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zolpidem
(Ambien, Edluar)
Class: Sedative/Hypnotics
Preg. Cat C
- Indications: short term management for insomnia
- Administration: for rapid sleep onset, drug should not be taken with or immediately after meals
- Adv. Reaction:
- cns- headache amnesia daytime drowsiness depression dizziness hangover lethargy sleep disorder
- cv- palpitations
- eent: pharyngitis, sinusitis
- gi- abdominal pain, constipation, diarrhea, dyspepsia, n/v
- other - anaphylaxis angioedema back or chest pain flu like syndrome
- Interactions:
- d-d: may cause cns depression
- Rifampin- may decrease effects of zolpidem avoid using together if possible consider another hypnotic
- d-lifestyle: avoid alcohol use
- Overdose S/S
- impaired conciousness, somnolence, coma, cv or resp compromise death
- Nx Consideration:
- warn pt may cause allergic reactions, facial swelling & complex sleep related behaviors such as driving eating & making phone calls while asleep. advise pt to report the adverse effects
- avoid alcohol use while taking drugs
- instruct pt to take the drug immediately before going to bed, onset action is rapid
- take drugs wit or immediately after meals
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lorazepam
(Ativan)
Class: Anticonvulsants/Antianxiety. Antianxiolytics, Benzodiazepines
Preg Cat: D
- Indications:
- anxiety, insomnia from anxietypreoperative sedation, status epilepticus
- Administration:
- monitor respirations every 5-15 mins & before each i.v. dose
- avoid use in neonates
- keep emergency resuscitation equip & oxygent available
- Incompatibilities:
- aldesleukin astreonam, buprenorphine, caffeine nitrate
- Action: may potentiate effects of GABA, depress the cns & supress the spread of zeisure activity
- Adverse reaction:
- cns - drowsiness sedation amnesia, insomnia, agitation dizziness, weakness
- cv - hypotension
- eent - visual disturbances, nasal congestions
- gi - abdominal discompfort , nausea change in appetite
- Interactions:
- d-d - cns depressants may increase cns depression
- digoxin - may increase digoxin level & risk for toxicity, monitor digoxin level closely
- d-herb - kava may increase sedation
- d-lifestyle - alcohol use
- smoking - may decrease effectiveness of drugs. monitor pt closely
- Lab Test - monitor LFT VALUES
- Contraindications and cautions
- contraindicated in pt hypersensitivity to drug benzodiazepines
- pt with acute angle-closure glaucoma
- pregnant women in first trimester
- pulmonary renal or hepatic impairment or hx of substance abuse
- Overdose S/S
- drowsiness confusion lethargy ataxia, hypotonia, hypotension , hypnotic state , stage 1-3 coma, death
- Nx Consideration
- monitor hepatic renal & hematopoietic function periodically in pt rcvng repeated and prolonged therapy
- alert: drug may lead to abuse & addiction don't stop abruptly withdrawal symptoms may occur
- Pt Teaching:
- Avoid use of alcohol, women to avoid becoming pregnant while taking drug, smoking will derease effectiveness, avoid hazardous activities that requires alertness until effects of drugs is known.
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quetiapine
(Seroquel)
Class: Antipsychotics, 2nd Generation; Dibenzothiazepine Dervative
Preg. Cat: C
- Indications - schizophrenia, monotherapy & adjucnt therapy with lithium or divalproex for the short-term tx of acute manic episode associated with bipolar 1 disorder; adjucnt maintenance therapy with lithium or divalproex. depression associated with bipolar disorder
- Administration:
- do not crush xr
- give drug without regard for food. give xr without food or light meal 300 calories
- Action:
- Blocks dopamine & serotonin5-ht receptors. Its action may be mediated through this antagonism
- Adverse reaction:
- cns - dizziness, headache, somnolence, neuroleptic malignant syndrome seizures, hypertonia, dysarthria, asthenia
- cv - orthostatic hypotension, tachycardia, palpitations, peripheral edema
- eent - ear pain, pharyngitis, rhinitis
- gi - dry mouth dyspepsia, abd pain, constipation, anorexia
- hematologic - leukopenia
- metabolic - wt gain, hyperglycemia
- musculoskeletal - back pain
- respiratory - increased cough dyspnea
- skin - rash, diaphoresis
- Interactions
- d-d: antihypertensives , monitor b/p; carbamazepines, glucocorticoids, phenobarbital, phenytoin, rifampin
- cns depressants may increase cns effects
- dopamine agonists levodopa - may antagonize effects monitor pt
- erythromycin fluconazole, itraconazole, ketoconazole
- avoid alcohol use
- Lab Tests Results -
- may increase liver enzyme cholesterol triglyceride & glucose levels, may decrease T4 & thyroid stimulating hormone levels
- may decrease wbc
- Contraindications & Cautions
- Pt at risk for aspiration PNA
- BBW: not approved for use in children
- Overdose S/S
- drowsiness hypotension, sedation, tachycardia, hypokalemia first-degree heart block
- Nx Considerations
- dispense lowest qty to avoid drug overdose
- watch for evidence of neuroleptic malignant syndrome
- monitor pt for tardive dyskinesia w/c may occur after prolonged use
- monitor wt gain
- hyperglycemia may occur, monitor pt with diabetes
- drug may cause cataract formation obtain baseline opthalmologic examination & reassess every 6 mos.
- Pt Teaching
- Warn pt about risk for dizziness when standing up quickly . the risk is greatest during the 3-5 day period of first dosage adjustment when resuming tx or adjusting
- Tell pt to avoid becoming overheated or dehydrated
- Avoid alcohol maybe taken w/ or w/o food.
- not to breasfeed while taking this drug
- BBW: may increase the risk of suicidal thinking & behavior in children adolescents
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ziprasidone
(Geodon)
Class: Antipsychotics, 2nd generation, Benzisoxazole derivative
Preg Cat: C
- Indications:
- Symptomatic Tx of Schizophrenia, Rapid control of acute agitation in Schizo pts, Acute bipolar mania including manic & mixed episodes w/ or w/o psychotic features
- Administrations:
- always give drug with food for optimal effects
- dont mix inj with other drugs
- Action:
- may inhibit dopamine & serotonin 2 receptors causing reduction in schizo symptoms
- Adverse Reactions:
- cns - dizziness, suicide attempts, h/a, somnolence, akathisia
- cv - bradycardia, qt interval prolongation, orthostatic hypotension
- eent - abnormal vision, rhinitis
- gi - n/v, constipation, rectal hemmorage, anorexia dyspepsia
- gu - dysmenorrhea, priapism
- metabolic - hyperglycemia
- muscoloskeletal - back pain, myalgia
- resp - cough
- skin - rash
- Interactions:
- d-d: antiarrhytmics (amiodaronedofetilide, procainamide, quinidine, sotalol) - may incease arrhythmias
- antihypertensives - may increase hypotensive effects. monitor b/p
- carbamazepine - may decrease ziprasidone levels
- drugs that decrease potassium or magnesium such as diuretics. monitor K & Mg level
- Contraindications & Cautions
- contraindicated in pt hypersensitive to drug and in those with recent MI or uncompensated heart failure
- Overdose S/S:
- sedation slurred speech transitory htn, somnolenceanxiety, extrapyramidal symptoms, tremor
- Pt Teaching
- Advise pt that symptoms may not improve for 4-6 weeks
- to report any recent episodes of diarrhea, abnormal movement, sudden fever, muscle rigidity or change in mental status
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benztropine
Cogentin
Class: Antiparkinsons Agents, Anticholinergics
Preg Cat: C
- Indications:
- drug induced extrapyramidal disorders (except tradive dyskinesia)
- acute dystonic reaction
- parkinsonism
- Administrationdrug may be given before & after meals depending on pt reaction
- Adv Reaction
- cns - ion, memory impairment, hallucinatons toxic psychosis
- cv - tachycardia
- eent - dilated pupils blurred vision
- gi - dry mouth constipation, nausea
- gu - urine retention, dysuria
- skin - decreased sweating
- Interactions
- d-d: amantadine, phenothiazines tricyclic antidepressants cholinergics may antagonize the therapeutic effects of these drugs
- Contraindications and Cautions
- use cautiously in pts with prostatic hyperplasia arrhytmias or seizure disorders
- Nx Considerations
- monitor v/s carefully watch closely for adverse reactions
- watch for intermittent constipation
- Pt Teaching
- If pt takes a single daily dose, take at bedtime
- relieve dry mouth with cool drinks, ice chips sugarless gum or hard candy
- limit hot weather activities because drug induced lack of sweating may cause overheating
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topiramate
(Topamax)
Class: Anticonvulsants
Preg Cat: C/D
- Indications
- Initial monotherapy for partial-onset or primary generalized tonic-clonic seizures
- Adjunct Tx for partial onset
- Lennox-Gastaut syndrome
- to prevent migraine headache
- Adjust a dose if creatinine clearance is less than 70 ml/minute
- Administration:
- give drug without regard for food
- crushed or broken tablets have a bitter taste
- capsules may be opened & contents sprinkled on a teaspoon of soft food. Pt should swallow immediately without chewing
- Action:
- unknown may block a sodium channel potentiate the activity of Gaba, & inhibits kainate's ability to activate an amino acid receptor
- Adverse reactions
- cns: ataxia confusion difficulty with memory dizziness fatigue nervousness paresthesia psychomotor slowing somnolence speech disorders, tremors, generalized tonic-clonic seizures, suicide attempts abnormal coordination, aggresive reaction, agitation, apathy, asthenia,
- cv- chest pain edema palpitations vasodilation
- eent - abnormal vision
- gi - anorexia
- gu - amenorrhea, dysuria dysmenorrhea, hematuria
- hematologic - leukopenia, anemia
- metabolic - decreased weight increased weight
- muscoloskeletal - athralgia, back or leg pain
- resp - upper resp tract infection, bronchitis, coughing, dyspnea
- skin - acne alopecia increased sweating pruritus
- other - body odor breast pain decreased libido
- Interactions
- d-d:
carbamazepine may decrease topiramate level. monitor pt carbonic anhydrase inhibitors, may cause renal calculus formation - hormonal contraceptives - may decrease efficacy. report changes in menstrual pattern advise to use another contraceptive method
- Phenytoin/Valproic - may decrease topiramate & increase phenytoin/valproic level monitors levels & pt
- d- lifestyle - alcohol use may cause cns depression & other psychiatric events
- Lab Results
- may increase liver enzyme levels, may decrease bicarbonate & hgb & hct levels
- may decrease wbc count
- Contraindications & cautions
- use caution to drugs predispose pts to heat related disorder including carbonic anhydrase inhibitors & anticholinergics
- Nx Considerations
- taper to minimize risk of increased seizure activity
- may cause hyperchloremic non-anion gap metabolic acidosis from renal bicarbonate loss
- measure baseline and periodic bicarbonate levels if metabolic acidosis develops and gradually persists consider reducing the dose
- Pt Teaching
- Tell pt to drink plenty of fluids durinh therapy to minimize risk of forming kidney stones
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metformin
(Glucophage)
Class: Antidiabetics, Biguanides
Preg Cat. B
see page 1040-1043
- Administration
- give drugs with meals maximum doses may be better tolerated if total dose is divided
- Action:
- decrease hepatic glucose production & intestinal absorption of glucose & improves insulin sensitivity
- Adv Reaction:
- cns - asthenia headache
- gi - d/n/v abdominal bloating flatulence, anorecia taste per version
- hematologic - megaloblastic anemia
- metabolic - lactic acidosis, hypoglycemia
- other - accidental injury, infection
- Interactions
- d-d: betablockers hypoglycemia, calcium channel blockers
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valproic acid
(Depakote / Depakene)
Class: Anticonvulsants, carboxylic acid derivative
Preg. Cat. D
- Indications:
- Simple & complex absence seizures mixed seizures including absence seizures, to prevent migraine headache
- Administration:
- Give drug with food or milk to reduce adverse GI effects
- Adverse reactions:
- cns- asthenia , dzness, headache, insomnia, nervousness, somnolence, tremor
- cv- chest pain, edema, htn, tachycardia, hypotension
- eent - blurred vision, diplopia, nystagmus, pharyngitis, rhinitis, tniitus
- gi- abd pain, anorexia, diarrhea, dyspepsia, N/V, pancreatitis, constipation
- musculoskeletal - back & neck pain
- respiratory - bronchitis, dyspnea
- Interactions:
- D-D: aspirin, chlorpromazine, cimetidine use cautiously and monitor drug level
- D- Lifestyle: no alcohol use
- Effects on Lab:
- may increase ammonia, alt ast & bilirubin levels. may decrease platelet rbc & wbc counts
- Contraindaications & Cautions:
- hepatic disease or hepatic dysfunction & in pts with urea cyccle disorder
- bbw: avoid
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