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Pharmacology N322 > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

Beta blocker suffix

A

-olol

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2
Q

Alpha 2 agonist suffix

A

-nidine

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3
Q

Carbonic anhydrase inhibitors suffix

A

-zolamide

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4
Q

Prostaglandin suffix

A

-prost

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5
Q

Lantaprost

A

 Considered just as effective as beta blockers and have fewer side effects  Action: Facilitates outflow by stimulating Prostaglandin F receptors  Eyelids and iris change color (brownish), luscious eyebrows. Not intended effect, now use it for lash growth, investigating use for male pattern baldness.

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6
Q

CHoline agonist pilocarpine pilo

A

pin point pupils Causes miosis or constriction of pupil–aka miotics

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7
Q

Buspirone onset

A

2-6 weeks Not taken PRN

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8
Q

Buspirone MOA

A

 Does not cause sedation or interact w/ other CNS stimulants  Don’t want to use long term but better than benzos, usually diminished effects after a year.

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9
Q

Interactions

A

CYP3A4–don’t take with grapefruit juice, macrolides, -zoles serotonin syndrome no dependence, tolerance, or withdrawal.

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10
Q

MAOI Phenelzine (nardil) MOA

A

stops break down of monoamines which include 5-HT, Dopamine, and NE

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11
Q

MAOI Phenelzine (nardil) Therapeutic use

A

• Depression, Panic disorders, OCD

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12
Q

MAOI Phenelzine (nardil) nursing implications

A

• SE: CNS stimulation (can cause anxiety, insomnia, agitation) • SE: Orthostatic Hypotension: • Major side effect: Hypertensive Crisis from Tyramine (cheese) • Teach about tyramine diet • Interacts with NUMEROUS other medications • Rarely prescribed

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13
Q

TCA, -tryptyline amyltriptyline Therapeutic use

A

Migraines, insomnia, neuropathic pain syndromes trigeminal neuralgia.

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14
Q

Why aren’t TCAs used to treat depression?

A

Very lethal overdose,

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15
Q

TCA overdose

A

• Anticholinergic syndrome • Three Cs: Coma, Convulsions, Cardiac conduction abnormalities. • Heart monitor, crash cart in room, gastric lavage, activated charcoal, oral airway, push sodium bicarb • QRS >0.12 sec is better predictor of toxicity than the serum drug level.

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16
Q

TCA side effects

A

• Orthostatic hypotension, drowsiness: generally take at night. • Anticholinergic effects: can’t see, can’t spit (dry mouth), can’t sit, can’t shit (laxative). • Treat side effect, take off if can’t void. • Cardiac Toxicity: not for anyone suicidal, not for depression, not for existing cardiac issues. • Can cause seizure. • Contraindicated w/ other CNS depressants, MAOI, anticholinergics • Because it causes hypotension, because it increases serotonin, • Monitor for suicidal ideation:

17
Q

SSRI drugs selective serotonins reuptake inhibitor

A

fluoxetine, citalopram, escitalopram, paroxetine.

18
Q

SSRI Nurse considerations

A

• SE: Sexual dysfunction: (might improve w/ decrease dose or sometimes drug holidays). Adding other drugs may help (mirtazapine, buproprion); Weight gain- cause unknown but thought to be insensitivity to the serotonin receptors that regulate appetite; Withdrawal syndromes—less likely w/ fluoxetine as it has a longer half-life; Pregnancy- no significant teratogenic effects, but child may experience some withdrawal • SE sometimes reversible, sometimes not. • Increased risk of suicide with initial treatment • Fluoxetine and sertraline deemed safe to use in children 8 and older • Others increase adolescent suicide risk. • Insomnia: take in the morning • GI: GI Bleed, diarrhea • Hyponatremia: SIADH-Syndrome of inappropriate anti-diuretic hormone.

19
Q

Serotonin syndrome treatment and symptoms

A

• Stop SSRI • Seizures—benzos, muscle relaxer • Treat symptoms • Symptoms: confusion, delirium, anxiety, fever, diaphoresis, tachycardia, hyperreflexia, tremors, elevated BP

20
Q

Discontinuation syndrome

A

• Withdrawal: flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, hyperarousal.

21
Q

SSRI pregnancy

A

• Pregnancy: some can be used during, but watch for discontinuation syndrome in infant

22
Q

SNRI Serotonin/norepi reuptake inhibitor venlafaxine side effect

A

mostly same effects of SSRI in addition to nausea, HTN, anorexia:

23
Q

Buproprion MOA

A

Variable actions depending on the drug. Some have little effect on serotonin, but instead work on NE and Dopamine.

24
Q

Buproprion therapeutic use

A

 Used to treat Depression, Smoking addiction, can be used as adjunct to combat sexual side effects of the other antidepressants,  Can lower the seizure threshold therefore contraindicated. appetite suppression

25
Q

Mirtazapine

A

 Action: Promotes release of serotonin and norepinephrine in the brain  Use for Depression and Bipolar disorder and can help with sexual adverse effects  SE: Appetite stimulant  Also activates Histamine receptor activity and causes sedation:

26
Q

trazadone

A

 Action: SARI: Inhibits Serotonin reuptake and minimally effects NE reup  Used for depression or insomnia  Strong sedative qualities and only taken at night  Rare, but dramatic side effect: priapism  Good choice for elderly with depression and sleeping problems. Minimal anticholinergic effects

27
Q

Lithium Chemically similar to what?

A

Na, body replaces Na with Li causes hyponatremia and dehydration inhibits ADH–polyuria

28
Q

Lithium therapeutic use

A

Bipolar Disorder w/ euphoric mania Has also been used w/ schizophrenia, ETOH, bulimia and for children w/ chronic neutropenia (raises WBC levels in select population) (think LI-Leukocyte increase, TH- Tremors and Thyroid Hypothyroidism, IU-Increased urination, M-mother-contraindicated for pregnancy)

29
Q

Lithium Nursing implications

A

• Must closely monitor blood levels: initial range 0.8-1.4 mEq/L; maintenance range 0.4-1 mEq/L; best to draw levels 12 hours after evening dose. Before next dose. • Side effects worsen with increasing levels. At therapeutic ranges some might experience hand tremor, slurred speech, n/v, thirst, polyuria and progress to o severe toxicity which includes extreme polyuria, blurred vision, seizures, hypotension, diarrhea, confusion, EKG changes, incoordination, stupor, and death. • Most common cause of lithium toxicity is Na depletion, most common cause of Na depletion is dehydration. • No antidote; supportive care only which may include dialysis • Drug Interactions: NSAIDS , Diuretics, ACE Inhibitors. All affect the kidneys. Interaction can cause 60% boost of Li. • Education includes: Consistent water and sodium intake. If sick and vomiting, need to seek treatment—dehydration can cause toxicity. • Test—have to know a lot because of toxicity and all the things that can go wrong.

30
Q

Lithium No Ace in the Hole

A

NO o NSAIDS, Ace inhibitors, HCTZ (common diuretic)

31
Q

• EPS symptoms:

A

 Akathisia (uncontrollable need for constant motion) Benzos, Benadryl, beta blocker.  Dystonia (muscles contract uncontrollably)  Benadryl or benztropine (anticholinergic)  Tardive Dyskinesia (months to years after starting med—(generally permanent effects) stop therapy and see if it gets better, but might not.  Parkinson-like symptoms  decreasing dopamine so look like parkinson’s patient. Will try to decrease dose to see if it helps. (could try amantadine)

32
Q

EPS Symptoms graphic

A
33
Q

Typical Antipsychotics

Chlorpromazine (thorazine), Haloperidol (haldol)

MOA

A
  1. Block NE, ACh, Dopamine, and Histamine receptors
  2. Produce “tranquil” effect
  3. Like walking dead, have too much dopamine, Thorazine lowers dopamine.
  4. Not used so much anymore, is used for hiccups.
34
Q

Typical Antipsychotics

Chlorpromazine (thorazine), Haloperidol (haldol)

Therapeutic use

A

Haloperidol- used for delirium and confusion. Elderly population. Probs #1 used. (look up)

  1. Therapeutic Use
    * Schizophrenia, Manic Bipolar, occ. hiccups (Thorazine), n/v (prochlorperazine or promethazine)
35
Q
A
36
Q

Typical Antipsychotics

Chlorpromazine (thorazine), Haloperidol (haldol)

Nursing implications

A
  • Cardiac Arrhythmias: especially prolonged QTà
  • Anticholinergic Effectà treat effects
  • Sedationà zombies
  • Weight gain
  • Hyperprolactinemiaà men develop breast and produce milk. Zombies with lactating boobs.
  • Neuroleptic Malignant Syndrome: High fever, unstable BP, LOC
    • Give dantrolene—stop rigidity and fever
  • Treat EPS symptoms with anticholinergics***
    • Benztropine, benadryl
37
Q

Atypical antipsychotics

Risperidone, clozapine, olanzapine, quetiapine, seroquel (insomnia)

MOA

A

Blocks dopamine and 5HT

  1. Improved symptom control in psychosis
  2. Lower risk for NMS and EPS
  3. Longer acting doses available
38
Q

Atypical antipsychotics

  • risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel–also used for insomnia)

Therapeutic use

A
  • Psychosis, Schizophrenia, Bipolar disorder, Autism agitation behaviors
39
Q

Atypical antipsychotics

risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel–also used for insomnia)

Nursing implications

A
  • Weight gain and associated metabolic syndrome such as diabetes and higher cholesterol:
  • EPS symptoms with higher doses
  • CNS effects- drowsy or insomnia
  • Agranulocytosis- low WBC most commonly associated w/ clozapine:
  • Medication Adherence: many stop taking because they don’t like the side effects.
  • Risperidone comes in v long acting shot (2 weeks)
  • Olanzepine—IM or oral disintegrating tab.
  • Aripiprazole

Pharmacology N322 (11 decks)

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