Exam 4 Flashcards
(176 cards)
1
Q
- Is a chronic neurological disorder that is an imbalance of neurotransmitter dopamine and acetylcholine.
- Is a degeneration of dopaminergic neurons leading to a lack of dopamine.
A
Parkinson’s Disease and Alzheimer’s
2
Q
Frequently occurs as an adverse reaction to various drugs
A
Pseudoparkinsonism
3
Q
- Has damage to the extrapyramidal motor tract
* Creation of dopamine is damaged so there is an imbalance of dopamine and acetylcholine
A
Parkinson’s Disease
4
Q
Is a an inhibitory neuro transmitter.
A
Dopamine
5
Q
Is an excitatory neuro transmitter.
A
Acetylcholine
6
Q
Characteristics of Parkinson’s Disease
A
- Involuntary tremors of limbs
- Rigidity of muscles
- Bradykinesia (slow movement)
- Postural changes
- Head and chest thrown forward
- Shuffling
- Lack of facial expression
- Pill-rolling motion of hands
7
Q
What can help prevent someone from getting Parkinson’s Disease?
A
Exercising
8
Q
What are Non-pharmacological ways to treat Parkinson’s Disease?
A
- Exercise
- Fiber Intake
- Fluid Intake
- Balanced diet
- Support Groups
9
Q
What drugs can treat Parkinson’s Disease?
A
- Anticholinergics
- Dopamine Replacements
- Dopamine agonists
- MAO-B Inhibitors
- COMT Inhibitors
10
Q
What drug blocks cholinergic receptors?
A
Anticholinergics
11
Q
What drug blocks cholinergic receptors?
A
Anticholinergics
12
Q
What drug stimulates dopamine receptors?
A
- Dopamine replacements
* Dopamine agonists
13
Q
What drug inhibits MAO-B enzyme that interferes with dopamine?
A
MAO-B Inhibitors
14
Q
What drug inhibits COMT enzyme that inactivates dopamine?
A
COMT Inhibitors
15
Q
Benztropine and trihexypenidyl are examples of what kind of drug?
A
Anticholinergics
16
Q
Anticholinergics Action is what?
A
- Reduces rigidity and some of the tremors.
* Minimal effect on bradykinesia
17
Q
Anticholinergics have what side effects?
A
- Blurred vision
- Ocular hypertension
- Weakness
- Dry mouth
- Constipation
- Anhidrosis
- Urinary retention
- Pupil dilation
18
Q
What is the Anticholinergic agent assessment?
A
- Health History
- History of glaucoma
- GI dysfunction history
- Urinary retention history
- Angina history
- Myasthenia gravis history
- Drug history
19
Q
What is the Anticholinergic agent nursing diagnosis?
A
- Mobility
- Impaired physical related to muscle rigidity
- Tremors
- Bradykinesia
20
Q
What is the Anticholinergic agent planning?
A
Patient will have decreased involuntary symptoms caused by Parkinson’s Disease.
21
Q
What is the Anticholinergic agent nursing interventions?
A
- Councel patients to get a routine eye exam because they are contraindicated in patients with glaucoma.
- Encourage patients to relieve a dry mouth with hard candy, ice chips, or sugarless gum.
- Monitor urine output for urine retention
- Increase fluid intake, fiber, and exercise to avoid constipation
22
Q
What drug is a dopaminergic?
A
Carbidopa-levodopa
23
Q
What is the carbidopa-levodopa action?
A
Converts to dopamine and increases mobility
24
Q
What is the carbidopa-levodopa side effects?
A
•Fatigue •Insomnia •Dry mouth •Blurred vision •Orthostatic hypotension •Palpitations •Dysrhythmias •GI distress •Urinary retention •Dyskinesia •Psychosis •Sever depression •Discolorization of urine (black, brown, red) Agranulocytosis
25
What should be taught about with Patient Teaching with Carbidopa-levodopa?
* Orthostatic hypotension
* Take meds with high protein foods even though it may decrease GI upsets it can delay absorption
* Urine may be discolored and dark perspiration
.•Report side effects & symptoms of dyskinesia
* Don't discontinue meds abruptly
* Can take months to get the full therapeutic effects of the medication
26
What does Bromocriptine do and why is it used?
* Acts directly on dopamine receptors in CNS, cardiovascular system, and GI tract
* Used when patients do not tolerate carbidopa-levodopa
27
What is the action of Selegiline?
Inhibit MAO-B enzyme that interferes with dopamine
28
What drug is Selegiline?
MAO-B
29
What is the interaction of Selegiline?
* Foods high in tyramine can cause hypertensive Crisis
| * CNS toxicity with tricyclic antidepressants or SSRIs
30
What are foods high in tyramine?
* Aged cheese
* Red wine
* Bananas
31
Large doses of Selegiline may inhibit what enzyme?
MAO-A
| •and enzyme that promotes metabolism of of tyramine in the GI tract
32
What do COMT Inhibitors do?
Inhibit COMT enzyme that inactivates dopamine.
33
What can Tolcapone be?
Hepatoxic- monitor for liver function
34
Entacapone does what?
* No effect on liver function
* Often combined with Carbidopa-levodopa
* Orange-brown urine
35
What is Alzheimer's Disease?
* Incurable dementia illness
* Chronic, progressive neurodegenerative disorder
* Marked cognitive dysfunction
* Onset usually between ages 45-65
36
What is the pathophysiology of Alzheimer's Disease?
* Cholinergic neuron degeneration and acetylcholine deficiency
* Neuritic plaques form
* Neurofibrillary tangles are in neurons
* Not completely understood
* Occurs more often in women than men
37
Alzheimer's disease had what stages?
* Mild (early stage)
* Moderate (middle stage)
* Severe (late stage).
38
Alzheimer's disease Mild Stage
* Memory loss
* Forgetfulness
* Trouble planning
* Organizing
39
Alzheimer's disease moderate stage
```
Middle stage
•Personality and behavioral changes
•Increased memory loss
•Frustration and anger
•Unable to perform routine tasks
•Loss of bowel or bladder control
```
40
Alzheimer's disease severe stage
```
Late Stage
•Does not recognize loved ones
•Increased assistance with ADLs
•Unable to walk or talk
•Loses ability to swallow
```
41
Acetylcholinesterase/Cholinesterase Inhibitors do what?
•Used to treat mild-moderate Alzheimer's disease
* Increase availability of acetylcholine in CNS
* Improved brain function or delay in loss of functions
* Also increases acetylcholine in periphery and Increases parasympathetic responses.
* Nausea, GI upset, diarrhea, bradycardia, hypotension, bronchoconstriction
•Stops acetylcholine from being broke down
42
What are examples of Acetylcholinesterase/Cholinesterase Inhibitors?
* Rivastigmine
| * Donepezil
43
What is the action of Rivastigmine?
* Allow more acetylcholine in neuron receptors
* Increase cognitive function, slows disease process
* Indirect acting
44
What are the side effects of Rivastigmine?
* Dizziness
* Headache
* Confusion
* Depression
* Dry mouth
* GI distress
* Dehydration
* Weight loss
* Bradycardia
* Orthostatic hypotension
* Dysrhythmia
* Hepatotoxicity
* Suicidal ideation
* Stevens-Johnspn syndrome
*Has to be taken on an empty stomach
45
What is the Assessment got Rivastigmine?
* Assess patients mental and physical abilities.
* Obtain a history especially hepatic or renal dysfunction.
* Assess for memory and judgement losses
46
What is the Nursing Diagnosis for Rivastigmine?
* Self care deficit, toileting related to memory loss
| * Confusion, chronic related to memory loss
47
What is the Planning for Rivastigmine?
* Patients memory will be improved
| * Patient will maintain self-care with assistance
48
What is the Nursing Interventions for Rivastigmine?
* Maintain consistency in care
* Record vitals
* Observe any patient behavioral changes and note any improvements or decline
* Teach family members about safety measures to avoid injury when the patient wanders
* Inform family members of availabile support groups
49
What is Meantime used for?
* Used to treat moderate to severe Alzheimer's symptoms
* NMDA receptor antagonist
* Blocks effects of glutamate at NMDA receptors
* Fewer side effects than cholinesterase Inhibitors
* Most common-dizzieness, HA, confusion, constipation
* About same incidence as placebo
50
What is Memantime used for?
* Used to treat moderate to severe Alzheimer's symptoms
* NMDA receptor antagonist
* Blocks effects of glutamate at NMDA receptors
* Fewer side effects than cholinesterase Inhibitors
* Most common-dizzieness, HA, confusion, constipation
* About same incidence as placebo
51
What is the pathophysiology of Myasthenia Gravis?
* Autoimmune disorder
* Antibodies attach to acetylcholine receptor sites, obstruct binding of acetylcholine, and destroy receptor sites
* Lack of acetylcholine impairs transmission of messages at neuromuscular junction s
* Leads to ineffective muscle contraction and muscle weakness
* Leads to weakness of respiratory, facial, and extremity muscles
52
Where are the nicotinic receptors found?
Skeletal muscles
53
The Thymus glad is what for Myasthenia Gravis?
Is the source of antibodies that that destroy acetylcholine receptors
54
Myasthenia Gravis and the Thymus Gland
* Lymph organ
* Produces T cells for immune system
* Enlarged in ~60% Myasthenia Gravis patients
* Thymectomy (removal of thymus)
* Early in diseases process
* Clinic symptoms decreased
* Remission or reduction in medication
55
Myasthenia Gravis Characteristics are what?
* Skeletal muscle weakness
* Fatigue, ptosis
* Dysphagia, dysarthria
* Respiratory muscle weakness, paralysis, and arrest
56
What is a Myasthenic crisis?
•Severe generalized muscle weakness that involves diaphragm and intercostal muscles
57
What are Myasthenic crisis Triggers
* Inadequate dosing
* Emoyional stress, menses, pregnancy
* Infection, surgery, trauma
* Hypokalemia, alcohol intake
* Temperature extremes
* Medications: Aminoglyciside antibiotics, CCB, phenytoin, psychotropics
* Treat with neostigmine
58
Myasthenia Gravis Cholinergic Crisis is what?
* Usually occurs within 30-60 minutes after taking Cholinesterase Inhibitor
* Triggered by overdosing
* Antidote is atropine (anticholinergic)
59
Myasthenia Gravis Symptoms
* Severe muscle weakness
* Possibly respiratory paralysis and arrest
* Abnormal pupil constriction
* Pallor, sweating, vertigo
* Excess salivation, GI distress
* Bradycardia, fasciculations
60
What is Myasthenic crisis?
Caused by underdosing
61
What is cholinergic crisis?
Caused my overdosing
62
Overdosing and underdosing have what?
* Similar symptoms
| * Muscle weakness, dyspnea, bradycardia
63
What kinda of drug is Edrophonium (Tension)?
•Ultra-short-acting Cholinesterase Inhibitor
64
What is Endrophonium used for?
•Used to determine if Myasthenic crisis or cholinergic crisis
•Also used to diagnose myasthenia gravis
Patients symptoms improve - Myasthenic crisis
Patient symptoms worsen - Cholinergic crisis
64
What is Endrophonium used for?
•Used to determine if Myasthenic crisis or cholinergic crisis
•Also used to diagnose myasthenia gravis
Patients symptoms improve - Myasthenic crisis
Patient symptoms worsen - Cholinergic crisis
65
What are come Acetylcholinesterase Inhibitors?
* Edrophonium
* Neostigmine
* Pyridostigmine
* Ambenonium
66
What is Endrophonium?
* Ultrashort-acting for diagnosing
| * Differentiates between Myasthenic and cholinergic crisis
67
What is Neostigmine?
Short acting
68
What is Pyridostigmine?
Intermediate-acting
69
What is Ambenonium?
* Long-lasting
| * Action: increases muscle strength in patients with myasthenia gravis
70
What are side effects of Acetylcholinesterase Inhibitors?
* Increased salivation and tearing
* Miosis, blurred vision
* Bradycardia, hypotension
* GI distress
* Nausea, vomiting, diarrhea, abdominal cramps
71
What can be used for patients that are unresponsive to Acetylcholinesterase Inhibitors?
•Prednisone: Drug of choice
•Plasma Exchange: Helps get rid of antibodies that are attacking the receptors
•Intravenous immune globulin
•Immunosuppressive drugs
Azathioprine: need to monitor for leukopenia and hepatoxicity
72
What is the concept of Acetylcholinesterase Inhibitors?
Sensory Perception
73
What is the assessment of Acetylcholinesterase Inhibitors?
Assess for evidence of overdosing/underdosing, such as muscle weakness with difficulty breathing and swallowing
74
What are patient problems with Acetylcholinesterase Inhibitors?
* Decreased gas exchange
| * Reduced motor function
75
What are patient problems with Acetylcholinesterase Inhibitors?
* Decreased gas exchange
| * Reduced motor function
76
What is the Planning with Acetylcholinesterase Inhibitors?
•The patients muscle weakness will improve with timely administration if Pyridostigmine
77
What are nursing interventions with Acetylcholinesterase Inhibitors?
* Administer doses on time
* Take drug before meals if possible
* Monitor drug effectiveness
* Have antidote available for cholinergic crisis
* Atropine (Anticholinergic)
* Encourage patient to wear medical identification
78
What is Multiple Sclerosis?
* Autoimmune disorder
* Attacks myelin sheath of nerve fibers in brain and spinal cord
* Causes lesions (plaques)
79
What are the characteristics of Multiple Sclerosis?
* Remissions and exacerbations
* Weakness and paralysis of extremeties, fatigue
* Muscle spasticity, paresthesia
* Dysarthria, dysphagia, ataxia
* Diplopia, blurred vision, vertigo, tinnitus
80
What is the Diagnosis of Multiple Sclerosis?
* No specific diagnostic test
* Indicators of diagnosis
* Medical history
* Neurologic exam
* Multiple lesions observable through MRI
* Visual evoked potential: measures electrical activity in the brain
* Elevated immunoglobulin G in the cerebrospinal fluid
81
What are the classifications of MS?
* Relapsing remitting
* Primary progressive
* Secondary progressive
* Progressice relapsing
82
What is relapsing remitting?
Relapse with full recovery and residual deficit
83
What is primary progressive?
Slowly worsening neurologic function without relapsed or remissions
84
What is secondary progressive?
Initial course is relapsing remitting, then progression with or without occasional relapses, minor remissions, and plateaus
85
What is progressive relapsing?
Progressive from onset with acute relapses with or without full recovery
86
What is the MS drug treatment?
* Immunomodulators
* Beta-interferon
* Corticosteroids
87
What do immunomodulators do?
* First line treatment
| * Slows disease progression and prevents relapses
88
What do Beta-interferon drugs do?
Slows the progression of relapsing remitting MS
89
What do corticosteroids do?
Reduces edema and acute inflammation
90
Centrally acting muscle relaxants do what?
* Relieves muscle spasms and spasticity
* Have sedative effect
* Cause drug dependence (all but cyclobenzaprine)
91
What are side effects of centrally acting muscle relaxants?
* Drowsiness
* Dizziness
* Headache
* Nausea
* Vomiting
92
What action does Cyclobenzaprine have?
Relax skeletal muscles
93
What uses does Cyclobenzaprine have?
Relieves muscle spasm
94
What side effects does Cyclobenzaprine have?
* Anticholinergic effects (blurred vision, dry mouth, tachycardia, urine retention, constipation)
* Drowsiness, dizziness, headache, nervousness
* GI distress, unpleasant taste.
* Dysrhythmias
95
What is the only muscle relaxant that does not cause dependence?
Cyclobenzaprine (Flexeril)
*Do not take more than 3 weeks
96
What can happen if muscle relaxers are stopped abruptly?
They can have rebound muscle spasms
97
What are come Central Acting muscle relaxants? *****
* Baclofen -used to tx muscle spasms R/T MS or CNS injury
* Carisoprodol (Soma)
* Chlorzoxazone (Parafon Forte)
* Methocarbamol (Robaxin)
98
What ways can Baclofen be administered?
•Intrathecal via a pump that's surgically implanted and delivers a consistently low dose for muscle spasms
99
What ways can Baclofen be administered?
•Intrathecal via a pump that's surgically implanted and delivers a consistently low dose for muscle spasms
100
Skeletal muscle relaxants have what assessment?
* Observe patients drug history for possible drug interactions
* Note whether patient has a history of narrow-angle glaucoma or myasthenia gravis
101
What nursing diagnoses are for skeletal muscle relaxants?
Physical mobility, impaired related to dizziness and hyperactive reflexes
102
What is the Planning for skeletal muscle relaxants?
The patients muscular pain will be reduced within 1 week
103
What are nursing interventions for skeletal muscle relaxants?
* Observe for CNS side effects.
* Teach patient not to stop abruptly but taper off over 1 week.
* Inform usually taken for <3 weeks
* Teach patient to avoid alcohol and CNS depressants
* Educate to take with food to decrease GI upset
104
A patient with myasthenia gravis come to the emergency department in respiratory distress. He has been diagnosed with Myasthenic crisis. The nurse anticipates administration of which drug?
Neostigmine
105
The patient is admitted to the emergency department with cholinergic crisis. The nurse anticipates administration of what?
Atropine
106
A patient with myasthenia gravis comes to the emergency department in respiratory distress. To determine if the patient is in Myasthenic crisis or cholinergic crisis, the nurse anticipates administration of which drug?
Edrophonium
107
A patient with myasthenia gravis is prescribed Neostigmine. The nurse identifies that the medication is effective when the patient experiences?
Increased .muscle strength
108
A patient with multiple sclerosis is being treated with large doses of corticosteroids. Which nursing diagnosis would be the priority at this time?
Risk for infection
109
A child with cerebral palsy is ordered to receive Baclofen. The nurse is aware that this medication is prescribed to
Reduce muscle spasticity
110
What do you give during a cholinergic crisis?
Atropine
111
What do you give for a Myasthenic crisis?
Neostigmine
112
What is the Etiology of Depression?
* Genetic predisposition.
| * Social and environmental factors
113
What are the pathophysiology theories of Depression?
•Decreased levels of monoamine neurotransmitters which are norepinephrine, serotonin, dopamine
114
What are the signs and Symptoms of depression?
* Depressed mood
* Despair
* Weight loss or gain
* Loss of interest in normal activities
* Fatigue
* Insominia
* Hypersomnia
* Decreased ability to think or colZncentrate
* Suicidal thoughts
115
What is Reactive depression?
* Usually sudden onset after a precipitating event
| * Usually lasts for months
116
What is major depression?
* May be primary or secondary to health problems
* Loss of interest in work or home
* Inability to concentrate and complete tasks
* Difficulty sleeping or excess sleeping
* Feelings of fatigue and worthlessness
* Deep depression
117
What is bipolar disorder?
Mood swings between manic and depressive
118
St. Johns wort helps depression by
•OTC treatment for depression
•Decreases reuptake of serotonin, norepinephrine, and dopamine
•Increased risk serotonin syndrome----sx: dizziness, HA, sweating, and agitation
Avoid Ginkgo biloba (another OTC meds used to tx depression) with prescription antidepressants also
119
What are the different Antidepressant groups?
* Tricyclic antidepressants (TCAs)
* Selectove serotonin reuptake Inhibitors (SSRIs)
* Serotonin norepinephrine reuptake Inhibitors (SNRIs)
* Atypical antidepressants
* Monoamine oxidase Inhibitors (MAOIs)
120
What are examples of Tricyclic Antidepressants?
* Amitriptyline (Elavil)
* Imipramine
* Trimipramine
* Desipramine
* Doxepin (Sinequan)
* Nortriptyline
* Protriptyline
121
What action does Tricyclic Antidepressants have?
* Blocks uptake of norepinephrine and serotonin in brain
* Elevated mood, increases want in ADLs, decreases insomnia
* Blocks histamine receptors which leads to sedation
* Blscks cholinergic receptors which leads to anticholinergic effects
122
What is the use of Tricyclic Antidepressants?
Major depression
123
How long might it take for Tricyclic Antidepressants to work?
2-4 weeks
124
What are side effects/adverse reactions while being on Tricyclic Antidepressants?
* Drowsiness, dizziness, blurred vision
* Dry mouth and eyes, GI distress
* Urinary retention, sexual dysfunction
* Sleep related behaviors, suicidal ideation
* Orthostatic hypotension, dysrhythmias
* Blood dyscrasias---Monitor CBC
* Extrapyramidal syndrome----amitriptyline
* Neuroleptic malignant syndrome----clomipramone (altered mental status, rigid muscles, facial ticks, fever, sympathetic nervous system stimulation)
* Cardiotoxicity
125
What are interactions associated with Tricyclic Antidepressants?
* Alcohol and other CNS depressants potentiate CNS depression
* MAOIs may lead to toxic psychosis, cardiotoxicity
* Antithyroid drugs may Increase dysrhythmias
126
What are some examples of Selective Serotonin Reuptake Inhibitors?
* Fluoxetine (Prozac)
* Sertraline (Zoloft)
* Paroxetine (Paxil)
* Citalopram (Celexa)
* Escitalopram (Lexapro)
127
Levodopa (Dopar) is what kind of drug and what is it used for?
Dopaminergic and it's used for Parkinson's Disease
128
Levodopa/carbidopa-levodopa (Sinemet) is what kind of drug and what is it used for?
Dopaminergic and it's used for Parkinson's
129
Entacapone (Comtan) is what kind of drug and what is it used for?
COMT Inhibitor and it's used for Parkinson's Disease
130
Donepezil (Aricept) is what kind of drug and what is it used for?
Acetylcholinesterase Inhibitors for Alzheimer's
131
Rivastigmine (Exelon) is what kind of drug and what is it used for?
Acetylcholinesterase Inhibitors for Alzheimer's
131
Rivastigmine (Exelon) is what kind of drug and what is it used for?
Cholinesterase Inhibitor used for Alzheimer's
132
Neostigmine (Prostigmine) is what kind of drug and what is it used for?
Acetylcholinesterase Inhibitors for Myasthenia Gravis
133
Pyridostigmine bromide (mestinon) is what kind of drug and what is it used for?
Acetylcholinesterase Inhibitors for Myasthenia Gravis
134
Glatiramer (Copaxone) is what kind of drug and what is it used for?
Immunomodulator for MS
135
Mitoxantrone is what kind of drug and what is it used for?
Immunosuppressant for MS
136
Diazepam (Valium) is what kind of drug and what is it used for?
Muscle relaxant is used to relieve muscle spasms for MS
137
Baclofen (Lioresal) is what kind of drug and what is it used for?
Muscle relaxant for muscle spasms caused by MS
138
Dantrolene (Dantrium) is what kind of drug and what is it used for?
Peripherally acting muscle relaxer used for chronic neurological disorders that cause spasms
139
Carisoprodol (Soma) is what kind of drug and what is it used for?
Centrally acting muscle relaxant used for acute, painful musculoskeletal conditions
140
Chlorzoxazone (Parafon Forte DCS) is what kind of drug and what is it used for?
A centrally acting muscle depressant used for skeletal muscle relaxing with sedative properties
141
Methocarbamol (Robaxin) is what kind of drug and what is it used for?
Centrally acting muscle relaxer used for musculoskeletal pain
142
Metaxalone (Skelaxin) is what kind of drug and what is it used for?
Centrally acting muscle relaxant used for musculoskeletal pain associated with MS
143
Cyclobenzaprine (Flexeril) is what kind of drug and what is it used for?
Anxiolytic/Centrally acting Muscle relaxant used for short term treatment of muscle spasms
144
Fluoxetine (Prozac) is what kind of drug and what is it used for?
Antidepressant: selective serotonin reuptake Inhibitor to treat depression, bipolar disorder, bulimia disorder, etc.
145
What is the action of selective serotonin reuptake Inhibitors?
Block uptake of neurotransmitter serotonin
146
What are the uses of serotonin reuptake Inhibitors?
* Major depression
* Anxiety disorders
* obsessive-compulsive disorder
* Panic disorders
* Phobias
* Posttraumatic stress disorder.
* Prevention of migraines headaches
* Decrease premenstrual tension syndrome
147
What are Selective serotonin reuptake Inhibitors interactions?
* Increased sedation with alcohol and other CNS depressants
| * Grapefruit juice with SSRIs can lead to toxicity
148
What are the side effects/adverse reactions of selective serotonin reuptake Inhibitors?
* Headache, nervousness
* Blurred vision, insomnia
* Dry mouth, GI distress
* Sexual dysfunction, suicidal ideation
* Side effects often decrease over 1 to 4 weeks
* Decrease or Increases in appetite
* Can cause Bruxism: grinding teeth
149
Selective Serotonin Reuptake Inhibitors should not be taken at the same time as what?
MAOI's
150
What are some examples of Serotonin Norepinephrine Reuptake Inhibitors?
* Venlafaxine (Effexor)- First one approved
* Duloxetine (Cymbalta)
* Desvenlafaxine (Prestiq)
151
What is the action of Serotonin Norepinephrine Reuptake Inhibitors?
Inhibit the reuptake of serotonin and norepinephrine
152
What are the uses for Serotonin Norepinephrine Reuptake Inhibitors?
* Major depression
* Generalized anxiety disorder
* Social anxiety disorder
153
What are the uses for Serotonin Norepinephrine Reuptake Inhibitors?
* Major depression
* Generalized anxiety disorder
* Social anxiety disorder
154
What is the interaction with Serotonin Norepinephrine Reuptake Inhibitors?
•Venlafaxibe & St. John's wort--increased risk of serotonin syndrome and NMS (Neuroleptic Malignant Syndrome)
155
What is the interaction with Serotonin Norepinephrine Reuptake Inhibitors?
•Venlafaxibe & St. John's wort--increased risk of serotonin syndrome and NMS (Neuroleptic Malignant Syndrome)
156
What are the side effects of Serotonin Norepinephrine Reuptake Inhibitors?
* Drowsiness
* Dizzieness
* Insomnia
* Headache
* Euphoria
* Amnesia
* Blurred vision
* Photosensitivity
* Ejaculation dysfunction
* Can cause an increase in liver enzymes
157
What are the adverse effects of Serotonin Norepinephrine Reuptake Inhibitors?
* Tachycardia
* Hypertension
* Angioedema
* Seizures
* Suicidal ideation
157
What are the adverse effects of Serotonin Norepinephrine Reuptake Inhibitors?
* Tachycardia
* Hypertension
* Angioedema
* Seizures
* Suicidal ideation
158
What are examples of Atypical Antidepressants?
* Amoxapine
* Maprotiline
* Trazadone
159
What is the action of Atypical Antidepressants?
•Affect one or two of the three neurotransmitters: serotonin, norepinephrine, and dopamine
160
What is the use of Atypical Antidepressants?
* Major depression
* Reactive depression
* Anxiety
* Sometimes a sleep aid
161
What are the Interactions of Atypical Antidepressants?
Do not take with MAOIs & do not use within 14 days after discontinuing MAOIs
162
What are examples of Monoamine Oxidase Inhibitors ?
Tranylcypromine sulfate, isocarboxazid, Selegiline, and phenylzine sulfate
163
What is the action of Monoamine Oxidase Inhibitors?
Monoamine Oxidase enzyme inactivates norepinephrine, dopamine, epinephrine, and serotonin
164
What is the use of Monoamine Oxidase Inhibitors?
Depression not controlled by TCAs and second-generation antidepressants
165
What drug interactions do Monoamine Oxidase Inhibitors have?
•CNS stimulants such as vasoconstrictors & cold medicine containing phenylephrine & pseudoephedrine--hypertensive crisis
166
What food Interactions does Monoamine Oxidase Inhibitors have?
* Foods that contain tyramine--- Hypertensive Crisis
* Some cheeses, cream, yogurt, coffee, chocolate, bananas, raisins, italian green beans, liver, picked foods, sausage, soy sauce, yeast, beer & red wines
167
What side effects/adverse effects do Monoamine Oxidase Inhibitors have?
* Agitation
* Restlessness
* Insomnia
* Anticholinergic effects
* Orthostatic hypotension
* Hypertensive crisis from tyramine interaction
168
What is kind of drug is Lithium?
Mood stabilizer
169
What therapeutic serum range does lithium have?
* 1.0 to 1.5 mEq/L
| * Serum lithium levels greater than 1.5 mEq/L may lead to toxicity
170
What action does Lithium have?
* Alteration of ion transport in muscle and nerve cells
| * Increased receptor sensitivity to serotonin
171
What use does Lithium have?
Bipolar disorder manic episodes
172
What side effects/adverse reactions
* Headaches, drowsiness, dizziness, blurred vision
* Restlessness, tremors, memory impairment
* Dry mouth, metallic taste
* Can deplete sodium levels
* Hypotension, dysrhythmias
* Edema of hands and ankles, dehydration
* Increased urination, blood dyscrasias, NMS
* Serotonin syndrome nephrotoxicity
173
What are Interactions with Lithium?
•Increased lithium level with
•Thiazides, methyldopa, haloperidol, NSAIDs, Antidepressants, theophylline, phenothiazines
•Decreased lithium level with
Caffeine, loop Diuretics
