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Pharmacology > Neurological System (2) > Flashcards

Neurological System (2) Flashcards

1
Q

List all of the benzodiazepines (end in ‘pam’ or ‘lam’)

A

Alprazolam, diazepam, lorazepam, oxazepam

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2
Q

Adverse Effects

Benzodiazepines

A

Drowsiness, slurred speech; impaired recall of events; paradoxical reaction (confusion, anxiety); hypotension, tachycardia, respiratory depression; tolerance and physical dependence (especially with alprazolam); withdrawal symptoms-insomnia, anxiety, tremors, diaphoresis, dizziness, panic, hypertension, seizures; overdose/toxicity; oral-sedation; parenteral-possibly life-threatening sedation, hypotension, respiratory depression, cardiac arrest

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3
Q

Nursing Intervention

Benzodiazepines

A

Monitor clients to prevent falls and other injury following administration; assess clients’ memory following administration; monitor clients, especially older adults, for a paradoxical reaction; monitor vital signs, especially with IV administration; monitor clients for signs of tolerance and dependence; taper over 1 o 2 weeks to prevent or minimize withdrawal; monitor for signs of withdrawal- reverse sedation with IV flumazenil; Provide airway and blood pressure support as needed for parenteral overdose

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4
Q

Therapeutic Use

Non-benzodiazepine (buspirone)

A

Short-term treatment of certain anxiety-disorders, such as generalized anxiety disorders

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5
Q

Medication Administration

Non-benzodiazepine (buspirone)

A

Give orally on a regular basis (not PRN) for anxiety

Begin buspirone 2 to 4 weeks before tapering benzodiazepines due to delayed therapeutic effect of buspirone

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6
Q

Paradoxical Adverse Effects

Non-benzodiazepine (buspirone)

A

Insomnia, anxiety, restlessness

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7
Q

Adverse Effects

Temazepam

A

Dizziness, drowsiness, indigestion, loss of muscle coordination, slurred speech

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8
Q 
Therapeutic Effect
Tricyclic antidepressants (amitriptyline) (TCA)
A

Treatment of major depression

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9
Q 
Adverse Effects including toxicity 
Tricyclic antidepressants (amitriptyline) (TCA)
A

Drowsiness, sedation; orthostatic hypotension; anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision); increased risk for suicide (especially in children, adolescents); withdrawal symptoms with abrupt discontinuation (anxiety, headache, muscle pain, nausea)
Toxicity/high risk for overdose (life-threatening dysrhythmias, confusion, seizures)

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10
Q 
Client Instructions
Tricyclic antidepressants (amitriptyline) (TCA)
A

Take at bedtime to prevent daytime drowsiness; do not drive or perform hazardous activities if drowsy; move slowly from lying to sitting or standing; urinate before taking daily dose; increase fiber and fluids to prevent constipation; chew gum, suck on hard candy, or sip water to prevent dry mouth; report any feelings of self-harm or worsening depression; do not stop taking the drug abruptly; take the drug exactly as prescribed

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11
Q

Therapeutic Use

Selective Serotonin Reuptake Inhibitors (fluoxetine) (SSRI)

A

Major depression, Bipolar disorder, Panic disorder, Obsessive Compulsive Disorder (OCD), premenstrual dysphoric disorder, bulimia nervosa

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12
Q

Adverse Effects

Selective Serotonin Reuptake Inhibitors (fluoxetine) (SSRI)

A

Insomnia, nervousness; sexual disfunction; headache; weight gain; hyponatremia (especially in older adults and those taking diuretics); Increased risk for suicidal ideation (especially children, young adults); Serotonin Syndrome

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13
Q

Signs of Serotonin Syndrome

A

Mental confusion, difficulty concentrating, fever, agitation, anxiety, hallucinations, incoordination, hyperreflexia, diaphoresis, and tremors

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14
Q

Interactions

Selective Serotonin Reuptake Inhibitors (fluoxetine) (SSRI)

A

Taking an SSRI with 2 weeks of MAOIs or another SSRI increase the risk of serotonin syndrome
Fluoxetine increases levels of tricyclic antidepressants and lithium
NSAIDs increase the risk of gastrointestinal bleeding

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15
Q

Therapeutic Use

Serotonin Norepinephrine Reuptake Inhibitors (venlafaxine) (SNRI)

A

Major depression
Social anxiety disorder
Generalized anxiety disorder (GAD)

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16
Q

Adverse Effects and Withdrawal Symptoms

Serotonin Norepinephrine Reuptake Inhibitors (venlafaxine) (SNRI)

A

Nausea, vomiting, anorexia; headache; hypertension; insomnia; nervousness; increased risk for suicide (especially children, young adults)
Withdrawal symptoms with abrupt discontinuation: anxiety, agitation, headache, tachycardia

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17
Q

Client Instructions

Serotonin Norepinephrine Reuptake Inhibitors (venlafaxine) (SNRI)

A

Take the drug with food; report headache; take over-the-counter analgesics as needed; have blood pressure checked regularly; take the drug in the morning to avoid interference with sleep; do not stop taking the drug abruptly, understand that this is a risk; report any worsening depression or thoughts of suicide

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18
Q

Herbal Interactions

Serotonin Norepinephrine Reuptake Inhibitors (venlafaxine) (SNRI)

A

St. John’s Wort and date nut increase the risk of serotonin syndrome

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19
Q

Therapeutic Use

Monoamine Oxidase Inhibitors (phenelzine) (MAOI)

A

Depression that has not responded to other classes of antidepressants
Depression in bipolar disorder

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20
Q

Adverse Effects

Monoamine Oxidase Inhibitors (phenelzine) (MAOI)

A

Orthostatic hypotension; Anxiety, insomnia, agitation; hypertensive crisis in presence of tyramine-containing foods; constipation, nausea, vomiting, and other GI symptoms; suicidal ideation (especially in children and young adults

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21
Q

Client Education

Monoamine Oxidase Inhibitors (phenelzine) (MAOI)

A

Instruct client to rise slowly from lying or sitting position and to lie down if lightheadedness occurs; report extreme anxiety, insomnia, and agitation to provider; provide client, caregiver, or significant other a list of foods that may contain tyramine; instruct clients to take non-tyramine-containing foods if GI symptoms occur, notify provider

22
Q 
Therapeutic Use
Atypical Antidepressants (bupropion hydrochloride)
A

Treats depression
Prevents seasonal affective disorder (SAD)
Smoking cessation adjunct

23
Q 
Adverse Effects
Atypical Antidepressants (bupropion hydrochloride)
A

Nausea, vomiting, weight loss; increased risk for seizures; CNS effects: insomnia, agitation, tremor, headache; psychosis, hallucinations, and delusions; increased risk for suicidal ideation (children and young adults)

24
Q 
Contraindications
Atypical Antidepressants (bupropion hydrocholide)
A

Previous allergy to bupropion; history of eating disorder; seizure disorder; suicidal ideation; concurrent administration of MAOI antidepressant; head trauma, tumor in CNS; liver or renal dysfunction; cardiac disease; schizophrenia or bipolar disorder; diabetes mellitus; alcohol use disorder

25
Q

What is the therapeutic level for lithium?

A

0.4mEq/L to 1.0mEq/L

26
Q

Adverse Effects and signs of toxicity

Lithium

A 
GI effects (early in treatment, subsiding with time); muscle weakness, drowsiness, headache, confusion; polyuria; goiter and hypothyroidism
Toxicity signs: nausea, muscle weakness, fine tremor progressing to coarse tremor, ataxia, confusion, seizures, coma, and death
27
Q

Nursing Interventions

Lithium

A

Monitor for early, transient adverse effects; differentiate transient effects from toxic effects by monitoring lithium levels; monitor fluid intake and output; monitor for electrolyte imbalance; give prescribed beta blocker to decease tremor; monitor for increasing tremor; monitor thyroid function tests yearly, monitor for signs of hypothyroidism; monitor serum lithium levels, should be below 1.0mEq/L; monitor sodium levels (low sodium can cause toxicity); recognize symptoms of toxicity to prevent severe effects; monitor kidney function during treatment

28
Q

Interactions

Lithium

A

NSAIDs (except aspirin), tetracyclines, diuretics, methyldopa, and probenecid increase risk for toxicity
Phenothiazine antipsychotics, such as haloperidol, increase risk for dyskinesis, urinary retention
ACE inhibitors may increase lithium levels causing toxicity

29
Q

Expected Pharmacological Action

Conventional/typical antipsychotic (chlorpromazine)

A

Conventional antipsychotics block several CNS and non-CNS receptors, including those for norepinephrine, acetylcholine, dopamine, and histamine. Dopamine receptor blockade, in particular, accounts for the suppression of the symptoms of various types of psychosis

30
Q

Define akathisia

A

Develops within first 2 months of treatment of chlorpromazine
Manifests as restlessness and an uncontrollable need for constant motion

31
Q

Define Parkinsonism

A

Occur within first month of treatment with chlorpromazine

Manifests as muscle rigidity, tremors, and sluggish movements

32
Q

Define acute dystonia

A

Occurs within a few hours to days after first dose of chlorpromazine and requires immediate intervention
Manifests as severe painful spasms of the neck and body, causing clients to assume an arched position

33
Q

Define tardive dyskinesia

A

Develops months to years after treatment of chlorpromazine

Manifests as writhing movements of the tongue and neck and may extend to extremities and trunk

34
Q

Nursing Interventions

Conventional/typical antipsychotic (chlorpromazine)

A

Treat with betablocker or benzodiazepine; possible switch to a low-potency antipsychotic; treat on short-term basis with anti-Parkinson drugs; be prepared to administer IM or IV anticholinergic, such as diphenhydramine, in case of acute dystonia; switch client to an atypical antipsychotic; monitor client for dry mouth, constipation, and urinary retention; counsel clients about sexual dysfunction; monitor vital signs, periodic ECG, and serum potassium levels; wear gloves when handling phenothiazines to prevent personal dermatitis; prepare to administer IV dantrolene and bromocriptine; use coding measures and antipyretics, keep client hydrated; give benzodiazepines for anxiety

35
Q 
Expected Pharmacological Action
Atypical antipsychotics (risperidone)
A

Atypical antipsychotics block the receptors for dopamine, but more strongly block those for serotonin. Since the dopamine receptor blockade is less than that of conventional antipsychotic drugs, they precipitate fewer extrapyramidal symptoms and subsequently fewer side effects

36
Q 
Nursing Interventions
Atypical antipsychotic (risperidone)
A

Monitor for drowsiness, insomnia, dizziness, and other CNS effects; prepare to treat acute dystonia with anticholinergic drugs as prescribed; prepare to treat Parkinson symptoms with anti-Parkinson drugs; some of these effects may require change to another antipsychotic drug; monitor weight loss, blood glucose, and cholesterol/triglyceride levels periodically

37
Q 
Evaluation of Medication Effectiveness
Atypical antipsychotic (risperidone)
A

Positive and negative manifestations (prevention of acute psychotic manifestations, absence of hallucinations, delusions, anxiety and hostility)
Ability to perform ADLs
Ability to interact socially with peers
Sleeping and eating habits

38
Q

Therapeutic Use

Beta-adrenergic blockers (betaxolol and timolol)

A

Topical therapy that helps lower IOP in chronic open-angle glaucoma and acute closed-angle glaucoma

39
Q

Adverse Effects

Beta-adrenergic blockers (betaxolol and timolol)

A

Stinging, burning, and eye discomfort

If systematically absorbed (cardiac of respiratory effects such as bradycardia, hypotension, and bronchospasm

40
Q

Client Education

Beta-adrenergic blockers (betaxolol and timolol)

A

Advise clients that stinging, burning, and eye discomfort after application are temporary; encourage clients to avoid rubbing their eyes after instillation, as this can increase discomfort; observe clients for caregivers instilling the eye drops prior to discharge to make sure they use proper techniques and apply pressure to the puncta and the nasolacrimal sac immediately after instillation; if the client experiences a slow pulse, fainting spell, or wheezing after administration using the proper techniques, tell them to notify the provider

41
Q

Drug Interactions

Beta-adrenergic blockers (betaxolol and timolol)

A

Use with systemic beta blockers causes increased systemic effects
Calcium channel blockers can increase systemic effects

42
Q 
Therapeutic Use
Cholinergic Agonists (pilocarpine)
A

Topical therapy that helps lower IOP in glaucoma

Adjunct to laser and other eye surgeries and procedures

43
Q 
Expected Pharmacological Action
Cholinergic Agonists (pilocarpine)
A

Increases secretion by endocrine glands, and produces contraction of iris sphincter muscle and ciliary muscle by stimulating muscarinic receptors

44
Q 
Adverse Effects
Cholinergic Agonists (pilocarpine)
A

Systemic effects: urinary urgency, bradycardia, constriction of bronchioles
Decreased visual acuity (especially at night), headache (occurs more often in younger clients), retinal detachment could occur

45
Q 
Administration Techniques
Cholinergic Agonists (pilocarpine)
A

Perform hand hygiene prior to instilling eye drop, then put on clean gloves. Make sure clients take out their contact lenses before you instill the drops. Immediately after instillation, hold pressure on the puncta and the nasolacrimal sac for at least 60 seconds. Take care not to touch or drop the eye dropper

46
Q 
Therapeutic Use
Cholinesterase Inhibitors (echothiophate)
A

Topical therapy that helps lower IOP in glaucoma

Adjunct to laser and eye surgeries and procedures

47
Q 
Adverse Effects
Cholinesterase Inhibitors (echothiophate)
A

Decreased visual acuity (especially at night); development of cataracts

48
Q

Common Side Effects for all antidepressants

A

Increased depression or thoughts of suicide

49
Q

Average length of time until antidepressants have therapeutic effects

A

2 to 4 weeks

50
Q

Treatments for depression

A

Monoamine Oxidase Inhibitors (MAOIs), Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs); Tricyclic Antidepressants (TCAs), Atypical Antidepressants

51
Q

Evaluation of Medication Effectiveness in antidepressants

A 
Verbalizing improvement in mood
Increased hopefulness and will to live
Ability to perform ADLs
Improved sleeping and eating habits
Increased interaction with peers

Pharmacology (9 decks)

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