Pharmocology Flashcards
What medications are used for anxiety?
- benzodiazepines
- buspirone (BuSpar)
- selective serotonin reuptake inhibitors (SSRIs - antidepressants)
What are some examples of benzodiazepines?
suffix: lam/pam
Alprazolam (Xanax)
chlordiazepoxide (Librium)
clonazepam
diazepam (Valium)
lorazepam (Ativan)
oxazepam (Serax)
What are the uses for benzodiazepines
- anxiety and anxiety disorders***
- Alcohol (ETOH) withdrawal***
- insomnia,
- skeletal muscle relaxation,
- seizure disorders
What is the actions of benzodiazepines?
- amplify GABA effects (inhibitory neurotransmitter)
What are some nursing considerations for benzodiazepines?
- used to induce sleep rapidly
- need to be tapered off
- do not use with alcohol, opioids, CNS depressants = extreme sedation/ overdose
- caffeine can counteract effect of benzos
What are some side effects of benzodiazepines? (6)
- Drowsiness, sedation, ataxia, dizziness
- Feelings of detachment, irritability or hostility
- Anterograde amnesia: a type of memory loss that occurs when you can’t form new memories
- Cognitive effects with long-term use
- Tolerance, dependency, rebound insomnia/anxiety
- Rarely nausea, headache, confusion, depression
What are the withdrawl symptoms of benzos? (13)
- Agitation/irritability
- Anorexia
- Hyperactivity
- Insomnia
- Nausea, vomiting
- Sensitivity to light, sounds
- Tinnitus
- Anxiety
- Autonomic arousal
- Dizziness
- Generalized seizures
- Hallucinations
- Headache
T or F: Elderly patients more vulnerable to side effects because the aging brain is more sensitive to sedatives
true
What is Busiprone (buSpar)
- antianxiety drug
- Does not exhibit muscle-relaxant or anticonvulsant activity, interaction with CNS depressants, or sedative-hypnotic properties
- Not effective to manage drug or alcohol withdrawal or panic disorder
What are the first-line therapy for anxiety?
selective serotonin reuptake inhibitors (SSRIs) - antidepressants
What are medications used for depression?
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin norepinephrine reuptake inhibitors (SNRIs)
- tricyclic antidepressants (TCAs)
- monoamine oxidase inhibitors (MAOIs)
What are some examples of SSRIs?
- suffix: ine
- Prozac/Fluoxetine
- Paxil/Paroxetine
- Celexa/Citalopram **
- Luvox/Fluoxamine
- Zoloft/Sertraline
What is the action of SSRIs?
- Preventing/inhibiting reuptake of neurotransmitter serotonin
- making it more available at synapses (more levels of serotonin)
What are indications for SSRIs?
depression, anxiety/panic, compulsion, PTSD
What are side effects of SSRIs? (5)
- GI disturbances (nausea and vomiting) - take with food
- Low libido or erectile dysfunction
- Weight gain
- Insomnia
- Dry mouth
How long does it take for antidepressants to work?
4-6 weeks
What are the signs of SSRI withdrawl?
- flulike symptoms
- Stomach pain, diarrhea, nausea, trouble sleeping, dizziness, ataxia, numbness and tingling
What are some nursing considerations for SSRIs?
- titrate off slowly to avoid withdrawl
-Do not take with MAOIs = serotonin syndrome
-other to not take with: Opioid, OTC cold medications, alcohol, migraine meds (triptans), St. John Worts (herbal medication)
What are examples of SNRIs?
- Duloxetine
- Venlafaxine
What is the action of SNRIs?
- increases serotonin and norepinephrine by blocking reuptake into cells
- Can also be used for chronic pain
nursing considerations for SNRIs
- Can lead to serotonin syndrome
- Avoid ST. John’s Wort: increases serotonin levels
- Avoid MAOIs
What are examples of TCAs?
- Elavil/Amitriptyline
- Anafranil/Clomipramine
- Surmontil/Trimipramine
- Silenor/Doxepin
What neurotransmitters do TCAs effect?
serotonin and norepinephrine
What are side effects of TCAs? (8)
- Blurred vision
- Urinary retention***
- Dry mouth
- Constipation
- Sweating
- Seizures
- Sedation
- Orthostatic hypotension
T or F: TCAs are lethal in overdose
True
What are some nursing considerations for TCAs?
- Slow position changes
- Drink fluids
- Eat fiber
- do not take with MAOIs
What are some examples of MAOIs
- Nardil/Phenelzine
- Parnate/Tranylcypromine
- Marplan/Isocaroxazid
What is the action of MAOIs and what kind of neurotransmitters does it effect?
- Action: Blocking particular enzyme which is helping prevent too little of serotonin, norepinephrine and dopamine
What are nursing considerations for MAOIs?
- Drugs: do not mix with SSRIs - can lead to serotonin syndrome (Or any other antidepressants)
- Food: fermented food = hypertensive crisis (wine, cheese, sauerkraut)
- Others: beer, chocolate, no meat
T or F: Antidepressants may inadvertently switch patients with bipolar illness into mania
True
What are medications used for mania or bipolar disorders (aka mood stabilizers)
- lithium
- anticonvulsants
What is the first line of treatment for acute mania or bipolar disorders?
lithium
What are the normal side effects of lithium?
- weight gain
- CNS: fine hand tremor (50% of patients), fatigue, headache, mental dullness, and lethargy
- Endocrine: thyroid dysfunction
- Gastrointestinal: gastric irritation, anorexia, cramps, nausea, vomiting, diarrhea
- Renal: polyuria (frequent urination), polydipsia (urge to drink too much because of dry mouth), and edema
What are the levels for normal, early, advanced, and severe lithium intoxication?
normal: 0.6 - 1.2 mEq/L
- note: anything greater than 1.5 mEq/L = lithium toxicity
early: <1.5 mEq/L
Advanced: 1.5-2.0 mEq/L
Severe: > 2.5 mEq/L
polyuria, polydipsia, and fine hand tremor = _______(early, advanced, severe) lithium toxicity
early
anorexia, nausea, vomiting, diarrhea, coarse hand tremor, twitching, lethargy, dysarthria, hyperactive deep tendon reflexes, ataxia, tinnitus, vertigo, weakness, drowsiness = _______ (early, advanced, severe) lithium toxicity
advanced
fever, oliguria (decreased urine output), hypotension, irregular pulse, ECG changes, impaired consciousness, seizures, coma, death = = _______ (early, advanced, severe) lithium toxicity
severe
What are some common causes of increased lithium levels?
- Decreased sodium intake
- Diuretic therapy
- Decreased renal functioning
- Fluid and electrolyte loss, sweating, diarrhea, dehydration, fever, vomiting
-Medical illness
-Overdose
- Nonsteroidal anti-inflammatory therapy
What is the treatment for lithium toxicity?
- hold all doses
- Quickly check vital signs, level of consciousness; provide oxygen and stabilization procedures
- Monitor lithium blood level, electrolytes, kidney function tests, complete blood count, ECG
- Vigorously hydrate; use emetic, GI suctioning if overdose
How do anticonvulsants work for bipolar disorders?
enhancing effects of inhibitory neurotransmitter GABA and by desensitizing “kindling” effect in bipolar illness
What are examples of anticonvulsants?
- Carbamazepine
- topiramate
- lamotrigine
- Divalproex (Epival)
What are some side effects of carbamazepine (anticonvulsant)?
nausea, vomiting, dizziness, constipation, dry mouth
- Stevens-johnson syndrome (serious)
What are some nursing considerations for carbamazepine (anticonvulsant)?
- May make you more sensitive to sun
- Alcohol or cannabis can make you more dizzy or drowsy
- Birth control may not work if used with medication (May cause defects if pregnant)
- Avoid MAOIs
What are the uses for antipsychotics?
- psychosis
- schizophrenia
- dementia
- short-term: severe depression
What are the target symptoms for typical and atypical antipsychotics?
- typical: positive only (excess or distortion of normal function)
- atypical antipsychotics: positive and Negative symptoms (decrease or loss of normal function)
What are some examples of first generation (typical) antipsychotics?
- suffix: zine
- Phenothiazines: Chlorpromazine (Thorazine), thioridazine (Mellaril), mesoridazine (Serentil), perphenazine (Trilafon), trifluoperazine (Stelazine), fluphenazine
- Thiothixene (Navane)
- Butyrophenone: haloperidol (Haldol) ***
- Dibenzoxazepine: loxapine (Loxitane)
- Diphenylbutylpiperidine: pimozide (Orap)
What is the action of antipsychotics?
Dopamine antagonists (D2 receptor antagonists): block dopamine receptors = less dopamine
T or F: first generation (typical) antipsychotics are 1st line treatment
F: atypical 2nd gen are 1st line
What are some examples of 2nd generation (atypical) antipsychotics?
- suffix: pine/done
- Clozapine (Clozaril)
- Paliperidone (Invega)
- Risperidone (Risperdal, Consta, M-Tabs)
- Olanzapine (Zyprexa, Zydis)
- Quetiapine (Seroquel)
- Zuclopenthixol – (Accuphase)
- Apriprazole (abilify)
What are the some differences between atypical and typical antipsychotics?
- typical: only pos. symptoms, has EPS
- atypical: pos and neg symptoms, less risk of EPS
What are anticholinergic effects of antipsychotics?
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
What are endocrine/sexual side effects of antipsychotics?
- Increased prolactin
- Decreased sexual drive
- Retrograde ejaculation
- Erectile dysfunction
What are the serious side effects of antipsychotics?
- Extrapyramidal side effects (EPS)
- Neuroleptic malignant syndrome
- metabolic syndrome
What are Extrapyramidal side effects (EPS)?
- Dystonia (acute dystonic reactions) - continuous spasms + muscle contractions (back, neck, eyes)
- Akathisia - restlessness
- Parkinsonism (parkinsonian syndrome) - rigidity, slow movements (bradykinesia), tremors, impaired posture and balance
- Bradykinesia - slowing of movement
- Tardive Dyskinesia - irregular jerky movements, in lower face and distal extremities (Can be chronic**)
What is neuroleptic malignant syndrome? (NMS)
Rare and potentially fatal side effect of antipsychotic meds (dopamine receptor blockers), such as Haloperidol/Haldol
What are S&S of neuroleptic malignant syndrome?
fever
altered mental status (reduced consciousness),
muscle rigidity
labile hypertension
tachycardia
sweating (diaphoresis)
autonomic dysfunction
What are some medications that can treat EPS?
- Benztropine (Cogentin)
- Procyclidine (Kemadrin)
- Trihexyphenidyl (Artane)
What is clozapine?
- atypical antipsychotic that needs to be monitored thoroughly
What are the side effects of clozapine?
- Neutropenia or agranulocytosis
- Decreases seizure threshold
- Risk of myocarditis
What blood work do you need done when taking clozapine?
- white blood cells
- absolute neutrophil count
When would you stop clozapine therapy?
WBC < 3.0 x 10^9/L
neutrophils <1.5 x 10^9/L
What is serotonin syndrome? What would cause it?
too much serotonin
Cause: Antidepressant, pain meds, LSD, herbal supplements, cold meds - anything that resists serotonin reuptake
What are the S&S of serotonin syndrome? (7)
- Tachycardia
- Elevated BP
- Irritability
- Seizures (tremors/twitching/rigid muscles)
- Diarrhea
- Sweating
- Nervous (anxiety)
What is metabolic syndrome?
cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes
What are the S&S of metabolic syndrome?
- low HDL cholesterol
- visceral obesity (fat around waist)
- insulin resistance (leads to high blood sugar)
- hypertension
- high triglycerides
