Nervous System Flashcards
Benzodiazepines Examples
Alprazolam
Chlordiazepoxide
Diazepam
Lorazepam
Buspirone Classification
anxiolytic
Benzodiazepines Indications
generalized anxiety disorder and panic disorder
insomnia
alcohol withdrawal
induction of anesthesia
Buspirone Indications
generalized anxiety disorder
panic disorder
Benzodiazepines Precautions
use caution with substance use disorder and liver disease
Benzodiazepines Complications
CNS depression
Paradoxical response (insomnia, excitation, euphoria)
Withdrawal symptoms
risk for abuse and overdose
Benzodiazepines Administration
monitor vital signs
never abruptly discontinue medication
monitor for CNS depression/other complications
avoid alcohol and other CNS depressants
SSRI examples
Citalopram
Fluoxetine
Paroxetine
Sertraline
SNRI examples
Duloxetine
Venlafazine
SSRI and SNRI Precautions
avoid alcohol
do not discontinue abruptly
monitor for serotonin syndrome (agitation, confusion, hallucination)
SSRI and SNRI Complications
weight gain
sexual dysfunction
fatigue
drowsiness
Tricyclic Antidepressants Examples
Amitriptyline
Imipramine
Tricyclic Antidepressants Precautions
do not administer with MAOIs or St. John’s wort
must avoid alcohol
contraindicated for clients with seizure disorders
Tricyclic Complications
anticholinergic effects
orthostatic hypotension
cardiac dysrhythmias
decreased seizure threshold
MAOIs Examples
Isocarboxazid
Tranylcypromine
Phenelzine
MAOIs Precautions
avoid tyramine containing food
antihypertensives have additive hypotensive effect
contraindicated with SSRIs, tricyclic antidepressants, heart failure, CVA, renal insufficiency
MAOIs complications
CNS stimulation
Orthostatic hypotension
hypertensive crisis with intake of tyramine, SSRIs, tricyclic
2 week separation between MAOIs and other antidepressants to avoid serotonin syndrome
Antidepressants Administrations
assess for suicide risk
take medication daily and never miss a dose
medication may take weeks to months for full therapeutic effects
do not discontinue abruptly
take SSRIs in the morning to minimize sleep disturbances
provide patients taking MAOIs a list of tyramine containing foods
avoid taking other medications without consulting provider
Lithium indications
bipolar disorder
alcohol use disorder
bulimia
schizophrenia
Lithium Precautions
use cautiously in renal dysfunction, heart disease, hyponatremia, dehydration
NSAIDs will increase lithium levels
monitor serum sodium levels
Lithium Complications
GI distress fine hand tremors polyuria hypothyroidism renal toxicity
Lithium Administration
monitor therapeutic levels
monitor serum sodium levels
instruct clients that therapeutic effects take 7 to 14 days
administer 1-3 times daily per prescription
provide nutritional counseling for food sources for sodium
administer with food to decrease GI distress
Typical Antipsychotics Examples
Chlorpromazine
Fluphenazine
Haloperidol
Thiothixene
Atypical Antipsychotics Examples
Aripiprazole Clozapine Olanzapine Paliperidone Quetiapine Ziprasidone
Antipsychotics Indications
acute and chronic psychosis schizophrenia manic phase of bipolar disorder Tourette's syndrome delusional and schizoaffective disorder dementia
Antipsychotics Precautions
contraindicated for clients who have severe depression, Parkinson’s disease, prolactin-dependent cancer, severe hypotension
use caution with glaucoma, paralytic ileus, prostate enlargement, seizure disorder
Typical Antipsychotics Complications
sedation extrapyramidal effects anticholinergic effects tardive dyskinesia agranulocytosis neuroleptic malignant syndrome seizures
Atypical Antipsychotics Complications
Agranulocytosis Weight gain diabetes dyslipidemia orthostatic hypotension extrapyramidal effects
Antipsychotics Administration
advise clients to be aware of side effects
monitor CBC
encourage fluids
stop medication for signs of neuroleptic malignant syndrome
ADHD Simulants Examples
Dextroamphetamine
Amphetamine
Methylphenidate
ADHD Stimulants Complications
Insomnia
Headache
suppressed appetitie
abdominal pain
ADHD Stimulants Administration
Administer in the morning, do not administer before bed give with or after meals do not abruptly discontinue monitor for signs of abuse monitor for signs of agitation
ADHD Nonstimulants Examples
Atomoxetine
Guanfacine
ADHD Nonstimulants Complications
GI upset
Insomnia
Mood swings
ADHD Nonstimulants Administration
Take medications daily
do not crush or chew
instruct client to immediately report worsening of anxiety, agitation
Do not take with MAOIs
Abstinence Maintenance Medication Examples
Disulfiram
Methadone
Disulfiram Indication
Maintain sobriety in treatment of alcohol use disorer
Disulfiram Precautions
INH will increase risk of adverse CNS effects for clients taking disulfiram
Ingestion of large amounts of alcohol may cause respiratory depression, dysrhythmias, cardiac arrest
Adjust medication doses of warfarin and phenytoin
Disulfiram Complications
Drowsiness
Headache
Metallic taste
Hepatotoxicity
Disulfiram Administration
must wait 12hr between last alcohol intake and starting medication
consumption of alcohol while taking medication will result in: flushing, throbbing in head/neck, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, uneasiness, weakness, vertigo, blurred vision, confusion
effects last 30 min to several hours after consumption of alcohol
effects may still occur for weeks after therapy is discontinued
therapy may last months to years
Methadone Indications
prevent withdrawal symptoms in clients who are addicted to opiate drugs
Methadone Precautions
do not use in clients who have severe asthma, chronic respiratory disease, history of head injury
avoid in clients with QT syndrome
Methadone Complications
sedation
respiratory depression
paradoxical CNS excitation
Methadone Administration
monitor clients for signs of drug tolerance and psychological dependence
monitor for respiratory depression
methadone must be slowly reduced to produce detoxification
may monitor through treatment centers
Cholinesterase Inhibitors Examples
Neostigmine
Ambenonium
Edrophonium
Cholinesterase Inhibitors Indications
Myasthenia gravis
Cholinesterase Inhibitors Precautions
do not administer if heart rate is less than 60bpm
Cholinesterase Inhibitors Complications
slow heart rate chest pain, weak pulse, increased sweating dizziness, feelings of syncope weak/shallow breathing urinating more than usual seizures trouble swallowing
Cholinesterase Inhibitors Administration
dose must be individualized
instruct client to keep diary to record side effects
wear a medical alert bracelet
monitor for cholinergic crisis
Anti-Parkinson’s Medications Examples
Benztropine
Carbidopa/Levodopa
Levodopa
Anti-Parkinson’s Medications Indications
Parkinson’s disease
Anti-Parkinson’s Medications Precautions
do not use levodopa within 2 weeks of MAOI use
Pyridoxine (Vitamin B6) decreases effects of levodopa
Benztropine is contraindicated in glaucoma
discontinue 6-8hrs before anesthesia
Anti-Parkinson’s Medications Complications
muscle twitching headache dizziness dark urine orthostatic hypotension
Anti-Parkinson’s Medications Administration
notify provider if sudden loss of medication effects occurs
maximum therapeutic effects may take 4-6 weeks
monitor for signs of adverse reactions
avoid high protein diet
keep medications away from heat, light, moisture
if pills become darkened they have lost potency
Antiseizure Medications Examples
Carbamazepine Gabapentin Phenobarbital Phenytoin Valproic Acid
Antiseizure Medications Indication
Prevent and/or control seizure activity
Antiseizure Medications Administration
monitor for therapeutic effects
instruct patients regarding compliance: medication is a treatment, not a cure
individualize treatment regimens
monitor for signs of adverse effects
for status epilepticus: diazepam or lorazepam IV push followed by IV phenytoin or fosphenytoin
Carbamazepine Precautions
contraindicated in bone marrow suppression or bleeding disorders
decreases the effectiveness of oral contraceptives and warfarin
Carbamazepine Complications
anemia
leukopenia
Stevens-Johnson syndrome
Gabapentin Precautions
do not abruptly discontinue
Gabapentin Complications
headache, weight loss, nausea
report CNS depression, seizures, visual changes, unusual bruising
Phenobarbital Precautions
contraindicated in history of substance use disorder
Phenobarbital Complications
drowsiness
hypotension
respiratory depression
Phenytoin Precautions
increased excretion of digoxin, warfarin, oral contraceptives
monitor serum levels and signs of toxicity
Phenytoin Complications
gingival hypertrophy
diplopia
drowsiness
hirsutism
Valproic Acid Precautions
contraindicated in liver disease, pregnancy
Valproic Acid Complications
hepatotoxicity
teratogenic effects
pancreatitis
Antiglaucoma Medications Examples
Levobunolol
Timolol
Pilocarpine
Latanoprost
Antiglaucoma Medications Precautions
use caution in clients taking oral beta blockers or calcium channel blockers
Antiglaucoma Medications Complications
systemic effect of beta blockers: bradycardia, heart failure, bronchospasm
brown discoloration of the iris (latanoprost)
retinal detachment (pilocarpine)
Antiglaucoma Medications Administration
use sterile technique when handling applicator portion of the container
hold gentle pressure on the nasolacrimal duct for 30 to 60 seconds immediately after instilling drops
monitor pulse rate/rhythm for clients taking oral beta blockers or calcium channel blockers
