Neurological Part 3 Flashcards
diazepam (Valium) and Alprazolam (Xanax): class
Benzodiazepines
diazepam (Valium) and Alprazolam (Xanax): EPA
enhance inhibitory effects of gamma-aminobutyric acid (GABA), GABA can reduce excitability of neuronal activity
diazepam (Valium) and Alprazolam (Xanax): Use
generalized anxiety disorder (GAD) & Panic disorder
diazepam (Valium) and Alprazolam (Xanax): ADR
CONTROLLED SUBSTANCE, CNS depression, hypotension, tachycardiac, respiratory depression, tolerance and physical dependence, overdose/toxicity: life-threatening sedation, hypotension, respiratory depression, cardiac arrest
diazepam (Valium) and Alprazolam (Xanax): contraindications
teratogenic, glaucoma, respiratory and CNS depression, concurrent use of CNS depressant
diazepam (Valium) and Alprazolam (Xanax): RN Intervention
monitor for withdrawal symptoms, monitor for phlebitis, assess falls, regular vital signs, do not stop abruptly, assess CNS and respiratory
What is the antidote for benzodiazepines (Diazepam and Alprzolam)?
Flumazenil (Anexate, Romazicon)
Buspirone (BuSpar): class
Non-benzodiazepines/ misc. anxiolytic
Buspirone (BuSpar): EPA
binds to serotonin & dopamine receptors, agonistic action on dopamine
Buspirone (BuSpar): administration
PO, can take 2-4 weeks to take effect, taper
Buspirone (BuSpar): Use
short term treatment of generalized anxiety
Buspirone (BuSpar): ADRs
paradoxical effects, insomnia, anxiety, restlessness, headache, dizziness, generally well tolerated
Buspirone (BuSpar): contraindications
MAOI can lead to HTN, grapefruit juice, ketoconazole, erythromycin may increase blood levels
Buspirone (BuSpar): RN Interventions
monitor for paradoxical effects, assess/monitor falls, avoid grapefruit juice
Amitriptyline (Elavil): class
tricyclic antidepressants (TCA)
Amitriptyline (Elavil): EPA
blocks norepinephrine reuptake pump & serotonin reuptake pump in synaptic space which boosts availability of serotonin, norepinephrine, acetylcholine, and dopamine
Amitriptyline (Elavil): administration
take at bedtime due to sedative effects, takes several weeks for effects
Amitriptyline (Elavil): use
major depression, 2nd line drug
Amitriptyline (Elavil): ADRs
MANY, Anticholinergic effects; sedation, inc risk for suicide (child/adolescent); abrupt discontinuation can cause withdrawal (anxiety, headache, muscle pain, nausea); high risk for overdose (life threatening dysrhythmias, confusion, seizure)
Amitriptyline (Elavil): contraindications
avoid with MAOIs, avoid with anticholinergics, avoid with CNS depressants, cardiac dysrhythmias, seizure disorders, recent MI, MANY
Amitriptyline (Elavil): RN Intervention
at bedtime, monitor vital signs, monitor for increase in depression, suicide precautions, taper drug over 2 weeks, no more than 1 week supply given at a time
tricyclic antidepressants
amitriptyline, imapramine, nortriptyline
Fluoxetine (Prozac): Class
selective serotonin reuptake inhibitor (SSRI)
selective serotonin reuptake inhibitors (SSRI)
fluoxetine, citalopram, escitalopram, paroxetine, sertraline
Fluoxetine (Prozac): EPA
block reuptake of serotonin -> strengthen transmission of serotonin at serotonergic synapses
Fluoxetine (Prozac): Use
depression, anxiety, OCD, bulimia nervosa, premenstrual dysphoric disorder
Fluoxetine (Prozac): ADRs
- Insomnia, nervousness, Sexual dysfunction, Weight gain, inc risk for GI bleeding; Hyponatremia (especially in older adults and those taking diuretics), Increased risk for suicidal ideation (especially children, young adults)
- Serotonin syndrome
Serotonin syndrome: Hypertensive crisis; hyperpyrexia, agitation -> coma, muscle rigidity, seizure
Fluoxetine (Prozac): contraindications
MAOIs, St. Johns wort, ibuprofen, many decrease glucose control in diabetics
Fluoxetine (Prozac): RN Interventions
monitor for adverse effects, do not stop abruptly, notify provider if you develop persistent headaches
Vanlafaxine (Effexor XR): class
selective norepinephrine reuptake inhibitor (SNRI)
Vanlafaxine (Effexor XR): EPA
block neuronal reuptake of serotonin and norepinephrine -> increase amount of serotonin/norepinephrine available
Vanlafaxine (Effexor XR): use
major depression, social anxiety disorder, generalized anxiety
Vanlafaxine (Effexor XR): ARDs
very similar to SSRI, sexual dysfunction less common, hypertension, many
Vanlafaxine (Effexor XR): contraindications
MAOIs, First generation antipsychotics/typicals, ibuprofen
Vanlafaxine (Effexor XR): RN Interventions
give in the morning with food, monitor for adverse effects, do not stop abruptly, monitor BP periodically
Phenelzine (Nardil): class
Monoamine Oxidase Inhibitor (MAOI)
Monoamine Oxidase Inhibitors (MAOI)
phenelzine, isocarboxazid
Phenelzine (Nardil): EPA
blocks monoamine oxidase - A and monoamine oxidase - B
Phenelzine (Nardil): use
depression that hasn’t responded to other medications, depression in bipolar
Phenelzine (Nardil): ADRs
CNS stimulation, constipation, dry mouth, nausea, weight gain, sexual dysfunction, orthostatic hypotension, hypertensive crisis when eating foods with tyramine
Phenelzine (Nardil): contraindications
renal failure, liver disease, cardiac disease, clients over 60, SSRIs, Glaucoma
Phenelzine (Nardil): RN Interventions
monitor vitals, list of foods to avoid, report severe anxiety, insomnia, and agitation
Bupropion (Wellbutrin): class
atypical antidepressant
Bupropion (Wellbutrin): EPA
inhibits dopamine reuptake thereby increase dopamine availability
Bupropion (Wellbutrin): Use
depression, seasonal affective disorder, adjunctive to smoking cessation
Bupropion (Wellbutrin): ADR
N/V, weight loss, appetite suppression, increase seizure risk, CNS stimulation, increase risk psychosis
Bupropion (Wellbutrin): contraindications
history of eating disorder, seizure disorder, MAOI, head trauma, interacts with many medications
Bupropion (Wellbutrin): RN Interventions
give with food, in the am, weekly weights, asses for increase depression
lithium carbonate (Lithobid): class
mood stabilizer
lithium carbonate (Lithobid): EPA
not well understood, changes sodium transport
lithium carbonate (Lithobid): use
controls acute mania, bipolar, prophylactically to prevent recurrence of mania or depression
lithium carbonate (Lithobid): ADR
GI distress, fatigue, confusion, muscle weakness, memory impairment, polyuria, decrease secretion of thyroid hormone: goiter, toxicity!
lithium carbonate (Lithobid): toxicity
due to narrow therapeutic window, muscle weakness, fine tremor to course tremor, ataxia, confusion, seizures, coma, death
lithium carbonate (Lithobid): contraindications
teratogenic, cardiac disorders, dehydration, hyponatremia, renal insufficiency, Many drug interactions, Avoid NSAIDS
lithium carbonate (Lithobid): RN Interventions
narrow therapeutic range, monitor lithium levels (.6-.8), regular blood work, monitor for toxicity, drink 2-3L fluid, avoid caffeine, consume foods with sodium
chlorpromazine: class
1st generation antipsychotics/ traditional
chlorpromazine: EPA
blocks several receptors: norepinephrine, acetylcholine, dopamine, histamine
chlorpromazine: Use
suppresses symptoms of schizophrenia, acute manic phase of bipolar
chlorpromazine: ADR
- Extrapyramidal symptoms (EPS): Abnormal muscle contraction/posturing and Acute dystonia
- Neuroleptic malignant syndrome: Fever, stiffness of muscles, altered mental status, change in BP resp. failure
- Akathisia (inability to sit still)
- Anticholinergic Symptoms (dry mouth, dizziness, urinary retention, etc)
- Parkinsonism
- Orthostatic hypotension
- Cardiac arrhythmias: prolonged QT interval
Liver failure
chlorpromazine: contraindications
- CNS depressants
- Caution with meds that activate dopamine receptors (levodopa)
- SSRIs: increase levels of serotonin ->serotonin syndrome
- Hyponatremia
- Antihypertensives
- Pregnancy/Lactation
- Parkinsons disease, bone marrow depression
chlorpromazine: RN Interventions
wear gloves when handling, have client report adverse reactions
Risperidone (Risperdal): class
second generation antipsychotics/ Atypicals
Risperidone (Risperdal): EPA
Block receptors for dopamine and serotonin.
Risperidone (Risperdal): use
treat symptoms of schizophrenia and bipolar disorder
Risperidone (Risperdal): ADRs
Dizziness; sedation; hypotension (blockade of alpha-adrenergic receptors); Metabolic syndrome: wt gain, diabetes, dyslipidemia; Arrhythmias; Agranulocytosis (Clozapine); liver and kidney dysfunction; severe constipation. Extrapyramidal symptoms when given high doses
Risperidone (Risperdal): contraindications
- Prolonged QT
- Severe CNS depression
- Psychosis related to dementia in older adults
- Pregnancy/Lactation
- Drugs to treat parkinsons disease
- MANY drug interactions
Risperidone (Risperdal): RN Interventions
weekly blood tests, periodic blood glucose levels, report symptoms, wear gloves, BLACK BOX WARNING
Risperidone (Risperdal): BLACK BOX WARNING
risk of death increases in elderly patients with dementia