Test 2 Flashcards
Treatment challenges
Treating from above & below
Medication adherence
Self-medication
3 Medication options
Lithium
Antiepileptic medications
Atypical antipsychotics
Benefits of Lithium
Highly effective
Treats from above or below
Lowers suicide risk
Problem with lithium?
Narrow therapeutic window.
Lithium levels should be:
Less than 1.5 mEq/L
Normal SE of Lithium
Mild nausea
Fine hand tremors
Polyuria or polydipsia
Weight gain
Early Signs of Toxicity [ACNE] :
Ataxia
Coarse hand tremors
N/V/D
Ears ringing
Pt teaching for Lithium:
Take with food to decrease GI upset
Maintain adequate fluid & salt intake
Avoid strenuous exercise
Signs of toxicity
What does a brand new nurse need to know about lithium?
Low salt levels and water loss leads to lithium toxicity
Know the early sign of toxicity
Levels should not be more than 1.5
Anxioltics: Benzos Common Uses
Anxiety disorders Sleep disorders Muscle spasms Seizure disorders Alcohol withdrawal
Benzo Drugs to know.
Alprazolam - short duration & quick onset Clonazepam- long onset & duration Diazepam Chlordiazepoxide Lorazepam
Benzos MOA:
Help GABA work better
Work on the same receptor as alcohol
Benzos SE:
Ataxia
Sedation
Impaired Memory
Benzo Precautions:
Elderly
Liver dz.
Drug Abuse history
High yield concepts on Benzos:
Benzos are for short term use only
Never combine Benzos with alcohol
Do not quit Benzos abruptly
Flumazenil is the antidote for benzo overdose.
Buspirone MOA
Binds strongly to 5HT receptors and loosely to DA receptors
Advantages of Buspirone
No abouse potential
Not a CNA depressant
No major withdrawal issues
Disadvantage of Buspirone
Takes much longer to work (weeks)
Pts must avoid what when taking Buspirone ?
Grapefruit juice.
High yield concepts Busprione :
Non-addicitve
It takes several weeks to reach full effect
Avoid grapefruit juice
Antipsychotics: FGA (typical) drugs
Haloperidol
Chlorpromazine
FGAs Common uses:
Schizophrenia
Agitation/ aggression
N/V
Intractable hiccups
Schizo symptoms
Positive: hallucinations, delusions, disorganized speech & bizarre behavior
Negative: affective flattering, alogical, abolition, anhedonia, and social isolation
FGAs MOA:
Block DA receptors in the brain
Dopamine pathways:
Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular
SE of FGAs
Anticholinergic effects Orthostatic hypotension Sedation Neuroendocrine effects Photosensitivity
EPS
Acute dystonia
Akathisia
Parkisonism
Tardive dyskinesia
Neuroleptic Malignant Syndrome
Fever Elevated WBC & CPK Vital signs unstable Encephalopathy Rigidity (lead pipe)
High yield concepts FGAs
They work by blocking DA Lots of serious SE Notorious fir causing EPS Dont treat EPS with an antipsychotic Know the S/S of NMS Watch out for orthostatic hypotension Wear sunscreen
SGAs (atypical) drugs
Clozapine
Risperidone
Olanzapine
Aripiprazole
SGAs common uses:
Schizo
Bipolar disorder
Dementia w psychotic features
SGAs MOA:
Block DA(2) & 5HT(2a) receptors in the brain. Decrease of DA in areas with too much & increases it in areas with too-little at least that's the theory
Comparison to FGAs
Lower risk of EPS
Really high risk of metabolic syndrome
Super expensive
Probably equally effective
Metabolic syndrome
Central obesity
Hypertension
High BS
Dyslipidemia
Clozapine
Highly effective
Can cause agranulocytosis
Requires weekly monitoring (WBCs)
Report signs of infection immediately
High Yield concepts for SGAs
Lower risk for EPD
High risk for metabolic syndrome
Watch for sings of infection if a client is taking clozapine
Watch for sings of NMS (can occur in FGA/SGA)
