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NURB 3150 > Nervous System Drugs > Flashcards

Nervous System Drugs Flashcards

1
Q

benzodiazepines medications

A
  • prototype: alprazolam
  • diazepam
  • lorazepam
  • chlordiazepoxide
  • clorazepate
  • oxazepam
  • clonazepam
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2
Q

indications for benzodiazepines

A
  • anxiety and panic disorders
  • seizure disorders
  • alcohol withdrawal (to prevent and treat acute sx)
  • induction of anesthesia
  • amnesic prior to surgery or procedures
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3
Q

adverse effects of benzodiazepines

A
  • anterograde amnesia: difficulty recalling events that occur after dosing
  • oral toxicity: drowsiness, lethargy, confusion
  • IV toxicity: can lead to respiratory depression, severe hypotension, or cardiac/respiratory arrest
  • withdrawal effects: anxiety, insomnia, diaphoresis, tremors, lightheadedness, delirium, hypertension, muscle twitching, and seizures
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4
Q

contraindications of benzodiazepines

A
  • pregnancy: can cause harm to fetus
  • patients with sleep apnea, respiratory depression, or glaucoma
  • caution in elderly and those with liver disease
  • risk for dependence
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5
Q

interactions with benzodiazepines

A
  • CNS depressants (alcohol, barbiturates, opioids): can result in respiratory depression
  • grapefruit juice: reduce metabolism
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6
Q

implications of benzodiazepines

A
  • administer at bedtime if possible due to sedation
  • store in a secure place to prevent misuse by others
  • for short-term use only to prevent dependence
  • use gastric lavage followed by activated charcoal for toxicity antidote
  • avoid use of grapefruit juice
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7
Q

atypical anxiolytic/ nonbarbiturate anxiolytic meds

A

buspirone

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8
Q

atypical anxiolytic/ nonbarbiturate anxiolytic MOA

A
  • unknown
  • dependency less likely
  • doesn’t result in sedation or potentiate the effects of other CNS depressants
  • initial response takes a week and at least 2-4 weeks for it to reach its full effects
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9
Q

adverse effects of atypical anxiolytic/ nonbarbiturate anxiolytic

A
  • dizziness (will eventually go away)
  • constipation
  • suicidal ideation
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10
Q

contraindications of atypical anxiolytic/ nonbarbiturate anxiolytic

A
  • concurrent use with MAOIs

- use 14 days after MAOIs are discontinued

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11
Q

interactions with atypical anxiolytic/ nonbarbiturate anxiolytic

A

st. john’s wort

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12
Q

implications for atypical anxiolytic/ nonbarbiturate anxiolytic

A
  • take on a regular basis and not PRN
  • tolerance, dependence, or withdrawal effects are not an issue
  • avoid herbal preparations containing st. johns wort
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13
Q

SSRI antidepressants medications

A
  • paroxetine
  • sertraline
  • citalopram
  • escitalopram
  • fluoxetine
  • fluvoxamine
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14
Q

indications for SSRI antidepressants

A
  • anxiety disorder
  • panic disorder
  • OCD
  • social anxiety disorder
  • trauma/stress disorders
  • dissociative disorders
  • depressive disorders
  • adjustment disorder
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15
Q

adverse effects of SSRI antidepressants

A
  • early: nausea, diaphoresis, tremor, fatigue, drowsiness (first few days/weeks)
  • later: sexual dysfunction (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest)
  • GI bleeding
  • hyponatremia: more likely in elderly in diuretics
  • serotonin syndrome (can be extremely dangerous)
  • bruxism: grinding and clenching of teeth, usually during sleep
  • withdrawal syndrome
  • postural hypotension
  • suicidal ideation
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16
Q

Implications for SSRI antidepressants

A
  • can take up to 4 weeks to achieve therapeutic effect
  • effectiveness noted by improved mood
  • educate to change positions slowly, risk for falls
  • monitor for hypotension
  • taper off slowly
  • caution with history of GI bleeds
  • educate to report problems with sexual function
  • educate to report any adverse effects
  • serotonin syndrome begins between 2-72 hours after first dose
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17
Q

SSRI medications

A
  • fluoxetine
  • citalopram
  • escitalopram
  • paroxetine
  • sertraline
  • fluvoxamine
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18
Q

SSRI indications

A

depression (can take 1-3 weeks or longer for effect)

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19
Q

adverse effects for SSRI

A
  • sexual dysfunction
  • CNS stimulation: inability to sleep, agitation, anxiety
  • weight loss early in therapy: can be followed by weight gain with long-term treatment
  • serotonin syndrome: hallucinations, labile blood pressure
  • withdrawal syndrome
  • hyponatremia
  • rash
  • gastrointestinal bleeding
  • bruxism
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20
Q

contraindications for SSRI

A
  • pregnancy risk category C

- concurrent use with MAOIs or TCAs

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21
Q

serotonin-norepinephrine reuptake inhibitors (SNRIs) medications

A
  • venlafaxine (prototype)
  • desvenlafaxine
  • duloxetine
  • venlafazine
  • levomilnacipran
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22
Q

SNRIs MOA

A

-blocks reuptake of norepinephrine as well as serotonin with effects similar to SSRIs

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23
Q

SNRIs indications

A
  • major depression

- pain due to fibromyalgia, osteoarthritis, diabetic neuropathy

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24
Q

adverse effects of SNRIs

A
  • hypertension, tachycardia
  • withdrawal syndrome
  • sexual dysfunction
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25
Q

contraindications in SNRIs

A
  • concurrent use with SSRIs, MAOIs, or TCAs

- tape off slowly to prevent withdrawal syndrome

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26
Q

Atypical antidepressants medications

A
  • bupropion (prototype)
  • vilazodone
  • mirtazapine
  • nefazodone
  • trazodone ER
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27
Q

Atypical antidepressants MOA

A

inhibits norepinephrine and dopamine uptake

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28
Q

Atypical antidepressants indications

A
  • treat depression
  • alternative to SSRIs and SNRIs for clients unable to tolerate sexual dysfunction
  • aid for smoking cessation
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29
Q

adverse effects of atypical antidepressants

A
  • headache
  • dry mouth
  • n/v
  • anorexia
  • weight loss
  • seizures
30
Q

implications for Trazodone ER

A
  • sedation is a potential problem

- educate to seek medical attention immediately if priapism

31
Q

tricyclic antidepressants (TCAs) medications

A
  • amitriptyline
  • imipramine
  • doxepin
  • nortriptyline
  • amoxapine
  • trimipramine
  • desipramine
  • clomipramine
32
Q

TCA MOA

A
  • blocks reuptake of norepinephrine, serotonin, and acetylcholine
  • can take 10-14 days or longer to begin to work and 4-8 weeks for max effect
33
Q

indications for TCAs

A
  • depression

- OCD

34
Q

adverse effects of TCAs

A
  • orthostatic hypotension
  • anticholinergic effects
  • sedation
  • toxicity: results in cholinergic blockade and cardiac toxicity evidenced by dysrhythmias, metal confusion, and agitation, followed by seizures, coma, and possible death
35
Q

precautions for TCAs

A

-those with increased risk for suicide should receive a 1-week supply of meds at a time due to lethality of toxic dose

36
Q

TCAs interactions

A
  • concurrent use with MAOIs or St. John’s wort

- antihistamines and other anticholinergic agents

37
Q

TCA implications

A
  • minimize anticholinergic effects by chewing sugarless gum and regular exercise
  • risk for falls
  • monitor for “cheeking”
  • admin at bedtime due to sedation and risk for orthostatic hypotension
  • monitor for toxicity manifested by cardiac dysrhythmias
38
Q

monoamine oxidase inhibitors (MAOIs) medications

A
  • phenelzine (prototype)

- isocarboxazid

39
Q

MAOIs MOA

A
  • block MAOI enzymes in the brain, increasing norepinephrine, dopamine, serotonin, and tyramine available for transmission of impulses
  • increase in tyramine can cause increase bp or hypertensive crisis if dietary and medication restrictions are not implemented
40
Q

MAOI indications

A

depression

41
Q

MAOI adverse effects

A
  • orthostatic hypotension
  • hypertensive crisis: can lead to CVA; severe hypertension as a result of intensive vasoconstriction and stimulation of the heart; increased heart rate and bp
42
Q

MAOIs contraindication

A
  • concurrent use with SSRIs
  • heart failure
  • cardiovascular disease
43
Q

MAOIs interactions

A
  • tyramine rich foods: aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine
  • general anesthetics
44
Q

MAOIs implications

A
  • administer phentolamine IV or nifedipine to combat HTN
  • provide written instructions regarding foods and drinks to avoid
  • educate to avoid taking any meds without approval of provider
  • dietary and med restrictions should be continued for 2 weeks after d/c MAOI
  • don’t use within 10-14 days before or after surgery
  • full therapeutic effect can take 2-3 months
  • assess for suicide risk, mainly associated with those younger than 25
45
Q

mood stabilizer medication

A

lithium carbonate

46
Q

mood stabilizer indications

A

controls episodes of acute mania, and helps prevent the return of mania or depression

47
Q

mood stabilizer adverse effects

A
  • GI distress: nausea, diarrhea, abd pain
  • fine hand tremors: can be exacerbated by stress and caffeine
  • polyuria (use a potassium-sparing diuretic- spironolactone)
  • weight gain
  • renal toxicity
  • goiter and hypothyroidism (with long term treatment)
  • bradydysrhythmia
  • hypotension,
  • electrolyte imbalances
  • lithium toxicity (common: muscle weakness, fine hand tremor, slurred speech, lethargy)
48
Q

manifestations of lithium toxicity

A
  • early: mental confusion, poor coordination, coarse tremors
  • advanced: extreme polyuria of dilute urine, tinnitus, involuntary extremity movements, blurred vision, ataxia, seizures, severe hypotension leading to possible death from respiratory complications
  • severe: oliguria, seizures, rapid progression of manifestations leading to coma and death
49
Q

mood stabilizer interactions

A
  • diuretics (reduced blood sodium decreases lithium excretion which can lead to toxicity)
  • NSAIDs (increases renal reabsorption of lithium leading to toxicity
50
Q

mood stabilizer implications

A
  • obtain a lithium level with each dose change then every 2-3 months after a period of stability
  • maintenance level 0.6-1.2, 1.5 or greater can result in toxicity
  • maintain a diet adequate in sodium and drink replace with 1.5-3 L of water each day
  • withhold med and notify provider if have signs of lithium toxicity
  • low levels of lithium toxicity improve over time-obtain baseline T3, T4, and TSH levels prior to starting treatment, and then annually
  • admin levothyroxine to manage hypothyroid effects
  • monitor for manifestations of hypothyroidism (cold, dry skin, decreased heart rate, weight gain)
  • avoid use of NSAIDS
51
Q

severe mood stabilizer toxicity

A
  • treated in acute care setting with hemodialysis
  • monitor CBC, blood electrolytes, renal function test, and thyroid function tests
  • must admin in 2-3 daily due to short half life
  • encourage to adhere to lab appointments
  • emphasize high risk of toxicity due to narrow therapeutic range
  • stress importance of adequate fluid and sodium intake
  • educate to withhold meds and seek medical attention if experiencing diarrhea, vomiting, or excessive sweating
  • conditions that cause dehydration (exercise in hot weather or diarrhea) puts pt at risk for lithium toxicity
52
Q

antipsychotics: first generation (conventional) medications

A
  • chlorpromazine
  • haloperidol
  • fluphenazine
  • thiothixene
  • perphenazine
  • loxapine
  • trifluoperazine
53
Q

antipsychotics: first generation (conventional) MOA

A

blocks dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery

54
Q

antipsychotics: first generation (conventional) indications

A
  • acute and chronic psychotic

- bipolar disorders

55
Q

antipsychotics: first generation (conventional) adverse effects

A
  • acute dystonia (severe spasms of tongue, neck, face, or back; respirations can decrease)
  • parkinsonism (bradykinesia, rigiditym shuffling gait, drooling, and tremors)
  • akathisia (unable to stand still or sit, continually pacing and agitated)
  • tardive dyskinesia (TD) (involuntary movements of the tongue, arms, legs, or trunk, can occur months-years after start of med)
  • neuroleptic malignant syndrome (life threatening, medical emergency; sudden high-grade fever, muscle rigidity, change in LOC)
  • anticholinergic effects
  • orthostatic hypotension
  • agranulocytosis
  • severe dysrhythmias
56
Q

antipsychotics: first generation (conventional) implications

A
  • assess pt to differentiate between EPSs and worsening psychotic disorder
  • admin anticholinergics, beta blockers, and benzodiazepines to control early EPSs
  • obtain baseline ECG
  • obtain baseline WBC if infection appears, should be d/c if lab tests indicate presence of infection
  • monitor hr and bp for orthostatic hypotension
  • change position and get up slowly
  • stop medication for neuroleptic malignant syndrome and apply cooling blankets if have a high grade fever
  • administer lowest dose possible to control s/s of TD and evaluate after 12 months then every 3 months
  • treat acute dystonia with anticholinergic agents (benztropine or diphenhydramine [benadryl])
57
Q

antipsychotics: second and third generation (atypical) medications

A
  • risperidone (prototype)

- clozapine (no longer considered a first line med because of its serious adverse effects)

58
Q

antipsychotics: second and third generation (atypical) indications

A
  • schizophrenia
  • psychotic episodes
  • bipolar disorders
59
Q

complications of clozapine

A

agranulocytosis can occur. obtain baseline wbc and monitor weekly, bi-weekly to monthly per protocol

60
Q

central nervous system stimulants medications

A
  • methylphenidate
  • dexmethylphenidate
  • dextroamphetamine
  • amephetamine mixture
  • lisdexamfetamine dimesylate
61
Q

CNS stimulant indications

A
  • ADHD
  • conduct disorder
  • narcolepsy
  • obesity
62
Q

CNS stimulant adverse effects

A
  • cns stimulation (insomnia, restlessness)
  • decreased appetite
  • weight loss
  • growth suppression
  • cardiovascular effects (dysrhythmias, chest pain, high blood pressure)
  • toxicity (dizziness, palpitations, htn, hallucinations, seizures)
63
Q

CNS stimulant implications

A
  • admin med on regular schedule
  • alternate transdermal patch on hips in the morning and leave it in place no longer than 9 hours
  • ADHD not cured by meds but has improved outcomes with cognitive- behavioral therapy
  • handwritten prescriptions are required for refills
  • high potential for development of a substance use disorder, especially in adolescents
  • avoid ETOH
  • monitor height and weight and compare to baseline
64
Q

norepinephrine selective reuptake inhibitors medications

A
  • atomoxetine

- buproprion

65
Q

norepinephrine selective reuptake inhibitors indications

A
  • adhd

- depression

66
Q

norepinephrine selective reuptake inhibitors adverse effects

A
  • suicidal ideation

- hepatotoxicity

67
Q

norepinephrine selective reuptake inhibitors implications

A
  • not any changes in the child’s behavior r/t dosing and timing of med
  • admin med in a daily dose in the morning or in two divided doses (one in the am and afternoon)
  • effectiveness noted by improvement of manifestation of ADHD (increase in ability to focus and complete tasks, interact with peers, and manage impulsivity)
68
Q

medication to support withdrawal/abstinence from alcohol

A
  • disulfiram

- naltrexone

69
Q

disulfiram

A
  • aversion (behavioral) therapy
  • concurrent use with etoh can cause acetaldehyde syndrome (n/v, weakness, sweating, palpitations, hypotension), can progress to resp. depression, cardiovascular suppression, seizure, and death
  • avoid ingesting or applying any products that contain etoh (cough syrups, sauces, mouthwash, aftershave lotion, colognes, and hand sanitizer)
70
Q

medication to support withdrawal/abstinence from nicotine

A
  • bupropion

- varenicline

NURB 3150 (6 decks)

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