Week 7 Flashcards
Benzodiazepines have become among the most widely prescribed drugs, why are they preferred over older hypnotic agents such as barbiturates?
- Specific dose related anxiolytic(aniti anixety) action
- Lower fatality rates following acute toxicty/overdose
- Lower potential for abuse
- More favourable adverse effect profiles
- The availability of a specific antidote(Flumazenil)
- Fewer potentially serious drug interactions when administered with other medications.
Describe the manifestation and management of benzodiazepine overdose
Manifestion of benzodiazepine overdose presents can present with CNS depression, confusion/drowsiness through to coma, hypotonia, hypotension and respiratory depression.
Management of benzodiazepine overdose includes maintenance of an proper airway, VS monitoring , O2 therapy, IV fluids, vasopressors if needed also Flumazenil(antidote)
The administration and prescription of an antiepileptic medication depends largely on the correct diagnosis of seizure type. Describe the types of seizures listed below and give examples of the appropriate antiepileptic agent that may be prescribed.
Simple or Complex Partial -
Brief alterations in consciousness, unusual stereotyped movements( eg repetitive chewing/swallowing), confusion and changes in temperament.
Medications include: Carbamzepine, Phenytoin, Valproate, Gabapentin and Lamotrigine
Absence Seizures (or Petit mal) -
Brief loss and return of consciousness not followed by a period of lethargy
Medications include: Valproate, Clobazam, Clonazapam & Lamotrigine.
Generalized tonic clonic seizures (or Grand Mal) -
Sudden loss of consciousness & motor control. May also have numbness, visual disturbances, dizziness, muscular contractions(rigid synchronous jerking of body) and rolling upwards of the eyes.
Medications include: Carbamzepine, Valproate, Lamotrigine, Phenytoin & Gabapentin
Myoclonic Seizures -
Bilaterally symmetrical muscle jerks, loss of conciousness can occur
Medications include: Valproate, Lamotrigine, Clonazapam & Phenobarbitone
While no antiepileptic drug is considered completely ideal. List the characteristics considered desirable in the ideal antiepileptic drug
- Highly effective with low incidence of toxicty
- Effective against more than one type of seizure/mixed seizures
- Long acting and non-sedating(to remove patient inconvenience)
- Not highly protein bound and not involved in any significant drug interactions.
- Inexpensive
- No tolerance to therapeutic effects
A very real and common group of side effects related to the use of psychotropic medications are the extrapyramidal effects. As a nurse who may be caring for patients who are being administered these medications it is important to understand the possible side effects and possible treatment options. Describe the conditions below which all fall into the category of extrapyramidal effects and possible treatments.
Akathisia -
Description- Motor restlessness, unable to sit/stand still person feels urgent need to move/pace/rock/tap foot. Can also present with apprehension, irritability and general uneasiness.
Treatment- Reducing dose of neuroleptic agent, switching to an atypical psychotic agent eg Benztropine, Diazapam
Dystonia -
Description- Muscle spasms of face/tongue/neck/jaw or hands, hyperextension of neck/trunk arching of back and oculogyric(fixed upward gaze) crisis may occur.
Acute reactions require immediate intervention!
Treatment- Reducing dose and depending on the severity of reaction adminisration of Benztropine IM or IV
Drug-Induced Parkinsonism -
Description- Symptoms similiar to parkinson’s disease which include shuffling gait, drooling, tremors, bradykinesia, increased rigidity and akinesia
Treatment includes antiparkinson drugs Benztropine or Benzhexol and possible switching of neuroleptic.
Tardive Dyskinesia -
Description- Oral or facial dyskinesia(involuntary muscle movements such as tongue darting, lip smacking etc)
Reducing or stopping neuroleptic agent ASAP No effective treatment so prevention is vital as it can be irreversible.
Neuroleptic Malignant Syndrome -
Rare but potentially fatal adverse effect for a person on typical antipsychotics symptoms include high temperature, muscle rigidity, altered consciousness and impaired automnomic homeostasis.
Treatment includes widthdrawal of the drug, hydration and possible administration of Bromocriptine(dopamine agonist) & Dantrolene to control muscle spasms.
Describe the mechanism and characteristics of the serotonin syndrome, and name several drugs that can induce it.
Excess stimulation of 5-Ht 2a receptors by serotonergic drugs.
Characterised by mental status changes(confusion, delirium, hypomania), neuromuscular hyperactvity(hyper reflexia, tremors, incoordination), sweating , fever and shivering
Drugs that cause this are:
MAOI’s combined with SSRI’s
CNS stimulants, Migraine & opioid analgesics
St johns Wort
Patient education is an important role that nurses play in medication management. Describe and explain the mechanism of the tyramine reaction that can occur in patients taking MAO inhibitor drugs. Explain the education you would give a patient when started on this medication, give examples of food to avoid.
Foods to avoid would be aged cheeses, vegetables(avocardo, broad bean pods) Fruits, bananas/raisins.
Meat/yeast extracts eg vegemite
Red wine and coffee substitutes & soy products
. Caffeine is probably the most widely used stimulant in the world and is found in many beverages such as coffee, tea, cocoa and cola drinks. When taking a medication history, why is the amount of caffeine consumed daily by the patient a concern? Name three illness or conditions that may be induced or exacerbated by the chronic consumption of large amount of caffeine?
Hypertension, insomnia, pregnant persons & people prone to panic attacks.
