Nurs 605 Module 12 Flashcards
What are the first, second and third line drugs in depression and anxiety?
- SSRIs/SNRIs- fluoxetine, citalopram, escitalopram
- tricyclic antidepressants - nortriptyline, amytriptyline
- MAOIs - phenylzine
What are common side effects of SSRIs?
anticholinergic effects
dry mouth, blurred vision, urinary retentions
What is serotonin syndrome? When is the risk of this occurring greatest?
toxicity that abruptly occurs with SSRIs; greatly increased when combined with MAOis
agitation, diarrhea, hyperreflexes, fever
What are important patient education points for those taking medications for depression or anxiety?
meds take a while to work 2-4 weeks
take daily, don’t miss doses
suicidal ideation is very high in the first 2 weeks
may feel worse in the first two weeks when initating drug
do not abruptly stop the drug
What are common side effects of tricyclic antidepressants?
anticholinergic s/e: dry mouth, blurred vision, urinary retention
motor incoordiation-wears off in 2 weeks
What occurs during trycyclic antidepressant overdose? what are the manifestions?
overdose of antidepressants
results in cardiaotoxicity- dysrythmmias, qt prolongation
Discuss important side effects of MAOis
cheese effect-fatal food and drug toxicities
overdose: CNS toxixity, seizures, serotonin syndrome esp when combined with SSRIs
What is antidepressant discontinuation syndrome and what would be the management?
occurs when large dose reduction occurs or abrupt d/x of antidepressant.
occurs more likely with SSRIs
somatic, neurological and psychological s/e due to lack of serotonin-wil resume in 2 weeks
if not resolving, give fluoxetine
What pharmacological options are used in treatment of bipolar disorder?
lithium
antiepileptics- valproic acid, lamotrigine, carbemenzapine
divalproex
Explain the pharmacokinetic profile of lithium and its therapeutic range.
- Very narrow therapeutic window
- Effective at plasma concentration of 0.5-1mmol/L
- > 1.5mmol/L = toxic effects!
- Half a dose via mouth is excreted within 12 hours, rest stays in the sysmte and is excreted by kidneys =very slow excretion, quick to build in the blood = small therapeutic window and levels MUST be monitored
What are the s/s of lithium toxicity?
- n/v, diarrhea
- tremor
- thyroid enlargement
- weight gain, hair loss
- renal effects: polyuria, excessive thrist, renal tubular damage
- confusion, motor impairment, coma, convulsions, death
How often should blood monitoring occur in those taking lithium?
- Maintenance b/w: q 6 months for renal and thyroid levels; q 3 month lithium levels once dosage is stable
- Initial therapy
- Check lithium levels after each dose
- Adjust and then check at 5 days after (when reach steady state)
What are some adverse effects of FGA (first generation antipsychotics) and SGAs (second generation antipsyhocitics)? What is the major difference between these two generations of antipsychotics?
- FGA – typical antipsychotics
- Chlorpromazine; methotrimoprazine; fluphenazine; haloperidol, EPS
- Sedation, CV effects, anticholinergic effects, weight gain
- SGA- atypical antipsychotics
- Apiprazole; asenapine; brexipiprazole; palperidone/risperidone
- Weight gain, sedation, CV effects (hypotension, prolonged qT); less EPS symptoms
What are extrapyrimidial symptoms? What drugs are more likely to cause this?
- Mostly occurs with FGAs
- Higher doses of SGAs can also cause EPS
- Parkinsonism- dysphora, decreased concerntation, slowed cognition
- Akathisia -restlessless, often misdiagnosed as agitation
- Tardive dyskinesia – repetitive, involuntary movements mouth muscles, face, trunk, extrematies and respiratory muscles
Explain symptoms associated with neuromuscular malignant syndrome (NMS) and discuss the treatment of NMS.
- Medical EMERGENCY- can occur at any time, at any dosage of antipsychoitics; risk factor= dehydration
- High mortality rate
- Rare
- Muscle rigidity
- Fever
- Autonomic disturbance
- Labile blood pressure
- Fluctuating LOC
- Increased CK, WBCs
