quiz 1 Flashcards
Lithium Carbonate
Anticonvulsants (certain antiepileptic meds used)
Atypical Antipsychotics (many atypicals have mood-stabilizing properties
Antidepressants
mood stabilizing meds
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
Lithium (lithobid, eskalith)
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
pharmacokinetics of lithium
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
S/E A/E of Lithium
acute mania lithium level
1.0-1.5 mEq/L
maintenance of lithium level
0.6-1.2 mEq/L
Diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine tremors, slurred speech
Early indications (Li level less than 1.5 mEq/L – 1.2-1.5
Confusion, poor coordination, coarse tremors, GI distress, EKG changes
Advanced indications (Li level 1.5 to 2.0 mEq/L
Polyuria, dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma, possible death from respiratory complications
Severe Toxicity (Li level 2.0 to 2.5 mEq/L)
Multiple organ toxicity, rapid progression of symptoms leading to coma and death
Extreme Toxicity (Li levels > 2.5 mEq/L)
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
contraindications of lithium
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
nursing considerations of Lithium
follows water distribution
sodium alters it
lithium
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
anticonvulsants used for mood stabilization
Carbamazepine (Tegretol) Valproic Acid (Depakote) Draw levels but we don’t need to know levels for exam Lamotrigine (Lamictal) Topiramate (Topamax)
anticonvulsants used for mood stabilization
Absorbed from GI track
Metabolized in liver
Excreted in urine
Cross placenta and enter breast milk
pharmacokinetics from anticonvulsants for mood stabilization
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)
carbamazepine (tegretol)
anticonvulsant mood stabilization S/E
GI (nausea, vomiting); Hepatotoxicity; Pancreatitis; Thrombocytopenia; Increased liver enzymes; tremor; Stevens-Johnson Syndrome (mememory sluffs off and presents in purple/red rash)
valporic acid (Depakote) anticonvulsant for mood stabilization S/E
Double or blurred vision; Dizziness; Headache; Nausea, Vomiting; Skin rashes including Stevens-Johnson Syndrome
lamotrigine (lamictal)
anticonvulsants used for mood stabilization S/E
Fatigue; Weight loss; Dizziness; Visual Disturbances; Nausea; Abdominal pain; Tremor; Metabolic acidosis; Stevens-Johnson Syndrome
topiramate (Topamax)
anticonvulsant used for mood stabilization S/E
Known allergy
Pregnancy
Bone marrow suppression or bleeding disorders
Liver disorders
contraindications for anticonvulsants for mood stabilization
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
nursing considerations for anticonvulsants for mood stabilization
Aripiprazole (Abilify) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon)
Select Atypical Antipsychotic Meds for mood stabilization
work mainly by blocking serotonin and, to a lesser extent, dopamine receptors
Atypical Antipsychotic Meds for mood stabilization
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
Antidepressant meds
Main groups of antidepressants
- Tricyclic Antidepressants (TCAs)
- Monoamine Oxidase Inhibitors (MAOIs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Atypical/Multiple Mechanism Meds
Amitriptyline
Clomipramine (Anafranil)
Imipramine (Tofranil)
Nortriptyline (Pamelor, Aventyl)
Select TCA’s
Block reuptake of norepinephrine and serotonin
pharmacological action of TCA - 1st generation agents
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
pharmacokinetics of TCA
Change in sexual function Weight gain Orthostatic hypotension Anticholinergic effects Sedation
S/E of TCA
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
precautions/contraindications of TCA
MONITOR SUICIDE POTENTIAL – BLACK BOX WARNING
There is a very narrow range between therapeutic and toxic levels with Tricyclics
TCA
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)
MOAI pharmacological action
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (Emsam)
MAOI drugs
Rarely prescribed because of dietary restrictions and med-to-med interactions
MAOI
Absorbed from GI track
Metabolized in liver
Excreted in urine
Cross the placenta and enter breast milk
MAOI pharmacokinetics
CNS stimulation
Orthostatic hypotension
Hypertensive Crisis—from dietary intake of tyramine
Rash from transdermal Emsam patch
S/E of MAOI
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
contraindications MAOI
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
MAOI
block reuptake of serotonin with little to no effect on NE
SSRI
Absorbed from GI track
Metabolized in liver
Excreted in urine and feces
Associated with congenital abnormalities
pharmacokinetics of SSRI
Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) Vilazodone (Viibryd)
SSRI
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
SSRI side effects
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
serotonin syndrome
complication of SSRI
more mental mood changes
Occur with abrupt discontinuation of SSRI, esp after long time
Increase anxiousness, depressed mood and irritability
withdrawal syndrome and discontinuation syndrome
complication of SSRI
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
contraindications of SSRI
block reuptake of norepinephrine, and/or serotonin, and/or dopamine
pharmacological action of atypical / multiple mechanism antidepressants
Absorbed from GI track
Metabolized in liver
Excreted in urine
May pass into breast milk
pharmacokinetics of atypical / multiple mechanism antidepressants
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
MMR
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
S/E of MMR
Known allergy Pregnancy and lactation Concurrent use with MAOI Seizure disorder May be contraindicated for patient with anorexia or bulimia
contraindications of MMR
