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quiz 1 Flashcards

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1
Q

Lithium Carbonate
Anticonvulsants (certain antiepileptic meds used)
Atypical Antipsychotics (many atypicals have mood-stabilizing properties
Antidepressants

A

mood stabilizing meds

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2
Q

Alters sodium transport in nerve and muscle cells
Exact mechanism of action is unknown
May inhibit the release of norepinephrine and dopamine, but not serotonin

A

Lithium (lithobid, eskalith)

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3
Q

Follows same distribution pattern in the body as water
Excreted from the kidney, 80% reabsorbed
If sodium depletion or dehydration, the kidney reabsorbs more Lithium into the serum—often leading to Lithium toxicity
Crosses placenta and enters breast milk
absorbed from GI track

A

pharmacokinetics of lithium

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4
Q 
GI distress (nausea, diarrhea, abdominal pain)
Fine hand tremors
Polyuria, mild thirst
Renal toxicity
Goiter and hypothyroidism
Bradydysrhythmias, hypotension
Electrolyte imbalances

These are directly related to serum levels of drug
The more lithium the more A/E

A

S/E A/E of Lithium

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5
Q

acute mania lithium level

A

1.0-1.5 mEq/L

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6
Q

maintenance of lithium level

A

0.6-1.2 mEq/L

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7
Q

Diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine tremors, slurred speech

A

Early indications (Li level less than 1.5 mEq/L – 1.2-1.5

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8
Q

Confusion, poor coordination, coarse tremors, GI distress, EKG changes

A

Advanced indications (Li level 1.5 to 2.0 mEq/L

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9
Q

Polyuria, dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma, possible death from respiratory complications

A

Severe Toxicity (Li level 2.0 to 2.5 mEq/L)

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10
Q

Multiple organ toxicity, rapid progression of symptoms leading to coma and death

A

Extreme Toxicity (Li levels > 2.5 mEq/L)

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11
Q

Known allergy
Pregnancy and lactation
History of leukemia
Use cautiously with renal dysfunction, heart disease, thyroid disorder, sodium depletion, dehydration, diuretic use
Caution if alcohol use, concurrent CNS depressant, or NSAID use

A

contraindications of lithium

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12
Q

Pre-Lithium work up before first dose of Lithium given (baseline liver and renal functioning tests, thyroid functioning tests, CBC, EKG, etc)
Monitor serum Lithium levels
Take with food to decrease GI distress
Adequate fluid and sodium intake needed
Make sure diet doesn’t change – if they alter fluid/sodium intake that they’re used to it will effect how Lithium is distributed into their body
Monitor for signs/symptoms of Lithium toxicity

A

nursing considerations of Lithium

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13
Q

follows water distribution

sodium alters it

A

lithium

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14
Q

Thought to manage and treat Bipolar Disorder through various mechanisms including slowing the entrance of sodium and calcium back into the neuron; potentiating inhibitory effects of gamma aminobutyric acid (GABA); and inhibiting glutamic acid which suppresses CNS excitation

Exact mechanism of action in Bipolar Disorder not known

A

anticonvulsants used for mood stabilization

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15
Q 
Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Draw levels but we don’t need to know levels for exam
Lamotrigine (Lamictal)
Topiramate (Topamax)
A

anticonvulsants used for mood stabilization

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16
Q

Absorbed from GI track
Metabolized in liver
Excreted in urine
Cross placenta and enter breast milk

A

pharmacokinetics from anticonvulsants for mood stabilization

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17
Q

CNS (nystagmus, double vision, vertigo, headache, staggering gait); Blood dyscrasias (leukopenia, anemia, thrombocytopenia); Hyperosmolarity (can lead to edema, decreased urine output, hypertension); Skin disorders (rash, Stevens-Johnson Syndrome); GI (nausea and vomiting)

A

carbamazepine (tegretol)

anticonvulsant mood stabilization S/E

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18
Q

GI (nausea, vomiting); Hepatotoxicity; Pancreatitis; Thrombocytopenia; Increased liver enzymes; tremor; Stevens-Johnson Syndrome (mememory sluffs off and presents in purple/red rash)

A 
valporic acid (Depakote)
anticonvulsant for mood stabilization S/E
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19
Q

Double or blurred vision; Dizziness; Headache; Nausea, Vomiting; Skin rashes including Stevens-Johnson Syndrome

A

lamotrigine (lamictal)

anticonvulsants used for mood stabilization S/E

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20
Q

Fatigue; Weight loss; Dizziness; Visual Disturbances; Nausea; Abdominal pain; Tremor; Metabolic acidosis; Stevens-Johnson Syndrome

A

topiramate (Topamax)

anticonvulsant used for mood stabilization S/E

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21
Q

Known allergy
Pregnancy
Bone marrow suppression or bleeding disorders
Liver disorders

A

contraindications for anticonvulsants for mood stabilization

22
Q

Oral contraceptives used concurrently with Carbamazepine (Tegretol) or Lamotrigine (Lamictal) decreases effectiveness of both meds – education for patient
Grapefruit juice increases levels of Tegretol
Concurrent use of Phenytoin (Dilantin) and Phenobarbital with Valproic Acid (Depakote) or Carbamazepine (Tegretol) requires monitoring of Dilantin and Phenobarbital levels
Monitor serum levels of Tegretol and Depakote

A

nursing considerations for anticonvulsants for mood stabilization

23
Q 
Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
A

Select Atypical Antipsychotic Meds for mood stabilization

24
Q

work mainly by blocking serotonin and, to a lesser extent, dopamine receptors

A

Atypical Antipsychotic Meds for mood stabilization

25
Q

Counteract neurotransmitter deficiencies: Norepinephrine (NE), Serotonin (5HT), Dopamine

Accomplished in a variety of ways, e.g. blocking reuptake of neurotransmitters, boosting synthesis of neurotransmitters, blocking degradation of neurotransmitters

A

Antidepressant meds

26
Q

Main groups of antidepressants

A
  1. Tricyclic Antidepressants (TCAs)
  2. Monoamine Oxidase Inhibitors (MAOIs)
  3. Selective Serotonin Reuptake Inhibitors (SSRIs)
  4. Atypical/Multiple Mechanism Meds
27
Q

Amitriptyline
Clomipramine (Anafranil)
Imipramine (Tofranil)
Nortriptyline (Pamelor, Aventyl)

A

Select TCA’s

28
Q

Block reuptake of norepinephrine and serotonin

A

pharmacological action of TCA - 1st generation agents

29
Q

Absorbed from gastrointestinal (GI) track
Distributed widely in tissues including brain
Metabolized in liver
Excreted in urine
Relatively long half-lives (8-46 hours)
Cross the placenta and enter breast milk

A

pharmacokinetics of TCA

30
Q 
Change in sexual function
Weight gain
Orthostatic hypotension
Anticholinergic effects
Sedation
A

S/E of TCA

31
Q

Use cautiously in CV disease; diabetes; liver, kidney, respiratory disorders; urinary retention or obstruction; angle closure glaucoma; BPH; hyperthyroidism; and Bipolar Disorder
Known allergy; recent myocardial infarction; myelography; seizure disorder; pregnancy and lactation
Concurrent use with MAOIs, alcohol, benzodiazepines, opioids, antihistamines, oral anticoagulants

A

precautions/contraindications of TCA

32
Q

MONITOR SUICIDE POTENTIAL – BLACK BOX WARNING

There is a very narrow range between therapeutic and toxic levels with Tricyclics

A

TCA

33
Q

block MAO in the brain, thus increasing the amount of norepinephrine, dopamine, and serotonin available for transmission of impulses (which results in relief of depression)

A

MOAI pharmacological action

34
Q

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (Emsam)

A

MAOI drugs

35
Q

Rarely prescribed because of dietary restrictions and med-to-med interactions

A

MAOI

36
Q

Absorbed from GI track
Metabolized in liver
Excreted in urine
Cross the placenta and enter breast milk

A

MAOI pharmacokinetics

37
Q

CNS stimulation
Orthostatic hypotension
Hypertensive Crisis—from dietary intake of tyramine
Rash from transdermal Emsam patch

A

S/E of MAOI

38
Q

Known allergy
If taking SSRIs or other antidepressants
Pheochromocytoma
Cardiovascular and cerebral vascular disease
Renal or hepatic impairment
Use cautiously if diabetes or seizure disorder, or if pregnant or breast-feeding
Many medications interact with MAOIs—check with PCP before taking other meds

A

contraindications MAOI

39
Q

Dietary (tyramine) Restrictions
-Age cheese, raisins, Italian beans, red wines, smoked/processed meats, caviar, pickled haring, chicken/beef liver, soy sauce, meat tenderizer
Consequences if tyramine consumed (hypertensive crisis)
headache, n/v, fever, sweating, nuchal virginity

A

MAOI

40
Q

block reuptake of serotonin with little to no effect on NE

A

SSRI

41
Q

Absorbed from GI track
Metabolized in liver
Excreted in urine and feces
Associated with congenital abnormalities

A

pharmacokinetics of SSRI

42
Q 
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Vilazodone (Viibryd)
A

SSRI

43
Q

Sexual dysfunction
CNS stimulation—insomnia, agitation, anxiety
Weight loss early in therapy then weight gain
Drowsiness, dizziness, headache
GI effects—nausea, vomiting, diarrhea, dry mouth, constipation
Bruxism – teeth clinching or grinding

A

SSRI side effects

44
Q

more psychical body effects
Too much serotonin in body – prescribed too high
Change in mental status, restlessness, myoclonus twitching, tachycardia, diaphoresis, tremors, flu like symptoms

A

serotonin syndrome

complication of SSRI

45
Q

more mental mood changes
Occur with abrupt discontinuation of SSRI, esp after long time
Increase anxiousness, depressed mood and irritability

A

withdrawal syndrome and discontinuation syndrome

complication of SSRI

46
Q

Known allergy
Concurrently taking MAOI or TCA
Pregnancy, lactation
Use cautiously with liver/renal dysfunction; cardiac disease; seizure disorder; diabetes; ulcers; or history of GI bleeding
Monitor for med-to-med interactions, e.g. if concurrently taking antiarrhythmic, anticoagulant, or other psychotropic med

A

contraindications of SSRI

47
Q

block reuptake of norepinephrine, and/or serotonin, and/or dopamine

A

pharmacological action of atypical / multiple mechanism antidepressants

48
Q

Absorbed from GI track
Metabolized in liver
Excreted in urine
May pass into breast milk

A

pharmacokinetics of atypical / multiple mechanism antidepressants

49
Q 
Bupropion (Wellbutrin, Zyban)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Mirtazapine (Remeron)
Trazadone (Desyrel)
Venlafaxine (Effexor)
Note:  Wellbutrin and Remeron used as alternatives to SSRIs if patient experiences sexual side effects
A

MMR

50
Q

Headache
Dry mouth, constipation
GI distress, nausea, poor appetite, weight loss
Restlessness, insomnia
Increased heart rate
Priapism (prolong/painful eruption)—serious adverse effect with Trazadone

A

S/E of MMR

51
Q 
Known allergy	
Pregnancy and lactation
Concurrent use with MAOI
Seizure disorder
May be contraindicated for patient with anorexia or bulimia
A

contraindications of MMR

psych pharm (4 decks)

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