1
Q
Which prototype treats anxiety that is a sedative hypnotic anxiolytics?
A
Benzodiazepines - Alprazolam
2
Q
what is the route for alprazolam?
A
PO
- immediate
- ER Tablets
- Disintegrating Tablets
- Oral Solutions
3
Q
what does alprazolam do for its MOA?
A
Act by binding to the GABA receptor inhibing the CNS
4
Q
Is alprazolam short term or long term therapy for anxiety?
A
Short Term
5
Q
What does alprazolam treat?
A. Anxiety and panic disorders
B. DVT
C. PTSD
D. MI
E. Insomnia
F. DM
G. OCD
A
A. Anxiety and panic disorder
C. PTSD
E. Insomnia
G. OCD
- Generalized anxiety
- Panic Disorders
- Social anxiety
6
Q
what are contraindications of alprazolam?
Hint: what does alprazolam tx? Anxiety
A
A. pregnancy and lactation
C. sleep apnea
D. respiratory depression
F. glaucoma
7
Q
why is short term use used for alprazolam?
A
risk of dependence
8
Q
What are some drug interactions with alprazolam?
List 4
A
B. CNS depressants
- antihistamines
- anti-convulsants
- increase CNS depression
C. Grapefruit juice
E. Alcohol (reduces metabolism)
F. Smoking (decreases effect)
9
Q
What type of drug is alprazolam? control substance act?
A
Schedule IV
10
Q
What kind of dependence does alprazolam cause?
A
physical and psychological dependence
11
Q
Does alprazolam (XANAX) cause CNS depression?
A
YES
12
Q
What kind of amnesia occurs with alprazolam?
A
Aterograde (difficulty recalling events that occur after meds taken)
13
Q
what happens with alprazolam PO toxicity? (SATA)
A. EPS
B. Drowsiness
C. Lethargy
D. Confusion
E. Constipation
F. GI bleeds
A
Drowsiness
lethargy
confusion
14
Q
how to treat alprazolam PO toxicity?
A
gastric lavage
- also known as stomach pumping, is a medical procedure to remove stomach contents by inserting a tube to flush the stomach with water
15
Q
what happens with alprazolam IV toxicity?
A
Respiratroy depression
cardiac arrest
16
Q
how to treat IV toxicity ?
A
FLUMAZENIL is Antidote (Tx: Benzodiazepines overdose)
17
Q
what is alprazolam’s complication of pradoxical response about? (SATA)
A. insomnia
B. sweating
C. agitation
D. hyperreflexia
E. euphoria
F. Anxiety
G. Rage
A
insomnia
agitation
euphoria
anxiety
rage
18
Q
If you don’t taper off, what can happen when you get off of alprazolam?
A
withdrawal effects
19
Q
what do you need to monitor for alprazolam?
what is a caution you need to take for alprazolam?
A
V/S
- hypotension
- tachycardia
- respiratory depression
older adults
liver dz,
History of mental illness and substance abuse
20
Q
when should you take alprazolam?
A
bedtime because of sedation
21
Q
Do you want to take alprazolam with or without food?
A
Take with meals for GI upset
22
Q
What should you educate your patient regarding alprazolam?
A
dependency
23
Q
where should you keep alprazolam?
A
secure place due to their abuse potential
24
Q
what is something that can happen at the beginning when youre taking alprazolam?
A
rebound insomnia
25
What kind of diet should you have for alprazolam?
Avoid high fat foods because it decreases absorption
25
How should you get off of alprazolam?
TAPER OFF
26
what is the class for alprazolam?
sedative hypnotic anxiolytics: BENZODIAZEPINES
27
stopping abruptly for alprazolam can cause what?
seizures
27
what is the main prototype that treats depression?
fluoxetine
28
what is the class for fluoxetine?
selective serotonin reuptake inhibitors (SSRI)
29
What is fluoxetine (PROZAC) route?
PO
- immediate release caps
- sustained release caps
30
What is the MOA of fluoxetine?
selectively inhibits the reuptake of serotonin in the CNS
(serotonin activity increases!!!)
30
What is fluoxetine used for?
A. bronchospasms
B. major depression
C. OCD
D. Bulemia
E. Premenstrual dysphoric disorder
F. baldness
G. Panic disorders
H. PTSD
I. Social anxiety and generalized anxiety
J. Autism
**major depression
OCD
Bulemia
Premenstrual dysphoric disorder
panic disorders
PTSD
Social anxiety disorder
Generalized anxiety disorder
ASD**
NOT: bronchospasm
NOT: baldness
31
What do you need to assess for fluoxetine that could be dangerous?
suicide risk
31
how long to reach full therapeutic effect for fluoxetine?
3 months
31
What is a complication for fluoxetine (prozac) regarding sexual aspect?
sexual dysfunction
32
Do you need to taper off fluoxetine?
yes
33
how long does typical tx last for fluoxetine?
6 months after resolution of symptoms of depression (can be a year or longer)
33
What is a complication of fluoxetine?
A. EPS
B. CNS Stimulant
C. Amnesia
D. bronchospasms
B. CNS Stimulant
34
What is with weight gain and loss for fluoxetine?
Weight loss early on
Weight gain with long term
35
What is a complication for fluoxetine (Prozac)? (SATA)
A. Hypernatremia
B. Serotonin syndrome
C. Rash
D. Bruxism (teeth grinding)
E. osteoporosis
F. sleepiness and faintness
G. Withdrawal syndrome
H. Constipation
I. GI bleeding
A - not hypernatremia (HYPOnatremia)
B. Serotonin syndrome
C. Rash
D. Bruxism (Teeth grinding) - need mouth guard
F. Sleepiness and faintness
G. Withdrawal syndrome
I. GI bleeding
36
SHIVERS (serotonin syndrome mnemonic)
S - Seizures
H - Hyperreflexia (Exaggerated reflex)
I - Increased temperature (Fever)
V - V/S instability (tachycardia, labile BP)
E - Eyes dilate (mydriasis)
R - Restlessness (agitation)
S - Sweating (diaphoresis)
37
what is the first line of treatment for depression?
fluoxetine (prozac)
37
what is the drug for this contraindications for:
in late pregnancy
kidney dysfunction
liver dysfunction
cardiac diseae
seizures
diabetes
ulcers
GI bleeding
Fluoxetine
38
D/D interaction for fluoxetine (SSRI)
A. MAOI
B. TCA
C. St. John's Wort
D. Warfarin
E. Aspirin
F. insulin
G. NSAIDs and anticoagulants
H. Lithium
MAOI
TCA (tricyclic antidepressants)
st. john's wort
warfarin
NSAIDs and anticoagulants
lithium
39
what do you want to assess for fluoxetine?
Hint: what does fluoxetine treat?
suicide risk
39
what baseline do you want to monitor for older adults taking diuretics with fluoxetine?
sodium
40
when should you take fluoxetine the medication?
in the morning
40
do you want to take with or without food for fluoxetine?
YES with food
41
what kind of drink/ food should you avoid with fluoxetine?
caffeine
42
what happens if you abruptly stop fluoxetine?
dizziness, vertigo, ataxia, nausea, vomiting, muscle pain, headache
43
what should you do if you want to stop fluoxetine?
TAPER OFF
43
What happens if you take NSAIDs and anticoagulants with fluoxetine?
increase risk of bleeding and platelet aggregation
44
What drug prototype is used to treat bipolar disorder?
Lithium carbonate
45
what is the class for lithium carbonate?
mood stabilizer
46
when can serotonin syndrome start with fluoxetine?
2-72 hrs after start of tx
47
why is late pregnancy a contraindication for fluoxetine?
it can cause pulmonary hypertension in the newborn
48
What happens with fluoxetine if you take lithium and tricyclic antidepressants?
increase levels
48
What is lithium carbonates MOA?
changes the transport of sodium ions in nerve cells
this alters the metabolism of catecholamines used in response to stress
IT DECREASES MANIA ASSOCIATED WITH BIPOLAR
48
what is the use for lithium carbonate?
Bipolar
acute mania and prevent return of mania or depression
(prophalactically to prevent depression)
49
Is lithium carbonate monotherapy or used with other drugs?
BOTH
50
What drug is complications that could happen with this:
GI distress
Fine hand tremors
polyuria, thirst (maintain PO intake of 1500-3000mL)
weight GAIN
lithium toxicity
renal toxicity
Goiter/ hypothyroidism with long term treatment
Fluid and electrolyte imbalance
Lithium carbonate
51
what toxicities occur with lithium carbonate?
lithium toxicity
renal toxicity
52
what can happen with long term tx of lithium carbonate?
goiter / hypothyroidism
53
what are contraindications for
pregnancy and lactation
renal dysfunction
heart disease
dehydration
thyroid disease
seizures
DM
Lithium carbonate
54
What is the drug with some D/D with diuretics - sodium loss
NSAIDs - increase renal absorption --> lithium toxicity
Anticholinergics - urinary retention
Lithium carbonate
55
What fluid intake do we need to maintain with lithium carbonate?
PO intake of 1500-3000mL
56
what does lithium act like so it can cause lithium toxicity?
Sodium
57
what to monitor for lithium carbonate nursing interventions?
monitor serum lithium levels
58
how often do you want to monitor lithium levels for lithium carbonate?
Every 2-3 days after starting the meds
59
when do you monitor lithium carbonate?
at any dosage change
every 3-6 months after stable
60
What is the maintenance level range for lithium carbonate?
0.6-1.2mEq/L
61
What level must it pass to result in lithium toxicity for lithium carbonate?
1.5
62
does following up with HCP matter with lithium carbonate?
YES, stress follow up
63
What should you do for nutritional counseling for lithium carbonate?
maintaining adequate intake of fluid and sodium
64
how much should you drink for lithium carbonate?
1500-3000 mL of fluid
65
What in excess can cause lithium toxicity for lithium carbonate?
sweating or diarrhea
66
should you take lithium carbonate with food and milk?
YES
67
what is the early indicator level for lithium toxicity in lithium carbonate?
1.5-2.0mEq/L
68
What are s/sx of early indicators of lithium toxicity with lithium carbonate?
ongoing GI distress
mental confusion
poor coordination
coarse tremors
sedation
69
what is a client education for early indicator of lithium toxicity for lithium carbonate?
withhold med if experiencing s/sx and notify HCP
70
What is the level of lithium in advanced indicators of lithium toxicity? (lihtium carbonate)
2.0-2.5 mEq/L
71
What are s/sx of advanced indicators of lithium toxicity?
polyuria - extreme with dilute urine
involuntary extremity movement
blurred vision
tinnitus
seizures
hypotension - severe leading to death from respiratory complications
72
what can severe hypotension lead to with advanced indicators of lithium toxicity?
death from respiratory complications
73
what is a treatment that may need to be prescribed for advanced lithium toxicity?
whole bowel irrigation
74
what is the lithium level for severe toxicity of lithium?
greater than 2.5 mEq/L
75
What are s/sx of severe lithium toxicity of lithium carbonate? (SATA)
A. oliguria
B. polyuria
C. seizures
D. rapid progression of symptoms
E. blurry vision
F. hypothyroidism
oliguria
seizrues
rapid progression of symptoms leading to coma and death
76
what is a treatment for severe lithium toxicity?
hemodialysis
77
how often do you take lithium carbonate?
2-3 times daily
78
What is a drug to treat psychotic disorders prototype?
Chlorpromazine
79
What is the class for chlorpromazine?
Antipsychotic: 1st generation (conventional)
80
What is the route for chlorpromazine?
IV, IM, PO
81
What does chlorpromazine (Thorazine) mainly treat?
Schozophrenia
82
What is the MOA for chlorpromazine?
alters the effect of dopamine in the CNS, blocks several CNS and non CNS receptors to block symptoms
83
what are the uses for chlorpromazine?
acute and chronic psychotic disorders
schizophrenia
agitation
84
Does chlorpromazine cure the mental illness schizophrenia?
NO
85
what does chlorpromazine do to the dopamine in the CNS
it supresses dopamine
86
What are contraindications for chlorpromazine?
coma
severe depression
prakinsons
severe hypotension
older clients with dementia
87
What are D/D interactions for this drug:
anticholinergic
cns depressants
alcohol
levodopa
Chlorpromazine
88
Is clients in a coma contraindicated with chlorpromazine?
YES
89
Are clients with severe depression a contraindication for chlorpromazine?
YES
90
is parkinsons disease a contraindication for chlorpromazine? (thorazine)
YES
91
is severe hypotension a contraindication with chlorpromazine?
YES
92
is severe hypertension a contraindication with chlorpromazine?
NO
93
are older clients with dementia a contraindication with chlorpromazine?
YES
94
what medication causes this side effect?
**EPS**
* **Acute dystonia:** spasms of the neck, tongue, face or back. Requires immediate tx: with benzotropine!!
* **Prakinsonism:** shuffling gait, drooling, tremors
tx: benztropine or diphenhydramine
* **Akathisia:** continuous pacing and agitation
Manage with beta blocker
* **Tardive Dyskinesia (TD):** Lip smacking, involuntary tongue movements
**Severe dysthrythmias**
**Liver impairment**
**Seizures**
**Photosensitivity**
**Neuroleptic malignant syndrome** life-threatening (Sudden high fever)
Chlorpromazine
95
what do you administer with Neuroleptic malignant syndrome ?
dantrolene
96
What do you do if you have NMS?
Stop med, apply cooling blankets
administer dantrolene
97
What medication can result in the complication Neuroleptic Malignant Syndrome?
chlorpromazine
98
What do you do when you get anticholinergic effects as a complication from chlorpromazine?
push PO 1.5-3L fluids
99
what medication has the complication of neuroendocrine effects: gynecomastia?
chlorpromazine
100
what medication has the complication:
- sedation
- sexual dysfunction
- agranulocytosis
- photosensitivity
- seizures
- severe dysrhythmias
- liver impairment
chlorpromazine
101
what is the antipsychotic 1st generation medication? what does it treat?
Chlorpromazine; schizophrenia
102
what drug blocks dopamine in the CNS, acetylcholine, histamine, norepinephrine receptors in the brain to blocks symptoms?
Chlorpromazine
103
what can low doses of chlorpromazine be also used as?
antiemetic
104
What things can chlorpromazine also treat besides psychotic disorders, agitation, and schizophrenia?
1. bipolar disorders
2. tourette syndrome
3. prevention of N/V
105
what is the mneumonic for FARM for neuroleptic malignant syndrome?
Fever
Autonomic changes
Rigidity of muscles
Mental status altered
106
For neuroletpic malignent syndrome that you can get with chlorpromazine, what does autonomic changes mean?
checking vital signs for BP, HR and weating
107
What do you do for rigidity of muscles for neuroleptic malignent syndrome that you can get with chlorpromazine?
administer dantrolene
108
What kind of agonist is dantrolene sodium?
dopamine
109
how do you check for agranulocytosis?
serum lab levels for infection
110
what is this condition called:
spasms of the neck, tongue, face or back. Requires immediate tx
Tx: benzotropine
acute dystonia from EPS
111
what are the four major movement disorders of EPS?
1. acute dystonia
2. akathisia
3. Parkinsonism
4. tardive dyskinesia
112
what movement disorder thats part of EPS is: shuffling gait, drooling, tremors.
Tx: benzotropine or diphenhydramine
Parkinsonism
113
what movement disorder from EPS is:
continuous pacing and agitation
Manage with beta blocker
Akathisia
114
what movement disorder from EPS is: lip smacking, involuntary tongue movements?
Tardive dyskinesia
115
how long can the complication orthostatic hypotension last for chlorpromazine?
2-3 months
116
does chlorpromazine affect the kidney or liver?
liver impairment
117
What are the contraindications of chlorpromazine
Coma
Severe depression
Parkinson’s
Severe hypotension
Dementia
118
what drug is contraindicated with these sets of drugs:
Anticholinergic meds (increase effects)
CNS depressants (Additive)
Levodopa
St. Johns wort
Chlorpromazine
119
what drug would this nursing administeration be useful for for CNS? Use the abnormal involuntary movement scale (AIMS) to screen for presence of EPS
chlorpromazine
120
What drug would the nursing administration, start PO dosing BID then switch to QD ,take HS (at night) to decrease daytime drowsiness and promote sleep be good for in CNS?
Chlorpromazine
121
What drug would the nursing administration: to control early EPS, administer anticholinergics, beta-blockers, and benzodiazepines be good for in CNS?
chlorpromazine
122
what medication would you start PO doising BID then switch to QD at HS to decrease daytime drowsiness and promote sleep in CNS?
chlorpromazine
123
what med would you educate: will notice some effects within a few days but full therapeutic effect can take up to 4 weeks be for and avoid alcohol?
chlorpromazine
124
what drug would the education: antipsychotic medication do not cause addition and think safety be useful for that has a complication of EPS, severe dysrhythmias, liver impairment, seizures, sedation, and sexual dysfunction?
chlorpromazine
125
what is the prototype for this classification: central nervous stimulants?
Methylphenidate (Ritalin)
126
what med would you use to treat ADHD, Narcolepsy, and obesity?
methylphenidate
127
what drug raises levels of norepi and dopamine in the CNS?
methylphenidate
128
what is the route for methylphenidate?
PO or transdermal
129
what drug can cause these complications?
CNS stimulation (insomnia, restlessness)
decreased appetite, weight loss
Cardiovascular effects (dysrhythmias, HTN, chest pain)
Development of psychotic manifestations (hallucinations and paranoia)
Physical tolerance (Taper medication)
Rash and hives
methylphenidate
130
what would you administer if you get toxicity from methylphenidate?
diazepam
131
what kind of drug is methylphenidate that needs to be locked up/
Schedule II
132
Which drug has contraindication and precaution is true for
A. Pregnancy and lactation
B. history of substance abuse
C. HTN
F. Hyperthyroidism
G. Cardiovascular disorders
H. Glaucoma
J. Severe anxiety
K. Psychosis
methylphenidate
133
when should you take methylphenidate?
Morning AM
134
if you develop psychotic manifestations like hallucination from taking methylphenidate, what is a treatment for that?
Chlorpromazine
135
is MAOI a drug interaction with methylphenidate?
YES, can cause hypertensive crisis
136
Is phenytoin, warfarin, and phenobarbital drug interactions with methylphenidate?
YES
137
is caffeine a drug interaction with methylphenidate?
YES
138
is glucocorticoids a drug interaction with methylphenidate?
NO
139
how should you take the med methylphenidate?
regular intervals
140
what is an instruction for transdermal form with methylphenidate?
place 1 on hip daily in AM and alt site before 9 hours
141
do you need to TAPER methylphenidate?
YES
142
For toxicity of methylphenidate, what do you treat hallucinations with? what about seizures?
Hallucinations - chlorpromazine
seizures - diazepam
Administer fluids
143
what are these signs indicating?
tremors "pill rolling."
muscle rigidity
bradykinesia
postural instability
affective flattening
parkinsons disease
144
What is the term that describes difficulty chewing, swallowing, speaking? Shuffling feet is common
bradykinesia
brady = slow
kinesia = movement
145
what is a term that describes walking stooped over, loss of balance
postural instability
postural = relating to posture
(impaired balance)
146
what is the term that describes this: "masked face" little facial expression or blinking of the eyes
Affective flattening
Affective = emotion/ expression
flattening = reduced
reduced emotional expression
147
what is the prototype for the chronic neurologic disorder that is anti-parkinson's med
levodopa/ carbidopa
148
what is this drug: carbidopa increases levodopa by decreasing the amount of levodopa that converts to dopamine in the intestines and periphery, resulting in more levodopa reaching the CNS.
levodopa/carbidopa
149
is pregnancy and lactation contraindicated with methylphenidate?
YES
150
what is the route for levodopa/ carbidopa?
PO
151
should you take levodopa/carbidopa with food?
YES
152
Should you take levodopa/carbidopa on an empty stomach?
NO
153
What is levodopa/carbidopa used for ?
Parkinsons disease
But beneficial effects diminished by the end of year 5
154
what is the purpose of levodopa/carbidopa?
relief of symptoms and increase ADL ability
155
what drug do these adverse effects belong to ?
typically dose dependent:
N/V, drowsiness
dyskinesias (head bobbing, tics)
--> decrease dose
OH (orthostatic hypotension)
Cardiovascular effects
psychosis
--> admin 2nd gen antipsychotic
Discoloration of sweat and urine
Activation of malignant melanoma
Levodopa/ carbidopa
156
Does levodopa/carbidopa need to be TAPERED?
YES
157
What happens if you have a high proteins meal and snack with levodopa/carbidopa?
delays absorption and can reduce the therapeutic effect
158
How long can full therapeutic effect take for levodopa/ carbidopa?
several months, 6 months or more
159
Do you need to avoid with pregnancy for levodopa/ carbinopa?
YES
160
What happens if you take anticholinergic drugs with levodopa/carbinopa?
increase anticholinergic effects
161
what happens if you take MAOI with levadopa/carbadopa?
risk of severe hypertensive crisis
162
what does MAOI do?
MAO (monoamine oxidase is the enzyme responsible for inactiviating (breaking down) norepi, dopamine, and serotonin. When MAOI block this enzyme, the levels of these NT increase in the body
163
What happens with MAOI and dopamine for levodopa/carbidopa?
the excess dopamine created from the levodopa cannot be broken down quickly enough. There is a lethal buildup of catecholamines leading to severe vasoconstriciton, dangerous blood pressure elevation and cerebral vascular accident.
164
When should MAOI's be discontinued for levodopa/ carbidopa?
2 weeks
165
what is the prototype medication for traditional antiepileptic medications (2 meds)
Phenytoin
carbamazepine
166
what are the 2 types of partial seizures?
Simple partial
Complete partial (psychomotor)
167
which type of partial seizure is this:
olfactory, auditory, and visual hallucinations
intense emotions
twitching or arms, legs and face
simple partial
168
what type of parital seizure is this:
- aura (preceding)
- breif period of confusion with no memory of seizure
- fumbling with clothing
- no response to verbal commands
complete partial (psychomotor)
169
what is the 3 types of generalized seizures?
1. Absent (petit mal)
2. Myoclonic
3. Tonic-clonic (grand mal/generalized)
170
which generalized seizure is this:
- lasts few seconds
- seen most in children
- often misdiagnosed as ADHD or daydreaming
Absent (petit mal)
171
which type of general seizure is this:
- large jerking movement of a major muscle group, such as an arm
- falling from a sitting position or dropping waht is held
myoclonic
172
what type of general seizure is this:
aura (preceding)
intense muscle contraction (tonic) followed by an alternating contraction and relaxation of muscles (clonic)
crying at the beginning as air leaves lungs, loss of bladder control, lasts 1-2 min
disorientation and deep sleep following seizures (postictal state)
tonic-clonic (grand mal / generalized)
173
what is AEDs
Anti-epileptids
174
what does phenytoin treat mainly?
seizures
175
what does carbamazepine treat mainly?
seizures
176
which drug is this: controls the movement of electrolyes across neuronal membranes, slowing neuron firing to decrease seizure activity
Phenytoin and Carbamazepine
177
what is phenytoin used for?
treat seizures
178
what is hydantoins?
phenytoin
179
what route is phenytoin ?
PO and IV
180
which antiepileptic complication are these:
CNS effects
gingival hyperplasia (gum tissue grows)
skin rash
cardiovascular effects (admin slowly IV no faster than 50 mg/min)
Endocrine effects (facial hair, hirsutism)
interference with vit K clotting factors casuing bleeding in newborns
phenytoin
181
what is use for carbamazepine?
its an anticonvulsant
for seizures
bipolar disorder
trigeminal and glossopharyngeal neuralgias (cranial nerve in pain)
182
what is the route for carbamazepine?
PO
183
what complication does this belong to:
CNS effect
blood dyscrasias
hypo osmolarity
skin disorders (steven johnsons syndrome, photosensitivity)
carbamazepine
184
what are CNS effects for antiepileptic drugs?
Hint: affects brain and spinal cord (there are 5 things, 1 thing is just a fact)
nystagmus (eyes moving around rhythmically)
headache
virtigo
double vision
staggering gate
cognition is still intact
185
Why should you avoid immunosuppressant drugs with antiepileptics?
phenytoin and carbamazepine can decrease blood cell production
leukopenia
thrombocytopenia
platelets
CBC
Monitor Bleeding!! (thrombocytopenia)
186
do AED affect birth control?
YES, use barrier method instead
187
With hypo-osmolarity of carbamazepine, what should you monitor?
since it inhibits water secretion
monitor for edema, a decrease in urine output, and hypertension
188
who is contraindicated to take phenytoin and carbamazepine?
1. pregancy: TERATOGENIC
2. IV phenytoin is contraindicated for patients who have HEART PROBLEMS
189
what should you educate patients on regarding AEDs and birth control and what to monitor?
Birth control decreases effectiveness and requires monitoring therapeutic plasma levels as prescribed
190
does the AED cure seizures?
NO, provides contorl of seizures
191
what should you encourage the patient to keep when taking AEDs?
seizure frequency daily
192
What will happen if you suddenly stop taking AED (Antiepileptic drugs: phenytoin and carbamazepine?)
triggur status epilepticus
193
what should you avoid doing with AEDS?
Avoid activities that require alertness until seizures are fully controlled and medication effects are known
194
how does warfarin affect carbamazepine?
Decreases the effects of warfarin
Carbamazepine stimulates hepatic drug-metabolizing enzymes.
Monitor INR and PT levels
195
How does grapefruit juice affect carbamazepine?
increases carbamazepine levels.
Grapefruit juice inhibits metabolism
196
what are d/d interaction with carbamezepine and phenytoin?
phenytoin and phenorarbital, oral contraceptives, warfarin, grapefruit juice, alcohol
197
what are the 3 misc cns med that are muscle relaxants and antispasmodics and benzodiazepines
centrally acting: diazepam
peripherally acting: dantrolene
Benzo: midazolam
198
what is the drug that enhances the inhibitory effects of GABA causing sedation?
midazolam (Versed)
199
what is the use of midazolam?
induction of anesthesia/ preoperative sedation
200
what do these complications belong to:
CNS depression
Paradoxical response (insomnia, excitation, euphoria, anxiety, rage)
N/V, anorexia
respiratory depression
acute toxicity (respiratory depression and cardiac arrest)
midazolam
201
what are the routes for carbamazepine
PO
202
what is the antidote for acute toxicity from midazolam?
flumazenil
203
What should you have available in case you have an acute toxicity with midazolam?
crash cart
204
what is the route for midazolam?
PO, IV, KM, and intranasal
205
what do these contraindications belong to:
sleep apnea
respiratory depression
organic brain disease
breast feeding clients
midazolam
206
what do these contraindications belong to:
use caution if history of substance abuse, liver dysfunction, kidney failure
adjust dose in older client
D/D interaction is other CNS depressants and opioids
This is a schedule IV drug
midazolam
207
is midazolam teratogenic or its it safe to take during pregnancy?
TERATOGENIC
208
what drugs interact with midazolam?
other CNS depressants and opioids
209
what class is midazolam belong to ?
benzodiazepines
210
what drug would be good to use preoperatively as an amnesiac?
midozelam
211
what is the class for diazepam?
centrally acting muscle relaxants
212
what is the route for diazepam?
PO, IV, IM
213
what is the drug that acts in the CNS by mimicking the actions of GABA at the receptor in the spinal cord and brain to produce sedative effects and depress muscle spasticity?
diazepam
214
What is diazepam used for?
muscle spasms r/t injury and spasticity
anxiety and panic disorders
insomnia
status epilepticus
alcohol withdrawal
anesthesia induction
215
do you need to TAPER diazepam?
YES
216
what are contraindication and precaution of diazepam?
pregancy and lactation
use caution with impaired liver and renal function
217
what happens with acute toxicity with diazepam for PO?
drowsiness
lethargy
218
how will you treat acute toxicity with diazepam?
gastric lavage
219
what is acute toxicity IV for diazepam?
respiratory depression, cardiac arrest
220
what is a treatement for IV acute toxicity of diazepam?
administer flumazenil (ANTIDOTE)
221
what is the drug interaction of diazepam?
CNS depressants
- alcohol
- opioids
- antihistamines
222
what medication do you want to educate to provide assistance PRN in self administration of medication and performance of ADL's and to take medication as prescribed. This medication will be used to treat anesthesia induction, alcohol withdrawal and muscle spasms
dantrolene
223
what is a complication of diazepam?
CNS depression (Start at low dose)
Physical dependence with long term use
224
what do you treat with IV dantrolene?
Malignant Hyperthermia followed by PO 1-2 days
225
what complication can occur while taking diazepam?
1. CNS depression -- start with low dose
2. physical dependence with long term use
226
who is contraindicated to take diazepam?
1. pregnancy and lactation
2. people with imparied liver and renal function
227
what peripherally acting muscle relaxant is the prototype drug to know?
dantrolene
228
what drug peripherally acting muscle relaxant that acts directly on spastic muscles, inhibiting contractions
suppress release of Ca ion from skeletal muscle for contraction
dantrolene
229
what are the routes for dantrolene?
IV and PO
230
what do you use dantrolene for?
relief of spsticity r/t cerebral palsy, spinal cord injury, and MS
Treatment of malignant hyperthermia
231
what do these complications belong to? (what CNS drug?)
cns depression
hepatoxicity (anorexia, n/v, abdominal pain, jaundice)
muscle weakness,
N/V
drowsiness
diarrhea
dantrolene
232
which drug inhibits the release of calcium in skeletal muscle. This directly acts on spastic muscles to relax it.
Dantrolene
233
Who is contraindicated to take dantrolene?
1. pregnancy and lactation
2. impaired liver and renal function
234
what drugs does dantrolene interact with?
CNS depressants
Other calcium channel blockers
235
what happens if you take dantrolene with estrogen therapy for women over 35?
Increase risk for liver toxicity (hepatotoxicity)
236
what are examples of calcium channel blockers
verapamil
diltiazem
nifedipine
amlodipine
237
what do you want to educate people taking dantrolene regarding what it treats and what to think?
4 things it treats
1. relief of spasticity r/t cerebral palsy, spinal cord injury & MS
2. Treatment of malignant hyperthermia
3. Think safety
238
what should you monitor for with dantrolene?
weakness
decrease in Ca in skeletal
Tx: malignant Hyperthermia
239
What can happen in early tx of dantrolene of PO route?
diarrhea
240
what is malignant hyperthermia s/sx:
Fever
Autonomic instability
Muscle rigidity
Inhaled anesthetics
Less bowel sounds (hyporeflexia)
Yell (Agitated)
241
What condition is driven by a genetic predisposition that manifests when a susceptible individual is exposed to inhaled anesthesia agents?
Malignant hyperthermia
242
what med treats anxiety?
Alprazolam
Sedative hypnotic anxiolytics: Benzodiazepines
243
what med treats depression?
Fluoxetine
Selective serotonin reuptake inhibitors (SSRI)
244
What med treats bipolar?
Lithium carbonate
Mood stabilizer
245
what treats schizophrenia?
Chlorpromazine
Antipsychotic: 1st generation (conventional)
246
what treats ADHD?
Methylphenidate
central nervous stimulants
247
What treats parkinsons dz:
levodopa/ carbidopa
Anti-parkinson's med
248
What treats seizures?
Phenytoin
Antiepileptics: hydantroins
249
What treats seizures, bipolar, trigeninal and glossophanyngeal neuralgias?
Carbamazepine
Antiepileptics: Anticonvulsants
250
what is used as anesthesia/ preoperative sedation?
midazolam
Benzodiazepine
251
What is used as a centrally acting muscle relaxant for muscle spasms?
diazepam
centrally acting muscle relaxant
252
what is peripherally acting muscle relaxant that is used to relieve relief spasticity r/t cerebral palsy, spinal cord injury, and MS?
dantrolene
peripherally acting muscle relaxant
253
what is used to treat gram + cocci pneumonia and meningitis
prophylaxis endocarditis
meningitis due to gram - cocci
syphilis due to spirochetes
penicillins
254
LAB VALUE: WBC
5-10 k/uL
255
RBC female
4.2-5.4 M/UL
256
RBC male
4.7-6.1 m/uL
257
HBC female and male
Female - 12-15 g/dl
male - 14-18 g/dl
258
what is HCT female and male
F - 37-47%
M - 42-52%
259
what is platelet
150-400x1000
260
PT
11-12.5 sec
261
INR
0.8-1.1
262
aPTT
22.2-34.8 sec
263
glucose
74-106 mg/dl
264
BUN and creatinine
BUN - 10-20mg/dl
Creatinine F - 0.5-1.1 mg/dl
Creatinine M - 0.6-1.2 mg/dl
265
Na, K, Cl, Ca
Na - 136-145 mmol/dl
K - 3.5-5 mmol/dl
Cl - 98-106 mmol/dl
Ca - 9-10.5 mmol/dl
266
ALT and AST
ALT - 4-36 u/l
AST - 0-35 u/l
267
what drug weakens cell wall destroying bacteria?
penicillins
268
what are the 3 non opioid analgesics we need to know?
2 NSAIDS
ibuprofen
Aspirin
Acetominophen
269
what drug inhibits enzymes COX 1 and COX 2 stopping the production of prostaglandins.
Prostaglandins produce inflammation and pain
ibuprofen
270
what does inhibiting COX 1 do?
decreased platelet aggretgation and kidney damage
271
what does inhibiting COX 2 do?
decreased inflammation, fever, pain
does NOT decrease platelet aggregation
272
what drug supresses inflammation, analgesia, fever reduction
dysmenorrhea
ibuprofen
273
what do you want to educate patients on ibuprofen?
take with food, water or milk to reduce gastric discomfort
274
what salicylate do we need to be aware of?
aspirin
275
what drug is these complications from:
GI upset
impaired KIDNEY function
increased risk of MI and stroke
Salicylism (aspirin)
ibuprofen
276
what is aspirin used for and why is it good?
commonly used as pain medication
it costs less than other meds and used to control fever, pain and inflammation
277
what do you need to avoid aspirin?
to treat chicken pox or flu like syndrome in children and teens because of REYEs syndrome
278
Why is an anticoagulant an interaction with ibuprofen?
increase risk of bleeding
279
why are gluccocorticoids risk with ibuprofen?
incrased risk of GI bleed
280
why is alcohol a risk for ibuprofen
increase risk of GI bleed
281
what are these contraindications belonging to?
Peptic ulcer disease
bleeding disorders
pregnancy
children who have viral infections
older adults
smokers
ibuprofen
282
what is the class of ibuprofen
NSAIDS
283
what do these signs indicate?
sweating
fever
acidosis
dehydration
electrolyte imbalance
tinnitus
respiratory depression
coma
aspirin toxicity
284
what is this med:
slows production of prostaglandins in the CNS
acetaminophen
285
what is acetaminophen used for
analgesic (pain relief)
antipyretic (reduce fever)
286
what med are these complications from:
rare at therapeutic dosages: acute toxicity
liver damage
early s/sx: n/v, diarrhea, sweating, abdominal discomfort leading to hepatic failure and death
ANTIDOTE: acetylcystine
acetaminophen
287
how many grams can you not exceed per day for adults for acetaminophen?
4 grams
288
undernourished clients should not exceed how many grams of acetaminophen per day?
3 grams
289
does it matter if you take with or without food for acetaminophen?
NO
290
what pain drug is this for:
use with caution in clients who consume 3 or more alcoholic drinker per day
use with caution in clients who take warfarin
acetaminophen
291
what route is acetylcysteine?
IV
292
293
What does MAOI do?
Increase norepinephrine dopamine and serotonin and tyramine.
294
What does NMS mean in terms of hormones?
It blocks too much dopamine
Nervous system freaks out
High fever
Rigid muscles
Confusion and coma
Sweating
Tachycardia
BP imbalance
Fever
Encephalopathy
V/s instability
Elevated CKP
Rigidity
295
What to use to treat NMS
Dantrolene
Muscle relaxer
296
Difference of phenytoin and carbamazepine
Phenytoin - gingival hyperplasia (overgrowth of gum tissue)
Carbamazepine - T cell immune rxn = SJS deadly rash!!
297
What is lithium like?
Mood stabilizer: calms down overactive neurons and regular serotonin dopamine and norepinephrine
Small therapeutic window
298
Difference of alprazolam and Midazolam
Alprazolam: anxiety PO and long ish duration
Anti anxiety daily life pill
Midazolam: sedation anesthesia IV and IM and short
Knock you out!
299
What is NMS ?
Dopamine blockade: dopamine signals blocked
Body can’t regulate
If you block dopamine:
Psychosis can decrease hallucination
Movement pathways can cause EPS (similar to Parkinson’s)
300
What does dantrolene do?
Muscle relaxers from calcium block
ABSN
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