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Pharmacology Exam #1 > Neurological Part 3 > Flashcards

Neurological Part 3 Flashcards

1
Q

diazepam (Valium) and Alprazolam (Xanax): class

A

Benzodiazepines

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2
Q

diazepam (Valium) and Alprazolam (Xanax): EPA

A

enhance inhibitory effects of gamma-aminobutyric acid (GABA), GABA can reduce excitability of neuronal activity

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3
Q

diazepam (Valium) and Alprazolam (Xanax): Use

A

generalized anxiety disorder (GAD) & Panic disorder

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4
Q

diazepam (Valium) and Alprazolam (Xanax): ADR

A

CONTROLLED SUBSTANCE, CNS depression, hypotension, tachycardiac, respiratory depression, tolerance and physical dependence, overdose/toxicity: life-threatening sedation, hypotension, respiratory depression, cardiac arrest

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5
Q

diazepam (Valium) and Alprazolam (Xanax): contraindications

A

teratogenic, glaucoma, respiratory and CNS depression, concurrent use of CNS depressant

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6
Q

diazepam (Valium) and Alprazolam (Xanax): RN Intervention

A

monitor for withdrawal symptoms, monitor for phlebitis, assess falls, regular vital signs, do not stop abruptly, assess CNS and respiratory

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7
Q

What is the antidote for benzodiazepines (Diazepam and Alprzolam)?

A

Flumazenil (Anexate, Romazicon)

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8
Q

Buspirone (BuSpar): class

A

Non-benzodiazepines/ misc. anxiolytic

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9
Q

Buspirone (BuSpar): EPA

A

binds to serotonin & dopamine receptors, agonistic action on dopamine

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10
Q

Buspirone (BuSpar): administration

A

PO, can take 2-4 weeks to take effect, taper

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11
Q

Buspirone (BuSpar): Use

A

short term treatment of generalized anxiety

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12
Q

Buspirone (BuSpar): ADRs

A

paradoxical effects, insomnia, anxiety, restlessness, headache, dizziness, generally well tolerated

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13
Q

Buspirone (BuSpar): contraindications

A

MAOI can lead to HTN, grapefruit juice, ketoconazole, erythromycin may increase blood levels

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14
Q

Buspirone (BuSpar): RN Interventions

A

monitor for paradoxical effects, assess/monitor falls, avoid grapefruit juice

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15
Q

Amitriptyline (Elavil): class

A

tricyclic antidepressants (TCA)

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16
Q

Amitriptyline (Elavil): EPA

A

blocks norepinephrine reuptake pump & serotonin reuptake pump in synaptic space which boosts availability of serotonin, norepinephrine, acetylcholine, and dopamine

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17
Q

Amitriptyline (Elavil): administration

A

take at bedtime due to sedative effects, takes several weeks for effects

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18
Q

Amitriptyline (Elavil): use

A

major depression, 2nd line drug

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19
Q

Amitriptyline (Elavil): ADRs

A

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)

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20
Q

Amitriptyline (Elavil): contraindications

A

avoid with MAOIs, avoid with anticholinergics, avoid with CNS depressants, cardiac dysrhythmias, seizure disorders, recent MI, MANY

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21
Q

Amitriptyline (Elavil): RN Intervention

A

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

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22
Q

tricyclic antidepressants

A

amitriptyline, imapramine, nortriptyline

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23
Q

Fluoxetine (Prozac): Class

A

selective serotonin reuptake inhibitor (SSRI)

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24
Q

selective serotonin reuptake inhibitors (SSRI)

A

fluoxetine, citalopram, escitalopram, paroxetine, sertraline

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25
Q

Fluoxetine (Prozac): EPA

A

block reuptake of serotonin -> strengthen transmission of serotonin at serotonergic synapses

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26
Q

Fluoxetine (Prozac): Use

A

depression, anxiety, OCD, bulimia nervosa, premenstrual dysphoric disorder

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27
Q

Fluoxetine (Prozac): ADRs

A
  • 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
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28
Q

Fluoxetine (Prozac): contraindications

A

MAOIs, St. Johns wort, ibuprofen, many decrease glucose control in diabetics

29
Q

Fluoxetine (Prozac): RN Interventions

A

monitor for adverse effects, do not stop abruptly, notify provider if you develop persistent headaches

30
Q

Vanlafaxine (Effexor XR): class

A

selective norepinephrine reuptake inhibitor (SNRI)

31
Q

Vanlafaxine (Effexor XR): EPA

A

block neuronal reuptake of serotonin and norepinephrine -> increase amount of serotonin/norepinephrine available

32
Q

Vanlafaxine (Effexor XR): use

A

major depression, social anxiety disorder, generalized anxiety

33
Q

Vanlafaxine (Effexor XR): ARDs

A

very similar to SSRI, sexual dysfunction less common, hypertension, many

34
Q

Vanlafaxine (Effexor XR): contraindications

A

MAOIs, First generation antipsychotics/typicals, ibuprofen

35
Q

Vanlafaxine (Effexor XR): RN Interventions

A

give in the morning with food, monitor for adverse effects, do not stop abruptly, monitor BP periodically

36
Q

Phenelzine (Nardil): class

A

Monoamine Oxidase Inhibitor (MAOI)

37
Q

Monoamine Oxidase Inhibitors (MAOI)

A

phenelzine, isocarboxazid

38
Q

Phenelzine (Nardil): EPA

A

blocks monoamine oxidase - A and monoamine oxidase - B

39
Q

Phenelzine (Nardil): use

A

depression that hasn’t responded to other medications, depression in bipolar

40
Q

Phenelzine (Nardil): ADRs

A

CNS stimulation, constipation, dry mouth, nausea, weight gain, sexual dysfunction, orthostatic hypotension, hypertensive crisis when eating foods with tyramine

41
Q

Phenelzine (Nardil): contraindications

A

renal failure, liver disease, cardiac disease, clients over 60, SSRIs, Glaucoma

42
Q

Phenelzine (Nardil): RN Interventions

A

monitor vitals, list of foods to avoid, report severe anxiety, insomnia, and agitation

43
Q

Bupropion (Wellbutrin): class

A

atypical antidepressant

44
Q

Bupropion (Wellbutrin): EPA

A

inhibits dopamine reuptake thereby increase dopamine availability

45
Q

Bupropion (Wellbutrin): Use

A

depression, seasonal affective disorder, adjunctive to smoking cessation

46
Q

Bupropion (Wellbutrin): ADR

A

N/V, weight loss, appetite suppression, increase seizure risk, CNS stimulation, increase risk psychosis

47
Q

Bupropion (Wellbutrin): contraindications

A

history of eating disorder, seizure disorder, MAOI, head trauma, interacts with many medications

48
Q

Bupropion (Wellbutrin): RN Interventions

A

give with food, in the am, weekly weights, asses for increase depression

49
Q

lithium carbonate (Lithobid): class

A

mood stabilizer

50
Q

lithium carbonate (Lithobid): EPA

A

not well understood, changes sodium transport

51
Q

lithium carbonate (Lithobid): use

A

controls acute mania, bipolar, prophylactically to prevent recurrence of mania or depression

52
Q

lithium carbonate (Lithobid): ADR

A

GI distress, fatigue, confusion, muscle weakness, memory impairment, polyuria, decrease secretion of thyroid hormone: goiter, toxicity!

53
Q

lithium carbonate (Lithobid): toxicity

A

due to narrow therapeutic window, muscle weakness, fine tremor to course tremor, ataxia, confusion, seizures, coma, death

54
Q

lithium carbonate (Lithobid): contraindications

A

teratogenic, cardiac disorders, dehydration, hyponatremia, renal insufficiency, Many drug interactions, Avoid NSAIDS

55
Q

lithium carbonate (Lithobid): RN Interventions

A

narrow therapeutic range, monitor lithium levels (.6-.8), regular blood work, monitor for toxicity, drink 2-3L fluid, avoid caffeine, consume foods with sodium

56
Q

chlorpromazine: class

A

1st generation antipsychotics/ traditional

57
Q

chlorpromazine: EPA

A

blocks several receptors: norepinephrine, acetylcholine, dopamine, histamine

58
Q

chlorpromazine: Use

A

suppresses symptoms of schizophrenia, acute manic phase of bipolar

59
Q

chlorpromazine: ADR

A
  • 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
60
Q

chlorpromazine: contraindications

A
  • 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
61
Q

chlorpromazine: RN Interventions

A

wear gloves when handling, have client report adverse reactions

62
Q

Risperidone (Risperdal): class

A

second generation antipsychotics/ Atypicals

63
Q

Risperidone (Risperdal): EPA

A

Block receptors for dopamine and serotonin.

64
Q

Risperidone (Risperdal): use

A

treat symptoms of schizophrenia and bipolar disorder

65
Q

Risperidone (Risperdal): ADRs

A

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

66
Q

Risperidone (Risperdal): contraindications

A
  • Prolonged QT
  • Severe CNS depression
  • Psychosis related to dementia in older adults
  • Pregnancy/Lactation
  • Drugs to treat parkinsons disease
  • MANY drug interactions
67
Q

Risperidone (Risperdal): RN Interventions

A

weekly blood tests, periodic blood glucose levels, report symptoms, wear gloves, BLACK BOX WARNING

68
Q

Risperidone (Risperdal): BLACK BOX WARNING

A

risk of death increases in elderly patients with dementia

Pharmacology Exam #1 (4 decks)

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