benefit of using clonidine for opioid withdrawal?
used for pt with unstable VS
What is the benefit of using buprenorphine for opioid withdrawal?
used for detox and to decrease cravings
What are examples of CNS stimulants?
cocaine
methamphetamine
What are the effects of CNS stimulants?
increase alertness
heighten sexual arousal
increase energy
What are pts at right for when using CNS stimulants?
seizures
stroke
chest pain
overdose, which can lead to heart attack
What are the effects of methamphetamine?
long lasting
psychosis
cracked teeth
skin infections (tactile hallucinations - picking at skin)
What are pharmacological aids for nicotine?
nicotine based products
varenicline
bupropion
Describe marijuana
mixed depressant and hallucinogenic
