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NUR 346 > Exam 1 Drugs > Flashcards

Exam 1 Drugs Flashcards

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1
Q

Benzodiazepines

A

Anti-anxiety drug

Promote activity of GABA
decreased excitability ==> calming effect
sleeping inducing
anticonvulsant
muscle relaxant properties

controlled substance, addictive
used for insomnia, anti-anxiety, and alcohol withdrawal

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2
Q

List of Benzodiazepines - anxiety

A
  • ending in pam

Diazepam (Valium)
Clonazepam (Klonopin)
Alprazolam (Xanax)
Lorazepam (Ativan)

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3
Q

List of Benzodiazepines - insomnia

A
  • ending in pam, am

Flurazepam (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)

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4
Q

List of Benzodiazepines - alcohol withdrawal

A
  • ending in pam, xide

Chlordiazepoxide (Librium)
Diazepam (Valium)
Lorazepam (Ativan)

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5
Q

Short-Acting Sedative-Hypnotic Sleep Agents (“Z-hypnotics”)

A

Antianxiety and Hypnotic Drugs

Sedative effects without the anxiety, anticonvulsant, or muscle relaxant effects of other benzodiazepines.

Quick onset… take when ready to sleep

Short half lives (up to 8 hours)

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6
Q

List of Short-Acting Sedative-Hypnotic Sleep Agents (“Z-hypnotics”)

A
  • have Z in the beginning of the medication

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

Anti-anxiety and Hypnotic Drugs

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7
Q

Buspirone (BuSpar)

A

Anti-anxiety and Hypnotic - Melatonin Receptor Agonists

often better tolerated than benzos

Relieves anxiety with no sedative effect

No potential for addiction

Not a CNS depressant

thought to work as a partial serotonin agonist

SE: HA, dizziness, lightheadedness, nausea, insomnia

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8
Q

T/F

Many antidepressants have proven to be effective treatments for anxiety disorders.

A

TRUE

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9
Q

Tricyclic antidepressants (TCAs)

A

Antidepressant Drugs

Once was used as first line defense, however no longer

TCAs take longer to reach optimal dose, have many side effects, sedation, and MORE LETHAL IN OVERDOSE

Thought to act by blocking reuptake of norepinephrine or both norepinephrine and serotonin

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10
Q

Side effects of TCAs

A

Orthostatic hypotension (esp. with elderly), confusion, disturbed concentration; anti-cholinergic side effects including blurred vision, dry mouth, constipation, urinary retention

ER/MEDICAL FLOOR TIP: In overdose, may cause fatal arrhythmias, slows AV conduction (consider monitored bed, telemetry)

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11
Q

Side effects of TCAs

A

Orthostatic hypotension (esp. with elderly), confusion, disturbed concentration; anti-cholinergic side effects including blurred vision, dry mouth, constipation, urinary retention

ER/MEDICAL FLOOR TIP: In overdose, may cause fatal arrhythmias, slows AV conduction (consider monitored bed, telemetry)

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12
Q

Nursing Considerations for TCAs

A

suicidal precautions, sugarless lozenges for dry mouth, titrate down doses to avoid HA, Vertigo, wt. changes, avoid alcohol, sleeping pills, In bipolar patients, Tx with TCA’s may lead to hypomania or mania.

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13
Q

List of TCAs

A
  • end in ine

Amitriptyline (Elavil)
Imipramine (Tofranil)
Nortriptyline (Pamelor)

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14
Q

MAOIs

A

Antidepressant

drug that inhibits action of MAO by preventing destruction of monoamines… So synaptic level of neurotransmitters is increased and makes the antidepressant effects possible

If pt is taking this medication, must avoid tyramine rich foods (aged cheese, pickled or smoked fish, meats, wine) or risk hypertensive crisis

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15
Q

Side Effects of MAOIs

A

HTN crisis with consumption of high tyramine foods, photosensitivity, weight gain, sexual dysfunction

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16
Q

Nursing Considerations for MAOIs

A

Low tyramine diet
D/C 10 days prior to anesthesia
Monitor for urinary retention
Meds lower seizure threshold
Suicidal precautions

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17
Q

List MAOIs

A
  • end in ine or mine

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (EMSAM)
Tranylcypromine (Parnate

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18
Q

Tyramine Restrictive Food

A

Avocados
Strong or aged cheeses
Cured meats (salami, beef jerky)
Smoked or processed meats
Pickled or fermented foods
Soybean products
Sauces: soy sauce, shrimp sauce, fish sauce, miso, and teriyaki sauce
Snow peas & fava beans
Beer, red wine, sherry and liqueurs
Dried or overripe fruits (eg. Raisins, prunes, bananas, & avocados)
Meat tenderizers
Old or spoiled foods

**also found in some OTC meds

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19
Q

Major Side Effect of MAOIs

A

Hypertensive crisis (requiring emergency treatment)
Potentially causing a hemorrhagic stroke.

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20
Q

Why is MAOIs less commonly taken?

A

Due to restrictive diet

can cause hypertensive crisis that can require emergency treatment

interacts with many drugs

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21
Q

Adverse Drug Effect: Serotonin Syndrome

A

Can occur when multiple medications that alter serotonin metabolism are used together (MAOIs + SSRI, etc.)

Can be life-threatening

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22
Q

Adverse Drug Effect: Serotonin Syndrome Clinical Symptom Profile

A

Tachycardia
Sweating (diaphoresis)
Fever progressing to hyperthermia
Shivering, Tremor
Muscle rigidity (myoclonus)
Restlessness/Agitation/Delirium/Coma

**key: change in body temp

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23
Q

Selective serotonin reuptake inhibitors (SSRIs)

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A

Antidepressant Drugs

Block reuptake and destruction of serotonin.

Less anticholinergic and sedating side effects

24
Q

Indications for use of SSRIs

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A

Depression
Anxiety disorders
OCD
Obesity
Bulimia

25
Nursing Considerations for SSRIs
Suicide precautions Use in AM Requires 4 weeks for full effect monitor weight Good mouth care
26
What is the most common class prescribed for depressed mood?
SSRIs
27
Side Effects of SSRIs
fluctuating weight anticholinergic sexual dysfunction nausea, headache, painful menstruation, sexual dysfunction, insomnia, rash, taste changes, dry mouth, anxiety, tremor, dizziness, weight loss/gain
28
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Antidepressant HTN is side effect in some pts with higher doses Side effects include fewer anticholinergic effects.
29
List Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- have "x" in their name Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Levomilnacipran (Fetzima)
30
Mood Stabilizer - Lithium
"The Gold Standard” Stabilizes depression and mania (bipolar disorder). Narrows the therapeutic index. Has a potential for toxicity.
31
Mood Stabilizer - Lithium Toxic Effects
Toxic effects can include tremor, ataxia, confusion, convulsions, and N/V. mechanism of action unknown. May act by affecting electrical conductivity in neurons bc it is a positively charged ion - Affects cardiac contraction - can lead to sinus bradycardia Disturbances in fluid balance: polyuria, edema ** tremors, coma being KEY
32
What does Lithium cause when taken long-term?
Long term use: hypothyroidism
33
T/F If pt is hyponatremic, can get lithium toxicity
TRUE
34
How often do you draw blood to check for Lithium toxicity?
Initially weekly then biweekly followed by monthly **blood is drawn often
35
T/F Lithium has a high therapeutic effect
FALSE has a low therapeutic index… blood draws for effectiveness common
36
Labs drawn for Lithium include
Lab: CBC, specifically WBC Blood levels of Lithium, BUN, Creatinine
37
Nursing consideration for Lithium
Lab: CBC, specifically WBC Assessment of skin for rash Education on potential weight gain
38
Therapeutic blood level: Lithium
0.8 to 1.4 mEq/L
39
Maintenance blood level: Lithium
0.4 to 1.3 mEq/L
40
Toxic blood level: Lithium
1.5 mEq/L and above
41
What can affect Lithium Levels
New blood pressure medication (most of them shift lithium levels) NSAIDs (non-steroidal anti-inflammatories) can significantly shift Lithium Levels The most obvious is over-taking Lithium or continuing to take Lithium while losing a lot of water due to the flu, diarrhea, vomiting or excessive exercise without replenishing fluid.
42
Signs of Lithium Toxicity - Acute
Diarrhea; Nausea; Vomiting, Stomach Pains Dizziness; Weakness Confusion; Memory problems; Psychosis Hand tremors; Muscle twitching; Ataxia (incoordination) Nystagmus Seizures; Coma; Kidney Failure
43
Signs of Lithium Toxicity - Chronic
Tremors; Slurred Speech; Increase reflexes
44
What to watch for in anticonvulsant drugs?
Watch for rash; may indicate Stevens-Johnson syndrome.
45
Side Effect Profiles of Mood Stabilizers
Weight gain Somnolence Agranulocytosis Thrombocytopenia Hepatitis Steven Johnson Syndrome- life threatening rash.
46
Antipsychotic Drugs - First Generation
AKA conventional, typical or standard antipsychotic drugs
47
Antipsychotic Drugs - First Generation Side Effects
extrapyramidal side effects prolong QT interval Parkinsons **URGENT: if temperature is above 103F - they are having an extrapyramidal side effect
48
What are extrapyramidal side effects?
Extrapyramidal side effects are a group of symptoms that can occur in people taking antipsychotic medications. 1 Symptoms of extrapyramidal effects include an inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements
49
Second-Generation (Atypical) Antipsychotic Drugs
Produce fewer extrapyramidal side effects (EPS) Target both the negative and positive symptoms Predominantly D2 (dopamine) and 5-HT2A (serotonin) antagonists (blockers) Often chosen as first-line treatment
50
Second-Generation (Atypical) Antipsychotic Drugs Side Effects
Increase the risk of metabolic syndrome (increased weight, bs, triglycerides) Insulin resistance
51
List Second-Generation (Atypical) Antipsychotic Drugs
- ending in one, hole, and pine Clozapine (Clozaril) Risperidone (Risperdal) Quetiapine (Seroquel) Olanzapine (Zyprexa) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega) Iloperidone (Fanapt) Lurasidone (Latuda) Asenapine (Saphris)
52
Clozapine (Clozaril)
The first atypical antipsychotic Highly effective in treating treatment-resistant schizophrenia Has the least possibility of causing extrapyramidal side effects compared to traditional antipsychotics. Requires regular blood monitoring for agranulocytosis
53
Black Box Warning - Clozapine (Clozaril)
for agranulocytosis, seizures, myocarditis, for "other adverse cardiovascular and respiratory effects", and for "increased mortality in elderly patients with dementia-related psychosis.“ ~ FDA Additionally, it also often causes less serious side effects such as hypersalivation and weight gain.
54
ADHD - Atomoxetine (Strattera)
Nonstimulant: labeled for 6+ increase attention, promote calmness
55
Attention Deficit Hyperactivity Disorder (ADHD) Treatment
For short attention span, impulsivity, and overactivity May inhibit overactive part of limbic system

NUR 346 (10 decks)

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