Nervous System Meds Flashcards
Anti-Anxiety
Benzodiazepines (“-pams and -lams):
- Alprazolam
- Diazepam (flumazenil is antidote)
- Lorazepam
- Chlordiazepoxide
Antidepressants (“-iiiiines”)
-Venlafaxine
- Duloxetine
- Paroxetine
- Escitalopram
-Buspirone
Facts:
- treat anxiety disorder and panic disorder, insomina, alcohol withdrawl, induction of anesthesia
- also used for alcoholism to prevent delirium tremors
- flumazenil is the antidote for benzos
- can cause paradoxical response (insomnia, excitation, euphoria), CNS depression, withdrawal symptoms (not buspirone)
- risk for abuse and overdose for benzos
Dulexotine can cause orthostatic hypotension
- do not give venlafaxine with MAOIs
Antidepressants
SSRIs:
- Fluoxetine
- Paroxetine
- Sertraline
- Citalopram
SNRIs:
- Duloxetine
- Venlafaxine
Facts:
-Avoid alcohol
- monitor for seratonin syndrome (agitation, confusion, irritation)
- do not stop abruptly
- can cause weight gain, sexual dysfunction, fatigue, drowsiness
- Do not take with MAOIs (Venlafaxine)
- take SSRIs in the morning
- no NSAIDs
- no st. john’s wort
Tricyclic:
- Amitriptyline
- Imipramine
- Cyclobenzaprine
- Bupropion
Facts:
-do not take with alcohol
- Do not take with MAOIs or st. John’s wort
- contraindicated for those with seizures
- dry mouth is adverse effect (anticholinergic effects)
MAOIs
- Isocarboxacid
- Tranylcypromine
- Penelzine
Facts:
- avoid foods containing tyramine (Cured, smoked, or processed meats include dried sausages like pepperoni and salami, hot dogs, bologna, bacon, and smoked fish. Sauerkraut, kimchi, pickled beets, pickled cucumbers, and pickled peppers have high tyramine levels. Also, fermented soy products like tofu, miso, and soy sauce contain tyramine)
- do not take with antihypertensives
-take daily and do not miss dose
Bipolar Disorder
- Lithium
Facts:
- do not change salt intake
- if sodium is low, lithium is increased
- do not take with NSAIDs
- can cause polyuria, tremors, hypothyroidism, renal toxicity
- doses are 1-3x per day
- obtain daily weight due to risk of fluid imbalance
Antipsychotics
Typical (older, worse side effects):
- Chlorpromazine (wear sunscreen)
- Haloperidol (dystonia/akathisia)
- Thiothixene
- Fluphenazine
Atypical (newer, less side effects):
- Aripiprazole (lowest risk for EPS, no grapefruit juice)
- Clozapine (frequent CBCs)
- Olanzapine (hyperglycemia and weight gain)
- Paliperidone
- Quetiapine
- Ziprasidone
Facts:
-treat schizophrenia, manic phase of bipolar disorder, tourettes, and dementia
- do not give to patients with parkinson’s severe depression, prolactin dependent cancer, glaucoma, paralytic ileus, prostate enlargement, seizures, or hypotension,
- Typical side effects: sedation, extrapyramidal effects (EPS), anticholinergic effects (DRY), nephrotic malignant syndrome (fever, respiratory distress, diaphoresis, hyper/hypotension), seizures
-Atypical side effects: (more metabolic) weight gain, diabetes, dyslipidemia,
ADHD
Stimulants:
- Methylphenidate
- Dextroamphetamine and amphetamine
Facts:
- give early in the morning
- can cause insomnia and suppressed appetite
Nonstimulants:
- Atomoxetine
- Guanfacine
Facts:
- Guanfacine can also be treated for aspergers
- do not crush or chew
- do not take with MAOIs
- can cause insomnia, mood swings, and GI upset
Abstinence
- Disulfiram (alcohol)
- Methadone (opioids)
Facts:
- do not drink alcohol while taking, respiratory depression, dysrythmias, and cardiac arrest may occur if before 12 hours
- matallic taste and hepatotoxicty may occur
- do not give to clients with severe asthma
Chronic Neurological Disorders
Cholineserase Inhibitors:
- Neostigmine (MG)
- Ambenonium (MG)
- Edrophonium (MG)
- Donepezil (Alz)
Facts:
- Cholinergic = WET (SLUDGE)
- used for Myasthesia Gravis and alzheimers due to lack of Ach
- do not give if heart rate is less than 60
- side effects include miosis (pupil constriction), chest pain, dizziness, low BP and HR, seziures, polyuria
- cholinergic crisis (dyspnea) antidote is atropine
Anti-Parkinson’s:
- Benztropine
- Carbidopa/levodopa
- Levodopa
Facts:
- minimize tremors and rigidity
- do not use levodopa within 2 weeks of MAOI use
- pyridoxine (vitamin B6) decreases effects of levedopa
- Benztropine is contraindicated for patients with glaucoma
- stop 6-8 hours before anesthesia
- keep meds away from heat and light and moisture ( if pills are dark, they have lost potency and should be discarded)
- effects may take 4-6 weeks
- avoid high protein meals and snacks
- can cause headaches, dizziness, dark urine, orthosatic hypotension, and muscle twitching in eyes
Anti-seizure
- Carbamazepine ( do not take with oral contraceptives)
- Gabapentin
- Phenobarbital
- Phenytoin (skin rash = toxicity)
- Valporic Acid
Facts:
- can cause bruising, steven-johnson syndrome, drowsiness, respiratory depression, hepatotoxicity, pancreatitis, anemia, leukopenia
Anti-Glaucoma
-Levobunolol
- Timolol
- Pilocarpine
- Latanoprost
Facts:
- brown discolration of iris may occur, retinal detachment
- hold pressure on duct for 30 seconds after drops
- monitor pulse and rythm for beta or calcium channel blockers
Pain
Opiods:
- Fentanyl
- Hydromorphone
- Meperidine
- Codeine
Facts:
- can cause respiratory depression, urinary retention, blurred vision, contipation, orthostatic hypotension
- antidote: nalaxone
- fentanyl chew sticks should be placed in storage container when not being used
- take stool softener daily for fentanyl patch (cannot take naloxone in home setting)
NSAIDs:
- Acetaminophen
Facts:
- do not take with warfarin, rifampin, INH, carbamaepine, barbs
- long term use can cause hemolytic anemia, leukopenia, neutropniea, and thrombocytopnia
- monitor kidney and liver function
- do not exceed 3,000mg/24hr
- hepatotoxicity is greatest risk
- antidote: acetylcysteine
Other:
- Ergotamine sublingual
- Sumatriptan
Facts:
- treat migraines
- can cause coronary vasospams (sumatriptan)
- take 1 tablet at onset of symtpoms (ES)
