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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
contraindications in SNRIs
- concurrent use with SSRIs, MAOIs, or TCAs | - tape off slowly to prevent withdrawal syndrome
26
Atypical antidepressants medications
- bupropion (prototype) - vilazodone - mirtazapine - nefazodone - trazodone ER
27
Atypical antidepressants MOA
inhibits norepinephrine and dopamine uptake
28
Atypical antidepressants indications
- treat depression - alternative to SSRIs and SNRIs for clients unable to tolerate sexual dysfunction - aid for smoking cessation
29
adverse effects of atypical antidepressants
- headache - dry mouth - n/v - anorexia - weight loss - seizures
30
implications for Trazodone ER
- sedation is a potential problem | - educate to seek medical attention immediately if priapism
31
tricyclic antidepressants (TCAs) medications
- amitriptyline - imipramine - doxepin - nortriptyline - amoxapine - trimipramine - desipramine - clomipramine
32
TCA MOA
- 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
indications for TCAs
- depression | - OCD
34
adverse effects of TCAs
- 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
precautions for TCAs
-those with increased risk for suicide should receive a 1-week supply of meds at a time due to lethality of toxic dose
36
TCAs interactions
- concurrent use with MAOIs or St. John's wort | - antihistamines and other anticholinergic agents
37
TCA implications
- 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
monoamine oxidase inhibitors (MAOIs) medications
- phenelzine (prototype) | - isocarboxazid
39
MAOIs MOA
- 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
MAOI indications
depression
41
MAOI adverse effects
- 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
MAOIs contraindication
- concurrent use with SSRIs - heart failure - cardiovascular disease
43
MAOIs interactions
- 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
MAOIs implications
- 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
mood stabilizer medication
lithium carbonate
46
mood stabilizer indications
controls episodes of acute mania, and helps prevent the return of mania or depression
47
mood stabilizer adverse effects
- 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
manifestations of lithium toxicity
- 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
mood stabilizer interactions
- diuretics (reduced blood sodium decreases lithium excretion which can lead to toxicity) - NSAIDs (increases renal reabsorption of lithium leading to toxicity
50
mood stabilizer implications
- 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
severe mood stabilizer toxicity
- 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
antipsychotics: first generation (conventional) medications
- chlorpromazine - haloperidol - fluphenazine - thiothixene - perphenazine - loxapine - trifluoperazine
53
antipsychotics: first generation (conventional) MOA
blocks dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery
54
antipsychotics: first generation (conventional) indications
- acute and chronic psychotic | - bipolar disorders
55
antipsychotics: first generation (conventional) adverse effects
- 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
antipsychotics: first generation (conventional) implications
- 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
antipsychotics: second and third generation (atypical) medications
- risperidone (prototype) | - clozapine (no longer considered a first line med because of its serious adverse effects)
58
antipsychotics: second and third generation (atypical) indications
- schizophrenia - psychotic episodes - bipolar disorders
59
complications of clozapine
agranulocytosis can occur. obtain baseline wbc and monitor weekly, bi-weekly to monthly per protocol
60
central nervous system stimulants medications
- methylphenidate - dexmethylphenidate - dextroamphetamine - amephetamine mixture - lisdexamfetamine dimesylate
61
CNS stimulant indications
- ADHD - conduct disorder - narcolepsy - obesity
62
CNS stimulant adverse effects
- 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
CNS stimulant implications
- 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
norepinephrine selective reuptake inhibitors medications
- atomoxetine | - buproprion
65
norepinephrine selective reuptake inhibitors indications
- adhd | - depression
66
norepinephrine selective reuptake inhibitors adverse effects
- suicidal ideation | - hepatotoxicity
67
norepinephrine selective reuptake inhibitors implications
- 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
medication to support withdrawal/abstinence from alcohol
- disulfiram | - naltrexone
69
disulfiram
- 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
medication to support withdrawal/abstinence from nicotine
- bupropion | - varenicline

NURB 3150 (6 decks)

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