Nursing Implications Flashcards
Monitor drug plasma levels to adjust dosage, monitoring adherence, determining the cause of lost seizure control, and identifying the cause of toxicity
Antiepileptic Drugs (AEDs)
___________ accounts for nearly half of all treatment failures. To promote adherence, educate patients about the importance of taking AEDs exactly as prescribed.
Nonadherence
Abrupt discontinuation of AEDs can lead to _____ _________; medication must be slowly discontinued (over 6 weeks to several months).
status epilepticus
Most AEDs cause ___ _________, and small risk of suicidal thoughts and behavior. Screen for _________ before starting treatment.
Educate patients, families, and caregivers about signs that may precede suicidal behavior (eg, increased anxiety, agitation, mania, or hostility).
CNS depression
suicidality
▪ All traditional AEDs (and some newer AEDs) can ____ the developing fetus.
harm
Anti-seizure meds induce hepatic drug-metabolizing enzymes. Dosages of ________ and ____ ______________ may need to be increased.
warfarin
oral contraceptives
AED
What Drug:
Obtain baseline tests of liver function.
Valproic Acid
Monitor for suicide risk especially with children and young adults.
Nursing Implications of Depression/Mania Drugs
Inform the patient that antidepressant effects develop over - weeks. Premature discontinuation of therapy can result in relapse.
Nursing Implications of Depression/Mania Drugs
Assess patients for improvement in symptoms, especially depressed mood and loss of interest or pleasure in usual activities.
Nursing Implications of Depression/Mania Drugs
Watch for symptoms of Serotonin Syndrome: agitation, confusion, disorientation, anxiety, hallucinations, poor concentration, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever. Avoid concurrent use of _____.
SSRI/SNRI
MAOIs
May cause GI bleed through impaired platelet aggregation, hyponatremia, bruxism.
SSRI/SNRI
Drugs that inhibit CYP2D6 can raise levels of SSRIs and SNRIs, and can thereby pose a risk of ________.
toxicity
Use _____ with caution in patients with cardiac disorders, elevated intraocular pressure, urinary retention, hyperthyroidism, seizure disorders, and liver or kidney dysfunction.
TCAs
Inform patients about symptoms of hypotension, possible anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia).
TCAs
Sedation is most intense during the first weeks of therapy and declines with continued drug use. Giving at bedtime minimizes daytime sedation and promotes sleep.
TCAs
_____ decrease seizure threshold. Exercise caution in patients with seizure disorders.
TCAs
_____ interact adversely with many other drugs: contraindicated with SSRIs. Indirect-acting sympathomimetics (eg, ephedrine, methylphenidate, amphetamines, cocaine) may precipitate *hypertensive crisis.
__________ can produce hyperthermia in patients taking _____ and hence should be avoided.
MAOIs
Meperidine
MAOIs
Dietary ______ and indirect-acting sympathomimetics (eg, amphetamine, methylphenidate, ephedrine, cocaine) can precipitate a hypertensive crisis in patients taking MAOIs. Provide patients with a list of specific foods to avoid.
tyramine
Avoid chlorpromazine, thioridazine, haloperidol, and pimozide in patients with risk factors for torsades de pointes and for those taking drugs that prolong the QT interval.
Nursing Implications of Antipsychotics
Watch for Early Extrapyramidal symptoms EPS: Acute Dystonia, Parkinsonism, and Akathisia: develop within hours to months after starting treatment, greatest risk with high-potency _ _ _. (eg, muscle spasm of tongue, face, neck, or back; tremor; rigidity; restless movement.)
Watch for Late Extrapyramidal symptoms EPS: Tardive Dyskinesia: develops after months or years of continuous therapy, risk is equal with all _ _ _. (eg, fine, worm-like movements of the tongue).
FGA’s
First Generation Antipsychotics
Watch for anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia, suppression of sweating). Avoid other anticholinergics, including antihistamines and over-the-counter sleep aids.
Nursing Implications of Antipsychotics
Avoid use of alcohol and all other drugs with CNS depressants (eg, barbiturates, opioids, antihistamines, benzodiazepines).
Nursing Implications of Antipsychotics
All _ _ _—and especially clozapine and olanzapine—can promote weight gain, which can lead to diabetes and dyslipidemia . Obtain baseline measurements of weight, waist circumference, fasting blood glucose, and fasting lipid levels.
NOT Testable information, just good information to have
SGAs
Second Generation Antipsychotics
These drugs:
Cimetidine
Haloperidol
Paroxetine
Fluxetine
inhibit what?
CYP2D6
