Neuro 2 Flashcards
imipramine
trycyclic antidepressants
* imipramine
- Uses: mainly for major depression
- occasional use for nocturnal enuresis in children
- off-label uses: intractable pain, anxiety disorders, withdrawal symptoms for alcohol and concaine
s/s of toxicity
arrythmias, cardiac pts
monitor and hepatic and** kidney function **
can cause CNS depression, sedation, drowsiness
paradoxical diaphoresis
* diaphoresis doesn’t mean they’re necessarily hypoglycemic, less reliable of an indicator
- therapeutic effectivenss may not occur for 2 or more weeks
- contraindication: do not use within 14 days of d/c MAOIs
- always assess for SI
Bonus: anticholinergic effects
phenelzine
phenelzine (Nardil)
MAOI
Uses: manage symptoms of depression not responsive to safer medications and occasionally used for panic disorders
Administration/Interaction/Patient Teaching:
**washout periods 2-3 wks **required before introducing other drugs
Avoid food containing Tyramine
* tyramine normally degraded by MAOI
* when inhibit MAOI…
* within minutes can have hypertensive crisis
can’t give any other antidepressants
contraindications: pts with cardiovascular or cerebrobascular disease, hepatic impairement or CKD
very caustic
Foods containing Tyramine
do not consume foods with tyramine when taking MAOI
KNOW TABLE 16.2 (p.195)
Chocolate
Alcohol
* Beer
* Wines (esp. red wines)
Diary Products
* cheeses (cottage cheese is ok)
* sour cream
* yogurt
Fruits
* avocados, bananas
* papaya products (including meat tenderizers)
* raisins, canned figs
Meats
* liver (beef, chicken, pate)
*Processed meats - meat extracts, pepperoni, salami, sausage, bologna, hot dogs
Vegetables - Pods of broad beans (Fava beans)
Sauces - soy sauce
Yeast
carbidopa/levodopa
carbidopa/levodopa
Uses:
Parkinson’s Disease
restless leg syndrome
Therapeutic Effect:
slow progression of symptoms of Parkinson’s disease - tremors, rigidity, and mobility issues
this is not a cure, it is used to relieve symptoms
Pharmacology:
**crosses blood-brain barrier **
a dopamine precursor
don’t use dopamine because can’t cross blood brain barrier
Alert
orthostatic hypotension
fall risk
psychosis develops in up to 20% of pts taking levodopa
benztropine (Cogentin)
Therapeutic Class: antiparkinson drug
relieves symptoms
NOT a cure
Pharmacologic Class: anticholinergic*
blocks excess cholinergic stimulation
Administration/Dosage:
may divide doses 2 - 4 dose throughout day or take entire dose before bed
Adverse
can cause tachycardia - caution pt
anticholinergic effects
contraindications: BPH, glaucoma
sumatriptan
Pharmacologic Class: triptans (-triptan)
sumatriptan (Imitrex)
Action:
causes vasoconstriction of cranial arteries
moderately selectively reduces carotid arterial blood flow
Alert:
may cause cardiac ischemia in susceptible person without previous cardiac events
so if DO have hx then be extra precautious esp hx of MI or stroke
give pt precautions for cardiac
s/s
pt teaching
risk of increased BP although not common
drowsiness, dizziness, warmed feeling
most of time not enough to d/c it
duloxetine
SNRI
ADR:
serotonin syndrome -
neuroleptic malignant syndrome - fever, muscle, rigidity
hyponatremia - assess levels, risk of seizure
hepatotoxicity - liver labs
increased BP
Reye’s Syndrome
Reye’s syndrome -
swelling of brain and liver
can be caused by giving child or teen aspirin or** bismuth subsalicylate (Pepto Bismol)**
if they have chickenpox or flu (viral infection) or fever - do not give aspirin - give ibuprofen or Tylenol
aspirin
pharmacologic: salicylic acid; nsaid
therapeutic: Non-opioid analgesic, antipyretic, NSAID
used for pain and inflammation, produces mild to moderate relief of fever
inhibitor of thromboxane
**significant anticoagulation properties **- reduce risk of mortality after MI; prevention of stroke
specific to aspirin only (not other NSAIDs)
**Reye’s syndrome -
**swelling of brain and liver
can be caused by giving child or teen aspirin; if they have chickenpox or flu (viral infection) or fever - do not give aspirin - give ibuprofen or Tylenol
higher risk of bleeding associated with aspirin
NSAIDs
ibuprofen and _____
ibuprofen and ketorolac
mild to moderate pain, fever, inflammation
inhibit COX1 and COX2
increased risk of bleeding with Ginkgo and garlic
take with food
(can take without but harsher on stomach. Esp. important hx of peptic ulcer disease. if currently have one will not give)
Ketorolac can be given IV (also PO)
useful** post-op**
not for long-term use
Risk of** gastric bleeding**
harsh on kidneys - watch kidney labs, I&O, creatinine (normal: ***)
chronic use → can lead to CKD
