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Week 1 Flashcards

1
Q

What drug class is amitriptyline in?

A

Tricyclic antidepressant

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2
Q

What is an example of a tricyclic antidepressant?

A

Amitriptyline

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3
Q

What is the MOA of amitriptyline?

A

It blocks the reputake of serotonin and norepinephrine

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4
Q

What are the indications for amitriptyline?

A

Depression
Chronic pain
Enuresis in children over 6

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5
Q

What does amitriptyline work well for as well as the other indications?

A

Sleep disturbances related to depression and anxiety

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6
Q

What are some precautions for tricyclic antidepressants (TCAs)?

A

Black box warning for children
Anticholinergic effects in older adults- can’t pee, can’t see, can’t spit, can’t have BM
May cause insomnia

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7
Q

What are some labs to keep an eye on with amitriptyline?

A

ECG
Urine output
Drug levels

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8
Q

What are some common side effects of TCAs and which drug is a TCA?

A

Amitriptyline

Side effects: sweating, seizures, dysrhythmia, sedation, orthostatic hypotension

Anticholinergic effects

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9
Q

What are some vitals to monitor while a patient is on amitriptyline?

A

Blood pressure
Heart rate
Respiratory rate

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10
Q

What are some assessments to do on patients taking amitriptyline?

A

Mood improvement
Increase in activities?
Sleeping through the night?
Weight
Appetite
Level of consciousness

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11
Q

What drug class is Fluoxetine in?

A

SSRI

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12
Q

What is the example of an SSRI?

A

Fluoxetine

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13
Q

What are some indications for Fluoxetine?

A

Depression
Anxiety
Bulimia
Sleep disturbances r/t depression and anxiety

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14
Q

What is MOA of Fluoxetine?

A

Blocks reabsorption of serotonin to help elevate mood

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15
Q

What are contraindications for Fluoxetine?

A

Suicide attempts
Breast feeding

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16
Q

What does Fluoxetine interact with?

A

St. John’s wart
MAOI- serotonin syndrome- Sweaty and febrile, restless and rigid muscles, increased heart rate infection
Breast feeding

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17
Q

Who is Fluoxetine the drug of choice for?

A

Older adults

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18
Q

What are some SSRI (Fluoxetine) side effects?

A

HEAD RED FED

insomnia and anxiety, GI upset and risk of GI bleeding, weight gain and hypoglycemia in diabetics

Serotonin syndrome- sweaty and febrile, restless and rigid muscles, increased heart rate

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19
Q

What are some labs to keep an eye on with patients who take Fluoxetine?

A

Liver enzymes
Renal labs (BUN and creatinine)
Blood glucose

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20
Q

What are some monitoring rules with Fluoxetine?

A

Monitor heart rate and blood pressure for hypertensive crisis
Monitor temperature to watch for serotonin syndrome

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21
Q

What is some client education for SSRIs?

A

Takes 8-12 weeks to build up
Do not take with St. John’s wart and MAOIs

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22
Q

When should Fluoxetine be given?

A

In the morning to prevent sleep disruption

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23
Q

What is a contraindication for Amitriptyline?

A

Do not give to patients who are hospitalized post MI

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24
Q

What drug class is Diazapam in?

A

Benzodiazepines

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25
What drug is the example for benzodiazepines?
Diazapam
26
What are the indications for Diazapam?
Anxiety disorders Acute alcohol withdrawal Mood stabilizer Muscle relaxer Anticonvulsant Sedative
27
What is Diazapam concurrent with?
Antidepressants, antipsychotics, and mood stabilizers because they can take a while to become effective
28
What is the MOA of Diazapam?
Enhances the inhibitory effect of GABA
29
Where is Diazapam metabolized and excreted?
Metabolized in the liver and excreted in the urine
30
What are some precautions for Diazapam?
Kids more sensitive so they get smaller doses; may cause paradoxical CNS stimulation in kids Risk of paradoxical reaction in older adults with a hx of psychosis; fall risk medication Infants under 1 month do not get Caution in giving to the critically Ill because it’s a myocardial depressant
31
What are some interactions r/t to Diazapam?
Alcohol and CNS depressant drugs Caffeine or stimulant drugs
32
What are some labs to watch when someone is on Diazapam?
Liver and renal panels Heart rate and blood pressure
33
What are signs of overdose of Diazapam?
Blurred/double vision Labored breathing Weakness Stupor (coma)
34
How do you evaluate if Diazapam is working?
Pt reports decrease in anxiety Heart rate and blood pressure have lowered Pt is relaxed but easily aroused
35
What is the anecdote for Diazapam overdose?
Flumazenil
36
What are patient education topics r/t amitriptyline?
Avoid MAOIs and St. John’s wart Avoid grapefruit juice and alcohol Take at bedtime
37
What are patient education topics r/t Diazapam?
Avoid caffeine or stimulant drugs because they counteract the medication Avoid alcohol or CNS depressant drugs because they increase the sedative effect It is a fall risk medication Take with food if GI upset occurs
38
What is the metabolism pathway for all antidepressants?
Oral - GI absorption- liver metabolizes- excreted urine
39
What occurs when antidepressants are stopped suddenly?
Antidepressant discontinuation syndrome
40
What are some nursing pearls for antidepressants?
Initial increased risk of suicide Slow onset and taper off Never mix: SSRI with St. John’s wart; MAOI and antidepressant All psych drugs decrease BP so do slow position changes Cause weight changes- mostly increase
41
What drug class is Venlafaxine in?
SNRI
42
What is the drug example for SNRI?
Venlafaxine
43
What is the MOA of Venlafaxine?
Inhibits the reabsorption of serotonin and norepinephrine
44
What is the pathway for Venlafaxine?
Metabolized in the liver and excreted in the urine
45
What are the indications for Venlafaxine?
Depression Anxiety Neuropathic pain
46
What are some precautions for Venlafaxine?
Black box warning for children and can cause weight loss Risk of weight loss in older adults and can cause hyponatremia (low sodium levels in the blood caused by SIADH)
47
What are some SNRI adverse effects?
Insomnia Weight loss Serotonin syndrome
48
What are contraindications for Venlafaxine?
Use of an MAO inhibitor Sensitivity to drug Pregnancy
49
What are some patient teaching topics r/t to Venlafaxine?
Serotonin syndrome Take with food to decrease GI upset Take at the same time every day XR capsules can be sprinkled, but not chewed
50
How do you evaluate if Venlafaxine is working?
Improved mood Improvement in pain if using for neuropathic pain Decreased anxiety
51
What are some things to keep an eye on/do when a patient is taking Venlafaxine?
EKG and sodium levels Urine output Level of consciousness/insomnia Skin assessment Weight loss
52
What are some vital signs to watch when a patient is taking Venlafaxine?
Heart rate and blood pressure
53
What drug class is Phenelzine in?
MAOI
54
What is the drug example for MAOIs?
Phenelzine
55
What are the indications for an MAOI?
Depression Last resort due to major food and drug interactions
56
What is the MOA for Phenelzine?
Binds irreversibly to MAO increasing norepinephrine, serotonin, and dopamine
57
What are some precautions and contraindications for Phenelzine?
Children: contraindicated Risk of hypertensive crisis in adults Pregnancy/lactation: contraindicated
58
What is the pathway for Phenelzine?
Metabolized in the liver and excreted in the kidneys
59
What are some assessment questions for Phenelzine?
Irritability/insomnia? Improved mood?
60
What are some things to keep an eye on when a patient is taking Phenelzine?
Tyrosine levels (high levels can cause a hypertensive crisis) EKG heart rate and blood pressure Renal and liver functions
61
What are some patient education topics r/t Phenelzine?
Too much tyrosine in the diet can lead to hypertensive crisis Hypertensive crisis symptoms: blurred vision, severe headache, photophobia, neck stiffness, sweating, nausea, vomiting Don’t take OTC cold meds, interacts with most drugs and tyrosine containing foods
62
What is the treatment drug for hypertensive crisis?
Phentolamine
63
What drug class is Bupropion in?
Atypical antidepressant
64
What is the drug example for atypical antidepressants?
Bupropion
65
What is the MOA of Bupropion?
Inhibits reabsorption of dopamine, serotonin, and norepinephrine
66
What are the indications for Bupropion?
Depression Seasonal affective disorder Smoking cessation
67
Why are some precautions/contraindications for Bupropion?
Not recommended for children Caution in pregnancy; don’t use during lactation Black box warning for smoking: may cause neuropsychiatrics reaction
68
What are some assessments r/t Bupropion?
Mood baseline Activity and energy Appetite
69
What are some things to watch when a patient is taking Bupropion?
Weight Blood pressure Renal panel
70
What may Bupropion need to be taken with?
CNS depressant
71
What drug class is lithium carbonate in?
Mood stabilizing agent
72
What drug is the example for the drug class mood stabilizing agent?
Lithium carbonate
73
What is an important consideration for Lithium carbonate?
Not metabolized Excreted entirely by kidneys
74
What are the indications for lithium carbonate?
Treatment of manic episodes d/t bipolar
75
What are some nursing considerations for lithium carbonate?
Has a narrow therapeutic window Need baseline renal, cardiac, thyroid levels, electrolytes Serum drug levels 2-3 times a week; then every 3 months Peaks and troughs of medication; don’t give before pt is getting blood levels measured Doses increase gradually
76
What are some teaching points for lithium carbonate?
Don’t take the medication before getting blood levels checked Caution in those who sweat a lot and/or are diabetic; maintain hydration Continue birth control if on it to prevent pregnancy
77
Why are some assessments appropriate for lithium carbonate?
Normal/abnormal behaviors Mania Unkempt appearance
78
What are some things to watch for when someone is given lithium carbonate?
Blood pressure and weight EKG I&O
79
What are signs of lithium carbonate overdose?
vomiting, drowsy, stupor (coma), tremors, unsteady gait, muscle weakness, diarrhea

Pharm (9 decks)

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