-
What type of antidepressant is Tofranil?
Tricyclic
-
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
- constipation
-
Some tricyclic antidepressants (TCA's) block what in the brain?
This produces what symptom?
H1 receptors
Sleepiness & Tachycardia
-
3 major concerns of TCA's r/t cardiovascular system are?
- arrythmias/dysrythmias
- heartblock
- MI
-
Maximum effectiveness for Tofranil/imipramine (& all TCAs) is explerienced when?
2-4 weeks
-
Besides effects on cardio system, what are 4 other adverse reactions to Tofranil/imipramine?
- ECG changes
- Hypotension
- Hallucinations
- Paresthesia
-
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?
10-21 days
-
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?
Dopamine D2
Blocks dopamine receptor sites
-
Prolixin/fluphenazine what other drug is exactly alike?
How so?
Haldol/haloperidon & thorazine
- 1st generation antipsychotic look for pseudoparkinsoniaisms
- TD
- 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?
- agranulocytosis
- hyperpirolactinemia (milk menstrual disturbances women, E.D. in men)
- tachycardia
- 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?
Dopamine D2
blocks dopamine receptor sites
-
taking haloperidol/haldol may cause s.e. that look like a neuroligical disease what?
What are the s/s?
pseudo-parkinsonisms
s/s tardive dysk. & parkinsonisms
-
What are adverse reactions to haliperidol/Haldol?
- agranulocytosis
- ECG changes
- seizures
- respiratory depression
-
What category drug does atomoxetine/Strattera belong?
SNRI
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?
Liver damage
- -dark urine
- -URQ tenderness
- -jaundice
- -pruritis
- -flu like symptoms
-
What category of drug is Buprenorphine & naloxone (suboxone)?
opiod analgesic
-
What are 4 A/R of selgiline/Emsam
- Hallucination
- gambling/sexual urges
- melanoma
- abdominal pain
-
How would and RN recognize parkinsonisms?
- pill rolling tremor
- mask like face
- stooped posture
- shuffling gate
- arms not swinging w/walk
- bradykinesia
-
What category of drugs does Parnate/ trancypromine belong to?
Monoamine oxidase inhibitors
-
What neuro transmitter systems does Parnate/tranylcypromine work on?
- serotonin
- 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?
- rhinorrea
- diaphoresis
- muscle pain
- abd. cramps
- dilated pupils
- panic/insomnia
-
When using buprenorphine & naloxone for withdrawal/detox what route is usually given?
sublingual
-
What is the greatest danger of buprennorphine & naloxone?
If this occurs, what is the antedote?
respiratory depression
maloxone
-
What are the A.R. of buprenorphine and naloxone?
- Resp. depression
- anaphalaxis
- physiological dependence
-
What is the drug classification of clozapine/ Clozaril?
What does the drug act on? How?
2nd generation
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
a/r NMS
-
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?
hypertensive crisis
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
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What are 4 a/r other than hypertensive crisis that can occur with Parnate/trancypromine?
- seizures
- arrhythmias
- agranulocytosis
- thrombocytopenia
-
What is unique about selegiline/Emsam?
(name 2)
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
- licking
- puffing
- 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?
- hyperpyrexia
- muscle rigidity w/ cog wheeling
- HTN/hypotension
- tachy
- incontinent
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?
long-term
-
Buspar differs from short term anxiolytic medications in what way?
Not addictive
-
What drug category is lorazepam?
Benzodiazapine
-
What neurotransmitter system do benzos act on?
GABA
-
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?
30-60 minutes
-
Lorazepam is potentially ______, sudden cesation could result in the worst case scenario of _______?
Addicting
Statis epilepticus
-
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
- Nausea
- Vomitting
- HA
-
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?
- drowsiness
- fatigue
- constipation
- 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
- insomnia
- edema
- HA
- diarrhea
-
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?
- confusion
- dizziness
- fainting
- vivid dreams
-
What are the common side effects of chlorpromazine/thorazine?
- Photosensitivity
- Constipation
- 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?
stimulants
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
- Photosensitivity
- Anorexia
- Dry mouth
-
What are common side effects of benztropine/cogentin?
- Blurred vision
- Dry eyes
- Dry mouth
- constipation
-
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
- HTN
- arrhythmias
- hallucinations
-
A significant a/r with Wellbutrin used with other antidepressants?
seizures
-
One seriour a/r that may occur with Paxil, especially if combined with another anti-depressant or st. Johns Wart is?
Serotonin syndrome
-
What are the symptoms of Serotonin syndrome?
- Abd. pain
- Diarrhea
- Sweating
- Fever
- Tachycardia
- Increased BP
-
What are some a/r of Paxil?
- NMS (neuroleptic malignant syndrome)
- suicidal thoughts
- mental depression
- pruitis
-
Wellbutrin is unique among antidepressants because it effect the_______ & ______ neurotransmitter systems. It doe not effect the ________ neurotransmitter system.
Dopamine & norepinephrine
Serotonin
-
What is the optimum effect time period of Paxil?
Why?
2-4 Weeks
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
- leukopenia
- T.D.
-
What a/r is clozapine/Clozaril more likely to have, unlike haliperidol & fluphenazine?
What must the patient do to prevent this?
Agranulocytosis
Weekly blood draw to check ANC & WBC
-
What are 4 common s/e of lorazepam?
- Drowsiness
- Dizziness
- Lethargy
- Confusion
-
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?
Pre-frontal cortex
-
When does Buspar reach its maximum effectiveness?
3-6 weeks
-
What are 4 s/e of Buspar?
- dizziness
- tachycardia
- nausea
- 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?
EPSP
Excitatory Post Synaptic Potential
-
Buspar is unique because it has a mild agonist effect on what neurotransmitter system?
Dopamine
-
What neurotransmitter system does Buspar work primarily on?
Serotonin
-
What is Buspar used for?
Anxiety
-
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?
EPS
Extrapyramidal symptoms
-
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?
Tardive dyskinesia
-
What are a/r of benztropint/Cogentin?
- Hallucinations
- Depression
- Arrhythmias
- Sudden weakness
-
What are potential a/r of lorazepam?
- Apnea
- Cardiac arrest
- Hypotension
- Respiratory depression
-
If statis epilepticus is not controlled the result could be _______
This can also be a result of using lorazepam with______?
Death
Alcohol
-
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?
2-4 weeks
-
What are the a/r to Prolixin/fluphenazine?
- EPS
- Agranulocytosis
- Thrombocytopenia
- Death
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