1
Q
cognitive symptoms
A
difficulty w/ attention and applying information to make decisions
2
Q
blood-brain barrier
A
- lipid drugs can pass
- water-soluble can’t pass very easily
- not fully present at birth
3
Q
barbiturates safety concerns
A
- habit-forming
- low therapeutic index
- benzodiazepines are more commonly used because they are safer and more effective
4
Q
barbiturates drug effects
A
dose-dependent!
- low: sedative
- high: hypnotic, lower RR
- enzyme inducer (metabolism of other drugs)
5
Q
barbiturates increased metabolism of…
A
- C hloramphenicol
- WA rfarin
- S teroids
- T olbutamide & Theophylline
- G riseofulvin
(Cause WASTaGe)
6
Q
Barbiturates SE
A
- A taxia
- B ehavioural disturbance
- C oma & decreased Concentration
- D epression, Drowsiness, Diplopia
(ABCD)
7
Q
Barbiturates AE
A
- CV: vasodil, hypotn
- CNS: drowsiness, lethargy, vertigo
- Resp: depression, cough
- MS: ataxia
- GI: N/V, constipation
- Hem: thrombocytopenia, agranulocytosis
- Neuro: decreased REM
- SJS
8
Q
Barbiturate Toxicity/OD
A
- resp depression/arrest
- CNS depression: coma/death
- treated symptomatically but not reversible (oxygenation, fluids, charcoal)
9
Q
High (near toxic) doses of barbiturates used for
A
- induced coma
- anesthesia induction
- uncontrollable seizures
- must be in a controlled environment
10
Q
OTC Hypnotics
A
- sleep aids contain antihistamines (CNS depressant)
- Doxylamine (unisom)
- Diphenhydramine (Sominex)
- Acetaminophen/Diphenhydramine (Extra Strength Tylenol PM
- ZQuil
- use w/ alcohol can be fatal (resp depress)
11
Q
Benzodiazepines indications
A
- acute seizures
- alcohol withdrawal
- agitation
- moderate/conscious sedation
12
Q
Benzos MOA
A
- depress CNS
- affect hypo/thalamicm limbic systems
- Benzo receptors (GABA)
- Don’t suppress REM as much
- Don’t increase metabolism of drugs
13
Q
Benzos contraindications
A
- NA glaucoma
- pregnancy
14
Q
Benzos AE
A
- HA
- drowsiness
- dizziness/vertigo
- cognitive impairment
- lethargy
- fall hazard (older pt)
- REM rebound
- hangover effect
(these are mild and infrequent)
15
Q
Benzos toxicity/OD
A
- Somnolence (extremely tired)
- Confusion
- Coma
- decreased reflexes
- w/other CNS depressants: hypotn and resp depress
- symptomatic/supportive treatment
- antidote: Flumazenil
16
Q
Classifications of stimulants
A
- Amphetamines (i.e. Adderall)
- Serotonin agonists (Sumatriptan for migraines)
- Sympathomimetics (stim adrenergic receptors)
- Xanthines (caffeine)
17
Q
CNS stimulants therapeutic uses
A
- anti-ADD
- antinarcoleptic
- anorexiant
- antimigraine
18
Q
Drugs for ADHD
A
- CNS stimulats b/c they increase NT like dopamine, serotonin, epi
- Amphetamines: methylphenidate (Ritalin) and dextroamphetamine (Adderall)
- Nonamphetamines: modafinil (Provigil)
19
Q
Misc indications for antidepressants
A
- adjunct for schizophrenia
- eating disorders
- personality d/o
- migraines
- chronic pain/sleep d/o
- premenstrual syndrome (PMS)
- hot flashes (menopause)
20
Q
types of antidepressants
A
- Monoamine oxidase inhibitor (MAOI)
- Selective Srotonin Reuptake Inhibitors (SSRI)
- Serotonin-norepi reuptake inhibitors (SNRI)
(others are SARI, NDRI, alpha2 adrenoreceptor antagonist)
21
Q
Tricyclin Antidepressant
A
- TCAs
- second line (behind SSRIs)
- adjunct therapy with other antidepressants
- Amitriptyline
- Block reuptake of NT, so they accumulate
22
Q
TCA AE
A
- sedation
- impotence
- ortho hypo
- in older pt: dizziness, constipation, delayed micturition, edema, muscle tremors
23
Q
Antimania drugs
A
- mood stabiliziers
- Lithium was the 1st
- contraindicated in renal/CV dz, dehydration, Na depletion, diuretics (risk of toxicity)
- serum range of lithium 0.8-1.2
- lithium toxicity. (1.5)
24
Q
Antipsychotics
A
- Haloperidol (Haldol) for Tourette’s and schizo
- Haldol contraindicated in Parkinson’s, dementia with Lewy bodies (d/t blocking of dopamine receptors)
- Risperidone (Risperdal) for schizo, acute manic episodes, and irritability in autism
25
Tardive Dyskinesia
- AE of antipsychotics
- involuntary contraction of oral and facial muscles
- wavelike movements of extremities
26
Neuroleptic Malignant Syndrome (NMS)
- AE of antipsychotics
- life-threatening
- high fever
- unstable BP
- myoglobinemia (myoglobin in blood)
27
Extrapyramidial symptoms
- AE of antipsychotics
- involuntary motor symptoms similar to in Parkinson's
- akathisia (distressing motor restlessness)
- acute dystonia (painful muscle spasms)
- treated w/ anticholinergic meds (benzotropine and trihexyphenidyl)
28
GABA
- Gamma aminobutyric acid
- amino acid/NT in brain
- inhibitory
- reduce neuron excitability in NS
- some antiseizure drugs enhance this effect
- Gabapentin is anticonvulsant and treats nerve pain
29
Seizure
- episode of abnormal electrical activity in brain
30
Convulsion
- involuntary spasmodic contractions (any muscles in body)
31
Epilepsy
- chronic recurring pattern of seizures
32
Seizure disorder
- not always epilepsy
- may be caused by trauma, poisoning, fever, withdrawal, etc.
33
Status epilepticus
- multiple seizure with no recovery in between
- results in hypotension, brain damage, death
- can be caused by an abrupt discontinuation of anticonvulsants
34
Antiepileptics
- aka anticonvulsants
- control or prevent seizures
- minimize AE and drug induced toxicity
- lifelong therapy
- may be a combination of drugs
- serum must be measured
35
Serum concentrations of antiepileptics
- concentrations of phenytoin, phenobarbital, carbamazepine, levetiracetamm, primadone correlate with seizure control and toxicity
- concentrations of valproic acid, ethosuximide, and clonazepam do not correlate as well
36
Antiepileptic AE
- necessitate a med change
- long-term phenytoin may cause ginivial hyperplasia (skin grows over teeth), acne, hirsutism, Dilantin facies (skin thickens)
37
Antiepileptic contraindications
- birth control
- Carbamazepine: avoid grapefruit
38
DRESS
- Drug Reaction with Eosiniphilia and Systemic Symptoms
- rash
- fever
- eosiniphilia
- seen with antiepileptics
39
Phenytoin (Dilantin) drug class and nursing implications
- antiepileptic
- IV administration:
slow through large-gauge catheter
diluted in NS
filter
saline flush
stop if rash (DRESS)
40
Levetiracetam (Keppra) drug class and nursing implications
- antiepileptic
- adjunct for partial seizures
- CNS AE but generally fine
- no interactions
41
Nursing Implications of antiepileptics
- health history and current drugs
- liver function study (they are metabolized in liver)
- CBC
- baseline vitals
- pt monitor response to drug, occurance of seizures, AE
- wear medical alert tag
- don't discontinue abruptly (status epilepticus)
- driving recommendations
42
Anti-parkinson drugs
- drugs that stimulat substantia nigra to increase dopamine and inhibit acetylcholine
43
Carbidopa/Levodopa (Sinemet)
- for parkinson's
- crosses BBB
- converted into dopamine in brain
- Carbidopa helps prevent breakdown of Levodopa
44
Carbidopa/Levodopa AE
- Neuroleptic malignant syndrome
- dyskinesia
- depression
- suicidal ideation
- hallucinations
- intense urges
45
Selegiline (Eldepryl, Emsam, Zelapar) drug class and MOA
- Anti-Parkinson Drugs
- block breakdown of dopamine
46
Selegiline AE
- hypertn crisis in foods high in tyramine
(aged cheese, meats, overripe bananas, avacados, fermented soy like miso)
47
Amantadine (Symmetrel) drug class and effects
- Anti-Parkinson's
- reduces tremors
- reduces muscle rigidity
48
Amantadine AE
- CHF
- peripheral edema
- suicidal ideation
- incontrollable, intense urges
49
- acute seizures
- alcohol withdrawal
- agitation
- moderate/conscious sedation
Benzodiazepines indications
50
- sedative-hypnotic or anxiolytic
- long-acting
- intermediate-acting
- short-acting
Benzo types
51
- depress CNS
- affect hypo/thalamicm limbic systems
- Benzo receptors (GABA)
- Don't suppress REM as much
- Don't increase metabolism of drugs
Benzos MOA
52
- NA glaucoma
- pregnancy
Benzos contraindications
53
- HA
- drowsiness
- dizziness/vertigo
- cognitive impairment
- lethargy
- fall hazard (older pt)
- REM rebound
- hangover effect
(these are mild and infrequent)
Benzos AE
54
- Somnolence (extremely tired)
- Confusion
- Coma
- decreased reflexes
- w/other CNS depressants: hypotn and resp depress
- symptomatic/supportive treatment
- antidote: Flumazenil
Benzos toxicity/OD
55
- Amphetamines (Dextroamphetamine aka Adderall)
- Serotonin agonists (Sumatriptan for migraines)
- Sympathomimetics (stim adrenergic receptors)
- Xanthines (caffeine)
Classifications of stimulants
56
- anti-ADD
- antinarcoleptic
- anorexiant
- antimigraine
CNS stimulants therapeutic uses
57
- CNS stimulats b/c they increase NT like dopamine, serotonin, epi
- Amphetamines: methylphenidate (Ritalin) and dextroamphetamine (Adderall)
- Nonamphetamines: modafinil (Provigil)
Drugs for ADHD
58
- adjunct for schizophrenia
- eating disorders
- personality d/o
- migraines
- chronic pain/sleep d/o
- premenstrual syndrome (PMS)
- hot flashes (menopause)
Misc indications for antidepressants
59
- sedation
- impotence
- ortho hypo
- in older pt: dizziness, constipation, delayed micturition, edema, muscle tremors
TCA AE
60
- Haloperidol (Haldol) for Tourette's and schizo
- Haldol contraindicated in Parkinson's, dementia with Lewy bodies (d/t blocking of dopamine receptors)
- Risperidone (Risperdal) for schizo, acute manic episodes, and irritability in autism
Antipsychotics
61
- AE of antipsychotics
- involuntary contraction of oral and facial muscles
- wavelike movements of extremities
Tardive Dyskinesia
62
- AE of antipsychotics
- life-threatening
- high fever
- unstable BP
- myoglobinemia (myoglobin in blood)
Neuroleptic Malignant Syndrome (NMS)
63
- AE of antipsychotics
- involuntary motor symptoms similar to in Parkinson's
- akathisia (distressing motor restlessness)
- acute dystonia (painful muscle spasms)
- treated w/ anticholinergic meds (benzotropine and trihexyphenidyl)
Extrapyramidial symptoms
64
- episode of abnormal electrical activity in brain
Seizure
65
- involuntary spasmodic contractions (any muscles in body)
Convulsion
66
- chronic recurring pattern of seizures
Epilepsy
67
- not always epilepsy
- may be caused by trauma, poisoning, fever, withdrawal, etc.
Seizure disorder
68
- multiple seizure with no recovery in between
- results in hypotension, brain damage, death
- can be caused by an abrupt discontinuation of anticonvulsants
Status epilepticus
69
- aka anticonvulsants
- control or prevent seizures
- minimize AE and drug induced toxicity
- lifelong therapy
- may be a combination of drugs
- serum must be measured
Antiepileptics
70
- concentrations of phenytoin, phenobarbital, carbamazepine, levetiracetam, primadone correlate with seizure control and toxicity
- concentrations of valproic acid, ethosuximide, and clonazepam do not correlate as well
Serum concentrations of antiepileptics
71
- necessitate a med change
- long-term phenytoin may cause ginivial hyperplasia (skin grows over teeth), acne, hirsutism, Dilantin facies (skin thickens)
Antiepileptic AE
72
- birth control
- Carbamazepine: avoid grapefruit
Antiepileptic contraindications
73
- antiepileptic
- IV administration:
slow through large-gauge catheter
diluted in NS
filter
saline flush
stop if rash (DRESS)
Phenytoin (Dilantin)
74
- antiepileptic
- adjunct for partial seizures
- CNS AE but generally fine
- no interactions
Levetiracetam (Keppra) drug class and nursing implications
75
- health history and current drugs
- liver function study (they are metabolized in liver)
- CBC
- baseline vitals
- pt monitor response tod drug, occurance of seizures, AE
- wear medical alert tag
- don't discontinue abruptly (status epilepticus)
- driving recommendations
Nursing Implications of antiepileptics
76
- for parkinson's
- crosses BBB
- converted into dopamine in brain
- (1) helps prevent breakdown of (2)
Carbidopa/Levodopa (Sinemet)
77
- Neuroleptic malignant syndrome
- dyskinesia
- depression
- suicidal ideation
- hallucinations
- intense urges
Carbidopa/Levodopa AE
78
- Anti-Parkinson Drugs
- block breakdown of dopamine
Selegiline (Eldepryl, Emsam, Zelapar) drug class and MOA
79
- hypertn crisis in foods high in tyramine
(aged cheese, meats, overripe bananas, avacados, fermented soy like miso)
Selegiline AE
80
- Anti-Parkinson's
- reduces tremors
- reduces muscle rigidity
Amantadine (Symmetrel) drug class and effects
81
- CHF
- peripheral edema
- suicidal ideation
- incontrollable, intense urges
Amantadine AE
82
Haloperidol (Haldol) drug classes and uses
- antipsychotic
- for Tourette's and schizophrenia
83
Risperidone (Risperdal) drug class and effects
- antipsychotic
- for schizo, acute manic episodes, and irritability in autism
84
Carbamazepine drug class
- antiepileptic
85
Alprazolam (Xanax)
- used as an anxiolytic
- GAD, panic disorder, anxiety w/ depression
- AE: confusion, ataxia, headache
- Interactions: alcohol and contraceptives
| Intermediate-acting benzo
86
Diazepam (Valium)
- anxiety
- alcohol withdrawal
- status epilepticus
- preop sedation
- adjunct for muscle spasms
- Contraindications: hepatic dysfunction
- AE: headache, confusion, slurred speech
- Interactions: alcohol and contraceptives
| Long-acting benzo
87
Lorazepam (Ativan)
- can be given IV push for an agitated pt
- continuous for agitated pt w/ mechanical ventilation
- treat/prevent alcohol withdrawal
| Intermediate-acting benzo
88
Eszopiclone (Lunesta)
- hypnotic
- FDA approved for long term use
- 8 hours of sleep
| short/intermediate-acting NONbenzo
89
Zolpidem (Ambien)
- lower incidence of daytime sleepiness compared to benzos
| short-acting NONbenzo
90
Amphetamines contraindications
- recent use of an MAOI
- CV structural abnormalities
Pharm 4
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