1
Q
Non-Benzodiazepines: Zolpidem
Use:
A
Drug of choice for insomnia
2
Q
Non-Benzodiazepines: Zolpidem
SEs/ADRs, Interactions:
A
- SEs/ADRs
o Common: headache, drowsiness, dizziness, anxiety, abnormal dreams, hangover effect (residual sedation, you will still feel sleepy after waking up)
o Sleep-related behaviors-engaging in activities in your sleep and not being aware of them. Ex/ driving, walking, talking on phone, cooking etc.
o Suicidal thoughts
o Hallucinations - Interactions- no alcohol, CNS depressants
3
Q
Non-Benzodiazepines: Zolpidem
Contradictions:
A
o Sleep apnea (breathing repeatedly stops and starts)
o Severe respiratory impairment
o Hepatic/renal impairment
o BEERS: avoid in patients over 65 yrs. old
4
Q
Non-Benzodiazepines: Zolpidem
Administration:
A
Tablet- IR (immediate release) or ER (extended-release), SL (sublingual), best taken on an empty stomach at bedtime, used short term, only when you can get a full night’s sleep.
5
Q
IV Anesthetics: Midazolam
Indications:
A
Conscious sedation for minor surgery or procedures. The patient will be sedated and relaxed but still conscious/responsive.
6
Q
IV Anesthetics: Midazolam
ADRs:
A
o Impaired airway reflexes (can’t cough or gag, swallow),
o Hypotension, respiratory, and CV (cardiovascular) depression.
7
Q
IV Anesthetics: Midazolam
Contradictions:
A
o Allergy
o Unstable cardiorespiratory function
o Non-fasting state (risk for aspiration)
8
Q
Local Anesthetics: Lidocaine
MOA, Uses, Administration:
A
- MOA: numbs the skin
o Onset is rapid and provides a long duration of action. - Uses: minor surgeries/procedures (dental, IV start, suturing)
- Administration: infiltration (dermal injection)
9
Q
Spinal and Epidural Anesthesia
Uses:
A
o Spinal: total joint replacement
o Epidural: childbirth
10
Q
Spinal and Epidural Anesthesia
SEs/ADRs:
A
o Postural headache (occurs 1%- 1/100)
o Vital sign changes: hypotension, respiration depression
o Infection ex/ meningitis
o Bleeding
11
Q
Spinal and Epidural Anesthesia
A
- Spinal (intrathecal)- single shot
o Short-acting, regional anesthesia (short, quick, and powerful)
o Drug injected around spinal column (subarachnoid space), quick onset less than 5 min.
o Epidural: between dura and vertebral wall, takes about 30 mins for onset, longer acting and lasting regional anesthesia.
12
Q
Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
MOA, Uses:
A
- MOA: inhibit COX 1 and 2–> decrease prostaglandin synthesis–> decrease inflammation
- Uses:
o analgesics (meds that relive pain)
o antipyretics (meds that reduces fever)
o inhibit platelet aggregation,
o aspirin- MI (heart attack)/stroke prevention
13
Q
Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
SEs/ADRs:
A
o GI bleeding
o renal insufficiency/failure
o increased blood pressureCV (cardiovascular) complications
o tinnitus
o Reye’s syndrome in children (aspirin)
o thrombocytopenia.
o DO NOT GIVE ASPIRIN IF UNDER 18 YRS OLD
14
Q
Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
Interactions, Caution:
A
- Interactions:
o other NSAIDs
o 4 G’s (garlic, ginseng, ginkgo Biloba, green tea)- increased bleeding - Caution: best not to take 2 days before or 1st 2 days of menstrual cycle due to increase bleeding
15
Q
Traditional (non-selective) NSAIDS: Aspirin and Ibuprofen
Contraindications:
A
o Renal failure
o Hypertension
o DO NOT GIVE ASPIRIN IF UNDER 18 YRS OLD – due to increased risk of Reyes syndrome- associated with the use of aspirin during febrile illness (flu, chicken pox, URI (upper respiratory infection))
Reyes syndrome:
etiology- cause unknown, linked to brain swelling and liver damage.
symptoms: vomiting, lethargy, delirium, personality changes, seizures.
16
Q
COX 2 selective NSAID: Celecoxib
MOA, Uses:
A
- MOA: selectively blocks COX 2, fewer GI side effects
- Uses:
o Arthritis
o Acute pain
o Dysmenorrhea (pain associated with menstruation)
17
Q
COX 2 selective NSAID: Celecoxib
ADRs:
A
o Associated with increased risk of serious adverse CV (cardiovascular) events
o MI (heart attack)
o CVA
o New onset hypertension
o Events (fewer than traditional NSAIDs)
o Hepatitis
o Acute kidney injury
18
Q
COX 2 selective NSAID: Celecoxib
Contraindications, Interactions:
A
- Contradictions: history of heart disease
- Interactions:
o ACE inhibitors
o Anticoagulants
o SNRIs – antidepressants
o Lithium
o Ginkgo biloba -increased bleeding
19
Q
Gout and its Patho
A
Gout: due to accumulation of uric acid crystals into joints and other body tissuesinflammation
Patho:
o uric acid under secretion by kidneys
o overproduction of uric acid
o exogenous (high purine (meats and alcohol) diet)
male predominance, great toe (1st attack)
20
Q
Gout treatment: Allopurinol
A
preferred urate-lowering drug
21
Q
Gout treatment: Allopurinol
MOA, Use:
A
- MOA: lowers production of uric acid
- Use: gout prevention- treatment of chronic gout
22
Q
Gout treatment: Allopurinol
SEs/ADRs:
A
o Hepatotoxicity
o Hypersensitivity reactions
o Stevens Johnsons Syndrome – blisters and peels reaction
o GI: nausea/vomiting
o Renal: renal failure
o CNS: drowsiness
23
Q
Gout treatment: Allopurinol
Caution, Monitoring, Interactions:
A
- Caution: decrease dose or withdraw drug for renal impairment
- Monitoring: LFTs, renal function (BUN and Creatinine) periodically
- Interactions:
o thiazide/loop diuretics
o warfarin (allopurinol increases anticoagulant effect)
24
Q
Acetaminophen
A
non-opioid analgesics; NOT an NSAID, no anti-inflammatory action or anti-platelet.
25
Acetaminophen
MOA, Uses:
1. MOA: unknown……. Theories?
o Might weakly inhibit prostaglandin.
o Activate the cannabinoid system.
o Increase serotonin levels in the brain, which helps modulate pain.
2. Uses: reduce pain and fever
26
Acetaminophen
Administration:
Oral form can be taken with or without food. MAX: 4 gm daily from all sources. Lower for the elderly or for hepatic impairment (2-3 gm daily)
o do not self-medicate with acetaminophen for more than 10 days. -Pg 299
27
Acetaminophen
ADRs, Cautions:
1. ADRs:
o liver toxicity
o monitor LFTs.
o signs and symptoms of hepatotoxicity
2. Cautions: Use with caution in patients with hepatic impairments
28
Acetaminophen
Interactions:
o increase the effect with caffeine.
o avoid alcohol while taking acetaminophen.
o decrease the effect with oral contraceptives,
o Antacids (1-2 hrs. apart from other drugs)
o may interact with potentially hepatic toxic herbs: echinacea and kava.
29
Acetaminophen Overdose
Antidote: N-acetylcysteine ~ used in patients at increased risk of liver failure.
30
Opioid analgesics
“Mu” agonists- morphine like drugs
31
Opioid analgesics
MOA, Uses:
1. MOA: binds to opiate receptors in CNS-->decrease pain perception and suppresses cough center in the brain.
2. Uses:
o Decrease moderate to severe pain.
o Antitussive (cold medication- prevent/relieve cough)
32
Opioid analgesics
Administration, SEs/ADRs:
1. Administration: varies
2. SE/ADRs:
o Constipation
o Nausea and vomiting
o Urinary retention – dec sensation of bladder fullness
o Itching
o Sedation
o Orthostatic hypotension
o Bradycardia
o Respiratory depression
33
Opioid analgesics
Signs of OD(overdose), reversal agent:
1. Signs of OD (overdose): Pinpoint pupils- pg. 302
2. Reversal Agent: Naloxone
o Only lasts about 20 minutes; repeat dosing may be needed.
o IV, IM, SQ, intranasal
34
Opioid analgesics
Interactions:
o Increased effects of alcohol
o Sedatives
o Antipsychotics
o Muscle relaxers
o St. John’s Wort may decrease drug effects.
35
PCA “Patient Controlled Analgesics”
o Gives pt control over pain management.
o Usually morphine, hydromorphone, or fentanyl
1. High Alert: requires 2 nurse verification.
2. Only the patient can push the button.
36
“Triptans- medications used for headaches:” -Sumatriptan
MOA, Uses:
1. MOA: serotonin agonist- induce vasoconstriction of extracranial arteries
2. Uses:
Migraine, headache
P Pulsative quality
O One day duration
U Unilateral direction
N Nausea/vomiting
D Disabling intensity
Cluster, headache
Excruciating pain is generally situated around one eye.
“Lancinating pain”
No non-headache symptoms
Lasts 5 min-3 hrs.
Other symptoms on affected side
37
“Triptans- medications used for headaches:” -Sumatriptan
Administration, SEs/ADRs:
1. Administration: oral, SQ, intranasal
2. SE/ADRs: pg. 310
o Dizziness
o Drowsiness
o Flushing
o Blurred vision
o Pruritis (itchy skin)
o Hypotension
o Hypertensive crisis
o Angina (chest pain)
o Bradycardia
o Tachycardia
o Thrombus
o Seizures
o Hearing loss (2 triptans)
38
“Triptans- medications used for headaches:” -Sumatriptan
Contradictions:
o Uncontrolled hypertension
o History of stroke
o MI (heart attack)
o CAD (coronary artery disease)
39
“Triptans- medications used for headaches:” -Sumatriptan
Interactions:
o SSRIs
o St. John’s Wort – combination may lead to serotonin syndrome: too much serotonin stimulating basal ganglia--> tachycardia, hyperthermia, agitation, tremors, muscle rigidity….
40
CNS stimulant indications
Indications include treatment of ADHD, reduce narcolepsy, appetite control. Ex/methyl phenolate
41
ADHD
Characterized by inattentiveness, hyperactivity, and/or impulsivity that results in difficulty functioning in at least two settings (home/school). Symptoms must be present over 6 months.
Stimulants play a prominent role in therapy.
o Why?
Thought is that there’s a deficiency of dopamine. Dopamine increases focus/concentration.
42
Narcolepsy
A disorder of REM sleep in which the patient will complain of excessive daytime sleepiness, often accompanied by sleep attacks and sudden loss of muscle tone (cataplexy).
Diagnosis: symptoms present greater than 3 months.
43
Stimulant- Methylphenidate
a CNS stimulant
44
Stimulant- Methylphenidate
MOA, Use:
1. MOA: increased levels of catecholamines (dopamine and norepinephrine). Dopamine and norepinephrine increase focus and wakefulness.
2. Use: treatment of ADHD, management of narcolepsy
45
Stimulant- Methylphenidate
SEs/ADRs:
o Tachycardia
o Anxiety
o Headache
o Sweating
o Insomnia
o Weight loss (monitor 2x/week)
o Increased risk of stroke
o MI (heart attack)
o Arrhythmias
o Hypertension -contraindicated in clients with cardiac abnormalities.
o Psychotic symptoms -hallucinations, delusions, mania.
46
Stimulant- Methylphenidate
Administration, Interactions:
1. Administration:
o Give 30-45 mins before breakfast/lunch, this helps increase absorption.
o DO NOT take it in the evening.
2. Interactions:
o MAOIs
o Antihistamines
o Haloperidol
o Caffeine
o Dec effects of antihypertensives
o AVOID CAFFINE & ALCOHOL
47
Seizure
Characterized by abnormal electrical activity in the brain. Epilepsy is a chronic condition of recurrent seizures.
Characteristics: depends on type
Underlying cause may be idiopathic, or provoked by stroke, infection, metabolic causes, drugs and alcohol.
48
Anti-seizure drugs- how do they work?
1. Decrease excitatory neurotransmitters.
2. Increase inhibitory neurotransmitters.
49
Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
MOA, Use, Therapeutic level:
2. MOA: decrease excitation, enhance inhibition
3. Use: Prevent seizures- especially tonic-clonic
4. Therapeutic level: 10-20 mcg/ml
50
Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
SEs/ADRs:
o Hyperglycemia
o Headache
o Dizziness
o Confusion
o Gum hyperplasia (overgrowth)
o Thrombocytopenia (low levels of platelets)
o Leukopenia (low levels of WBCs)
o Hepatic injury
o Stevens Johnson Syndrome
o Teratogenicfetal malformations
o Suicidal ideation
o Depression
51
Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
Precautions:
o Impairs Vit D metabolism-->decrease absorption of calcium-->increased risk of osteoporosis-->increased risk fractures.
o DO NOT STOP SUDDENLY status epilepticus.
o Impairs folic acid absorption.
52
Anticonvulsants/Anti-seizure-
Hydantoins: Phenytoin
Administration, Interactions:
1. Administration: capsules, suspension, IV infusion no more than 50 mg/min
2. Typical Scenario:
Pt seizing- give benzo, then follow up with 1 gm of IV phenytoin to prevent seizure recurrence.
3. Interactions:
o dec effect of anticoagulants
o dec efficiency of OCPs (birth control)
53
Anticonvulsants/Anti-seizure-Valproid Acid
MOA, Uses:
1. MOA: dec excitation
2. Uses:
o Seizures (any type except absence)
o Broad spectrum, very effective
54
Anticonvulsants/Anti-seizure- Valproid Acid
SEs/ADRs:
o CNS depression
o Sedation
o Respiratory depression
o Hepatoxicity
55
Anticonvulsants/Anti-seizure- Valproid Acid
Valproid acid and pregnancy:
HIGHLY teratogenic! Exposure in utero is associated with major malformations. AVOID in pregnancy.
56
Anticonvulsants/Anti-seizure- Valproid Acid
Monitoring:
o Therapeutic level: 50-125 mcg/ml
o Risk for hepatotoxicity
- base line LFTs before starting and at frequent intervals thereafter, especially during the 1st six months.
57
Anticonvulsants/Anti-seizure- Valproid Acid
Precautions. Interactions:
1. Precautions: DO NOT SUDDENLY STOP TAKING! will lead to status epilepticus
2. Interactions: CNS depressants
58
Anticonvulsants/Anti-seizure-
Benzodiazepines:
“BB”- benzos break seizures. Ex/ diazepam, lorazepam, midazolam.
59
Anticonvulsants/Anti-seizure-
Benzodiazepines:
Uses, Administration:
1. Uses:
o Acute seizures
o Status epilepticus
2. Administration: give slowly to avoid respiratory depression
o Lorazepam IV
o Diazepam IV/PR (parenteral route)
o Midazolam IV, IM, intranasal
60
Anticonvulsants/Anti-seizure-
Phenobarbital
Barbiturate-oldest anti-seizure drugs, use is limited because of its sedating effects.
61
Anticonvulsants/Anti-seizure-
Phenobarbital
MOA, Uses:
1. MOA: decrease excitation
2. Uses: still first line agent in children and neonates, status epilepticus in adults
62
Anticonvulsants/Anti-seizure-
Phenobarbital
SEs, ADRs:
1. SEs: CNS depression, sedation
2. ADRs:
o Apnea
o Hyperventilation
o Hypotension
o Bradycardia
o Coma
63
Anticonvulsants/Anti-seizure-
Phenobarbital
Monitor: Therapeutic level
10-40 mcg/mL, over 40 lethal range
64
Anticonvulsants/Anti-seizure-
Phenobarbital
Precaution, Interactions:
1. Precaution: cannot be abruptly discontinue, taper to avoid withdrawal
2. Interactions: decrease efficacy of OCPs, corticosteroids, theophylline, CNS depressants
65
Psychosis
Broadly defined as loss of contact with reality, increased risk of harm to self and others.
Etiology: too much dopamine
Causes:
o Feature of psychiatric disorders
o Substance abuse
o Underlying medical disease
66
Schizophrenia
A psychiatric disorder involving chronic or recurrent psychosis.
Onset of illness: adolescence or early adulthood
Positive symptoms: reality distortion symptoms such as hallucinations or delusions.
Negative “deficit” symptoms:
o Decreased expressiveness
o Apathy
o Lack of energy
o Cognitive impairment:
* Attention
* Memory
* Learning
* Reasoning is affected.
67
EPS (Parkinson-type movements)-
most significant ADR of antipsychotics, particularly typicals (Haloperidol).
o Etiology: due to blockage of dopamine-->Parkinson’s type symptoms:
* Tremors
* Masked facies
* Rigidity
* Shuffling gait
* Dystonia (muscle spasms)
* Akathisia (restlessness)
* Tardive dyskinesia (irreversible- involuntary movements of face and jaw)
68
EPS (Parkinson-type movements)
Treatment:
* Anticholinergics
* Diphenhydramine
* Benztropine
* Switch to atypical
69
NMS (neuroleptic malignant syndrome)
Potentially lethal
MEDICAL EMERGENCY
Directly caused by antipsychotics
Cause: unknown? Dopamine receptor
Blockade-->destabilization of sympathetic nervous system
70
NMS (neuroleptic malignant syndrome)
Signs and Symptoms:
o MS (mental status) changes
o Muscle rigidity
o Increased fever -over 40 C
o Severe hypo/hypertension
o Seizure activity
o Tachycardia
o Tachypnea
71
NMS (neuroleptic malignant syndrome)
Treatment:
o Immediate withdrawal of antipsychotic
o Hydration
o Cool blankets
o Benzos if seizure develops.
72
Antipsychotic: Haloperidol
typical antipsychotic
73
Antipsychotic: Haloperidol
Uses:
o Psychotic disorder
o Acute agitation
o Movement disorders:
* Huntington’s disease-->attacks areas of the brain that control voluntary movement.
* Tourette’s syndrome-->tics/twitches
74
Antipsychotic: Haloperidol
SEs:
o Drowsiness
o Headache
o Photosensitivity
o Urinary retention
o Sexual dysfunction
o Orthostatic hypotension
75
Antipsychotic: Haloperidol
ADRs:
o EPS (Parkinson-type movements- twitches, jerks, twisting or writhing movements) and
o NMS (neuroleptic malignant syndrome- a life-threatening idiosyncratic reaction to antipsychotic drugs)
76
Antipsychotic-Atypicals~Aripiprazole
Used for long term treatment of psychosis, also used for depressive symptoms.
77
Antipsychotic-
Atypicals~Aripiprazole
MOA, teaching
1. MOA: block dopamine and serotonin.
2. Teach pt that initial improvement may be seen in 1-2 weeks but takes 4-6 weeks to achieve full effect.
78
Antipsychotic- Atypicals~Aripiprazole
Uses:
o Bipolar disorder
o Major depressive disorder
o Schizophrenia
o Tourette’s
o Autistic disorder
79
Antipsychotic- Atypicals~Aripiprazole
SEs:
o Restlessness or sedation
o Hyperglycemia
o Dyslipidemia (abnormal cholesterol)
o Photosensitivity
o Sexual disfunction
o Weight gain
80
Antipsychotic- Atypicals~Aripiprazole
ADRs:
o Low possibility of EPS/NMS
o Hematologic abnormalities:
o Neutropenia
- Recommendations: check CBC frequency within first few months of therapy
- Teach pt to report signs and symptoms of infection.
81
Anti-depressant groups
o Selective serotonin reuptake inhibitors (SSRIs)
o Serotonin-norepinephrine reuptake inhibitors (SNRIs)
o Tricyclic antidepressants (TCAs)
o Monoamine oxidase inhibitors (MAOIs)
82
Anti-depressants and mood stabilizers theory
Theory- due to abnormal levels of serotonin, norepinephrine, and dopamine.
83
Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
1st line therapy for depressive symptoms/anxiety disorders.
84
Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
MOA:
Increase availability of serotonin
85
Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
Uses:
o Depression
o Bipolar 2 disorder
o Dysthythia (persistent depression)
o Anxiety disorders
o Bulimia
86
Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
SEs:
o Sedation
o Sexual dysfunction
o Diarrhea
87
Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
ADRs:
o Hyponatremia
o Seizures
o Suicidal ideation
88
Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
Contradictions:
o Allergy
o Hypersensitivity
89
Anti-depressants-
SSRIs (Selective serotonin reuptake inhibitors): Fluoxetine
Interactions:
o Triptans
o MAOIs
o St. John’s Wort
90
Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
MOA:
Increases levels of serotonin and norepinephrine
91
Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
Uses:
o Depression
o Anxiety
o Chronic pain
92
Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
SEs:
o Nausea
o Sweating
o Loss of appetite
o Drowsiness or insomnia
o ED (erectile dysfunction)
93
Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
ADRs:
o Hypertension or orthostatic hypotension
o Suicide ideation (adolescence- early 20s)
o Seizures
o NMS (rare) pg. 271
94
Anti-depressants-
SNRI’s (Serotonin-norepinephrine reuptake inhibitors): Desvenlafaxine
Contraindications/ Interactions:
o Hypersensitivity
o MAOIs
o Linezolid
95
Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
Original therapy for depression long ago. Fallen out of favor. HIGH MORTALITY IN OVERDOSE.
96
Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
MOA:
Similar to SNRIs, increased serotonin and norepinephrine
97
Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
Uses:
o Depression
o Bedwetting
o OCD (obsessive compulsive disorder)
o Fibromyalgia
o Neuropathic pain
98
Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
SEs:
o Sedation
o Postural hypotension (common)
o Urinary retention
o Dry mouth
o Weight gain
99
Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
ADRs:
o Seizures
o Respiratory depression
o Arrhythmias
100
Anti-depressants-
TCAs (Tricyclic antidepressants)-Amitriptyline
Precautions, Interactions:
1. Precautions:
o Use with caution in pts with a history of cardiovascular disease.
2. Interactions:
o MAOIs
o CNS depressants
101
Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
RARELY USED for depression due to risk of hypertensive crisis (a sudden, severe increase in blood pressure 180/120 or greater) when taken with tyramine rich foods and certain medication (stimulant meds). -used when nothing else works.
102
Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
Action:
o MAO -degrades serotonin, norepinephrine and dopamine.
o MAOIs – prevent breakdown of these neurotransmitters.
103
Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
Uses:
o Depression
o Parkinson’s disease (caused by not enough serotonin)
104
Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
SEs:
o Dizziness
o Drowsiness
o Headache
o Dry mouth
o Constipation
o Weight gain
o Sexual side effects
105
Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
ADRs:
o Hypertensive crisis resulting from drug and food interactions.
- MAO normally breakdown tyramine (sympathomimetic-raises heart rate, blood pressure)
106
Anti-depressants-
MAOIs (Monoamine oxidase inhibitors)-Phenelzine
Interactions:
Foods that contain tyramine--
Aged (Swiss, parmesan, blue cheese) and fermented (sauerkraut, yogurt, soy sauce, no Asian food)
Processed meats (salami, pepperoni)
Pickled foods (kimchi)
Alcohol
Drugs--
CNS stimulants
Sympathomimetics
Cold medications
Other antidepressants
Drug-Herb pg 271--
Ginseng
Ephedra
St. Johns Worts
Brewer’s yeast (makes beer)
Anise
107
Mood stabilizer- Lithium
1st drug of choice for any of the bipolar disorders.
108
Mood stabilizer- Lithium
MOA:
o Decrease dopamine (dec excitation)
o Inc serotonin (happy hormone)
o Dec norepinephrine (stress hormone)
o Therapeutic effect: mood stabilization
109
Mood stabilizer- Lithium
Uses:
o Mania with bipolar disorder
o Mood stabilizer
110
Mood stabilizer- Lithium
SEs:
o GI upset
o Muscle weakness
o Tremors
o Memory loss
o Confusion
o Weight changes
o Polyuria
o Dehydration
111
Mood stabilizer- Lithium
ADRs:
o Hypotension
o Dysrhythmias
o Seizures
o Hyponatremia
o Nephrotoxicity
112
Mood stabilizer- Lithium
Contraindications:
o HIGLY TERATOGENIC – do not use during pregnancy.
o Keep drug levels below 1.5 meq/L
113
Mood stabilizer- Lithium
Interactions:
o NSAIDs
o Haldol increases lithium levels.
114
Mood stabilizer- Lithium
Pt teaching:
o Stay hydrated. Maintain a high level of hydration- 2-3 L/day initially, 1-2 L/day maintenance.
Dehydration-->lithium toxicity
o Drinking alcohol is not recommended.
o Take with food to decrease GI upset.
o Wear medical alert bracelet.
NUR 210 Pharm
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