What type of antidepressant is Tofranil?
What neurotransmitter systems does Tofranil work on?
What does this do?
Serotonin & norepinephrine
Creates anticholinergic effects
What are 4 anticholinergic effects of Tofranil/imipramine?
- Blurred vision
- Dry Mouth
- Orhto Static hypotension
Some tricyclic antidepressants (TCA's) block what in the brain?
This produces what symptom?
Sleepiness & Tachycardia
3 major concerns of TCA's r/t cardiovascular system are?
Maximum effectiveness for Tofranil/imipramine (& all TCAs) is explerienced when?
Besides effects on cardio system, what are 4 other adverse reactions to Tofranil/imipramine?
- ECG changes
How is lithium carbonate/Eskalith classified?
A mood stabilizer
What is the action mechanism of lithium carbonate/Eskalith?
- alters na+ transport in nerve and muscle cells
- Shifts toward inter neuronal muscle or catacholines
*specific action in mania is unknown
What is the therapeutic range of lithium carbonate?
Why is it important to maintain this range?
- 0.5-1.5 mEq/L
- higher levels @ risk to become toxic
What are 2 dietary concerns when taking lithium carbonate?
adequate intake of h2o and sodium Na+
How ling does it take for symptom control to occur when taking lithium?
With long-term use of lithium what are the concerning effects?
Development of thyroid, heart, kidney disorders
What are adverse reactions to lithium?
- Liver damage withing 1st 6 months
- Life threatening pancreatitis
- Clothing disorder
- Slurred speech or anaphalaxys
What is the classification of chlorpromazine/thorazine?
1st generation antipsychotic
What does chlorpromazine/thorazine act on (neuro system)?
What effect does it have on a neurotransmitter system?
Blocks dopamine receptor sites
Prolixin/fluphenazine what other drug is exactly alike?
Haldol/haloperidon & thorazine
- 1st generation antipsychotic look for pseudoparkinsoniaisms
- NMS - AR
A fatal adverse reaction for cholorpromazine/thorazine is what?
What are the symptoms?
NMS - neuroleptic malignant syndrome
muscle rigidity with cog wheeling, hyperpyrexia, HTN, diaphoresis, tachycardia, incontenence
What are the adverse reactions of chlorpromazine/thorazine?
- hyperpirolactinemia (milk menstrual disturbances women, E.D. in men)
- tardive dyskinesia
What is the classification of Haldol/haloperidol?
1st generation antypsychotic
What neuro system does haloperidol/ haldol act on, and how does it do this?
blocks dopamine receptor sites
taking haloperidol/haldol may cause s.e. that look like a neuroligical disease what?
What are the s/s?
s/s tardive dysk. & parkinsonisms
What are adverse reactions to haliperidol/Haldol?
- ECG changes
- respiratory depression
What category drug does atomoxetine/Strattera belong?
Selective Norepinephrine Reuptake Inhibitor
What is atomoetine/Stratta used for?
How does it work?
ADHD in kids and adults
Blocks the reuptake of norepinephrine into the presynaptic neuron!
What is the greatest risk when taking atomoxetine/Stratta?
How would the RN recognize this?
- -dark urine
- -URQ tenderness
- -flu like symptoms
What category of drug is Buprenorphine & naloxone (suboxone)?
What are 4 A/R of selgiline/Emsam
- gambling/sexual urges
- abdominal pain
How would and RN recognize parkinsonisms?
- pill rolling tremor
- mask like face
- stooped posture
- shuffling gate
- arms not swinging w/walk
What category of drugs does Parnate/ trancypromine belong to?
Monoamine oxidase inhibitors
What neuro transmitter systems does Parnate/tranylcypromine work on?
- dompamine & epinephrine
buprenorphine alone can be used for what?
Also, buprenorphine alone and in combo with naloxone can be used for what?
How would an RN know the s/s of withdrawal?
- muscle pain
- abd. cramps
- dilated pupils
When using buprenorphine & naloxone for withdrawal/detox what route is usually given?
What is the greatest danger of buprennorphine & naloxone?
If this occurs, what is the antedote?
What are the A.R. of buprenorphine and naloxone?
- Resp. depression
- physiological dependence
What is the drug classification of clozapine/ Clozaril?
What does the drug act on? How?
Acts on dopamine D2 and D4, and seratonin neuro systems. By blocking both seratonin and dopamine receptor sites.
Like Haldol & Prolixin what s/e and a/r can Clozapril/clozapine have?
s/e tardive dyskinesias - pseudoparkinsonisms
Exactly how does Parnate/tranylcypromine work on the neuro systems?
inactivates MAO-A which inactivates dopamine in the brain & MAO-B which inactivates norepinephrine & serotonin, increasing all SAID transmitters.
What is the most serious a/r to Parnate/tranylcypromine & what is caused by?
Parnate/tranycypromine prevents dreakdown of tyramine in the liver stimulating intense vasoconstriction
Because of risk of a serious a/r to Parnate what do patinet need to avoid?
Give 4 examples.
Tyramine in food
- aged cheese
- wines & beer
- processed meats
- fova beans
What are 4 a/r other than hypertensive crisis that can occur with Parnate/trancypromine?
What is unique about selegiline/Emsam?
delivered by transdermal patch
can maintain regular diet, does not require tyramine restricted diet, if dose is <6mg per 24 hours. MAOI
How would and RN recognize Tardive dyskinesia?
- lip smacking
- tongue thrust
- spastic facial distortion
- jerking movements
The fatal a/r with haloperidol/Haldol is?
NMS (neuroleptic malignant syndrome)
How would and RN recogniz NMS?
What would the RN do if they observed these signs?
- muscle rigidity w/ cog wheeling
Hold med and call MD ASAP.
What are the 4 most important patient teachings when taking selgiline/Emsam?
- -watch for HTN crisis symptoms
- -change positions slowly
- -get periodic skin checks
- -advise doctor if new urge to gamble or sexual desire intensifies
When taking chlorpromazine/Thorazine, what is the collective term for movement side effects?
What are they?
EPS - Extra Pyramidial Symptom
- acute dystonia - (involuntary muscular contractions)
- akathisia - restlessness
Besides EPS what other a/r can occur with Buspar?
CHF, MI, anger/aggression, paresthesia
Is Buspar used long term or short term?
Buspar differs from short term anxiolytic medications in what way?
What drug category is lorazepam?
What neurotransmitter system do benzos act on?
How do benzos act on the GABA neuro system?
They "enhance" the GABA neuro system which creates a "depressed" effect
When does a patient notice the effects of lorazepam?
Lorazepam is potentially ______, sudden cesation could result in the worst case scenario of _______?
What is the most important patient teaching for Paxil patients?
- -Do not double your dose
- -Watch for suicidal thoughts
- -Avoid alcohol & CNS depressants
- -Don't take while pregnant
What are 4 common side effects of Wellbutrin?
- Dry mouth
What are 4 patient teaching points for Wellbutrin?
- -Do not double missed dose or take more than prescribed
- -What for sucidality
- -Unused shell may pass in stool
- -Use sunscreen causes photosensitivity
What are 4 common s/e of tofranil/imiprmine?
- dry mouth
Most important patient teaching for Tofranil/imipramine are?
- -Don't drive until acclimated
- -avoid alcohol
- -call 911 if you experience angina
- -call MD if suicidal
- -Don't double dose
What are 4 common side effects of Parnate/trancypromine?
- Othostatic hypotension
What are 4 patient teachings important to share with patients taking Parnate/trancypromine?
- -Go to hospital if severe HA
- -Monitor b/p for first 6 weeks
- -Avoid all meds, vitamins, supplements until pharmacist okays
- -Maintain tyramine free diet for 2 weeks after med cessation
What are common s/e of selegiline/Emsam?
- vivid dreams
What are the common side effects of chlorpromazine/thorazine?
- Blurred vision
- Dry mouth
What are 4 most important patient teaching ops for someone on chlorpromazine/Thorazine?
- -Report signs of EPS, NMS, or TD
- -Change positions slowly
- -Avoid alcohol
- -Don't go in the sun w/o sunscreen or protective clothing
**Females may cause false+ pregnancy test
What drug category is Ritalin/methylphenidate?
What is it primarily used for?
ADHD- especially in children
What are the 4 most important patient teaching opportunities with lithium/Eskalith?
- -Take missed tab within 6 hours if on multi-dose or as soon as remembered if on single dose.
- -Do not stop abruptly
- -Call MD is severe n/v occur
What are common s/e of fluphenazine/Prolixin?
- Extrapyramidal reactions
- Dry mouth
What are common side effects of benztropine/cogentin?
- Blurred vision
- Dry eyes
- Dry mouth
What are the common s/e of lithium?
- Thinning of hair
- itching skin
- loss of appetite
- stomach pain
What are the 4 a/r for Wellbutrin
- suicidal thoughts
A significant a/r with Wellbutrin used with other antidepressants?
One seriour a/r that may occur with Paxil, especially if combined with another anti-depressant or st. Johns Wart is?
What are the symptoms of Serotonin syndrome?
- Abd. pain
- Increased BP
What are some a/r of Paxil?
- NMS (neuroleptic malignant syndrome)
- suicidal thoughts
- mental depression
Wellbutrin is unique among antidepressants because it effect the_______ & ______ neurotransmitter systems. It doe not effect the ________ neurotransmitter system.
Dopamine & norepinephrine
What is the optimum effect time period of Paxil?
Its believed Paxil stimulates growth of new neurons/receptors
How does Paxil work?
It effects the serotonin neurotransmitter system by blocking the reuptake of serotonin in the presynaptic cleft
What drug category does Paxil belong to?
SSRI (depression) (also used for anxiety disorder)
What a/r can happen with clozapine/clozaril?
- ventricular arrythmias
- cardiac arrest
What a/r is clozapine/Clozaril more likely to have, unlike haliperidol & fluphenazine?
What must the patient do to prevent this?
Weekly blood draw to check ANC & WBC
What are 4 common s/e of lorazepam?
What are the top 4 patient teachings for lrazepam?
- Don't combine w/ alcohol or sedatives
- Taper off use
- Don't use if pregnant
- Don't drive while taking this med
Where in the brain does Ritalin/methylphenidate work?
When does Buspar reach its maximum effectiveness?
What are 4 s/e of Buspar?
- blurred vision
For Buspar, what are the most important patient teaching points?
- Don't eat grapefruit
- Don't drink alcohol
- Take @ same time each day: either always with food or always without
- Tell MD about all meds including vitamins & supplements
What are the most important patient teaching for someone taking atomoxetine/Stratta
- Don't take more than prescribed dose in 24 hour period
- Take missed dose ASAP
- Call MD upon s/s of liver problems
- Never share your meds
What a/r can occur with atomoxetine/Strattera?
- Suicidal thoughts
- Allergic reaction anaphalaxis
- Angioneurotic edema
- Severe liver problems
What is a potentia a/r that could occur due to dopamine and serotonin neurotransmitter interuption in Buspar?
Excitatory Post Synaptic Potential
Buspar is unique because it has a mild agonist effect on what neurotransmitter system?
What neurotransmitter system does Buspar work primarily on?
What is Buspar used for?
Whar are important patient teachings for someone taking benztropine/Cogentin?
- Call MD if rapid heart beat
- Decreases perspiration-pt. at risk of overheating
- Change position slowly due to ortho hypertension
- Do no drink alcohol
What is the drug classification of benztropine/Cogentin?
anti-parkinson, anticholinergic agent
What is benztropine/Cogentin used to treat?
How does benztropine/Cogentin work?
How long does it take to work?
Blocks cholinergic activity in CNS, prolonging dopamine activity
immediately or 2-3 days
Long term use of benztropine/Cogentin in conjunction with an antipsycotic, predisposes a patient to develop what?
What are a/r of benztropint/Cogentin?
- Sudden weakness
What are potential a/r of lorazepam?
- Cardiac arrest
- Respiratory depression
If statis epilepticus is not controlled the result could be _______
This can also be a result of using lorazepam with______?
How is Prolixin/fluphenazine administered?
What form does it come in?
med is mixed in sesame oil-deconate
given z track
How long does a Prolixin/fluphenazine injection last?
What are the a/r to Prolixin/fluphenazine?