- Prevent anxiety without causing much sedation - less likely to cause physical dependence

- anticholinergic effects - sleep disturbances and decreased libildo

Exam 4 Module 7 Drug Purpose Flashcards by Rene Fenner

Properties of anxiolytics

Prevent tension or fear
Sedatives
Hypnotics (sleep and minor tranquilizing)

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Risk for addiction/dependence and sedation higher than benzos

Barbiturates

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phenobarbital (Luminal) indications

relief of s/sx of anxiety, sedation, insomnia, treatment of seizures

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phenobarbital (Luminal) adverse effects

CNS depression
bradycardia, hypotension, syncope, hypoventilation
hypersensitivity

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Flumazenil (Romazecon)

Used to treat acute withdrawal syndrome

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Benzodiazepines

Prevent anxiety without causing much sedation

- less likely to cause physical dependence

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Acute withdrawal syndrome

Caused by abrupt cessation of drug

Causes nausea, headache, malaise, vertigo, and nightmares

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Diazepam (Valium) indications

Anxiety disorders
Alcohol withdrawal
hyperexcitability
Agitation
Preop relief of anxiety and tension

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Diazepam (Valium) adverse effects

sedation, drowsiness, depression, lethargy, blurred vision, apathy, mild paradoxical reactions
HTN, hypotension, arrhytmias, respiratory difficulty
urinary retention, loss of libido
withdrawal

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Antidote for diazepam

flumazenil

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action of tricyclic antidepressants

prevents reuptake of 5HT and NE

- exact mechanism in decreasing depression unknown

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uses of Imipramine (Tofranil)

relief of depression
sedative effect for anxiety
might be effective in treating anuresis in children >6 years old
being investigated for treating chronic pain

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side effects of TCAs

anticholinergic effects

- sleep disturbances and decreased libildo

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nursing process for TCAs

abrupt cessation causes withdrawal syndrome

- administer at bedtime

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interactions with TCAs

oral anticoagulants lead to higher serum levels of the anticoagulant and increase risk of bleeding
sympathomimetics or clonidine: risk for HTN and arrhythmias
MAOIs- lead to severe hyperpyretic crisis with severe convusions, HTN episodes and eath
all drugs should be carefully considered when given with TCAs

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MAOIs (monoamine oxidase inhibitors) actions

irreversibly inhibit MAOs

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side effects of MAOIs

more fatal than other antidepressants r/t accumulation of NE in the synaptic cleft
HTN crisis: occipital headache, palpitations, neck stiffness, N/V, sweating, dilated pupils, photophonia, tachy, angina… may progress to intracranial bleeding and fatal stroke
liver toxicity
mania, hyperreflexia, tremors, confusion, insomnia, agitation, blurred vision

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contraindications for MAOIs

insuline, oral antidiabetic agents: additive hypoglycemic effects (monitor closely)
TCAs: can result in life threatening hypertensive crisis
SSRIs: serotonin syndrome… never give at same time

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MAOI diet

-avoid tyramine-containing foods: chocolate, aged foods like cheese, wine, meats

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treatment for hypertensive crisis

Phentolamine (Regitine) or another adrenergic blocker

actions of SSRIs (selective serotonin reuptake inhibitors)

blocks the reuptake of serotonin with little or no effect on NE

adverse effects of SSRIs

not as many adverse effects so its a good first-choice drug
effects are related to increase of 5HT levels
mild GI and GU
Resp: cough, upper resp infections, pharyngitis
CNS: headache, drowsiness, insomnia, anxiety, tremor, seizures (rare)

nursing priorities with pts starting SSRIs

suicide precautions

action of typical antipsychotics

-block dopamine receptors preventing the stimulation of the post-synaptic neurons by dopamine; also suppress the RAS, limiting the stimuli coming into the brain

side effects of antipsychotics

- anticholinergic, antihistamine, alpha-adrenergic blocking effects all related to blocking of dopamine receptor sites - sedation, tremors, EPS, pseudo-parkinsonism, dystonia, akethesia, tardif dyskonisia, NMS

nursing process for typical antipsychotics

- don't crush or chew sustained-release capsules - monitor for glucose intolerance - acute withdrawal syndrome - ice and hrd candies for dry mouth - void before taking if urinary retention is a problem

actions of atypical antipsychotics

block both dopamine and serotonin receptors, helping to alleviate some of the unpleasant neurological effects found in typical

actions of antimanic drugs (lithium)

alters Na+ transport in nerve and muscle cells, inhibits release of NE and dopamine, but not serotonin, from from stimulated neurons; increases the interneuronal stores of NE and dopamine slightly and decreases interneuronal content of second messengers (may allow it to selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state

contraindications of lithium

hyponatremia | s/s: lethargy, slurred speech, muscle weakness, fine tremor, polyuria (renal toxicity), n/v and diarrhea

nursing considerations for lithium

- hold if serum lithium is too high or Na+ is too low - narrow therapeutic range - lots of CNS effects

actions and uses of CNS stimulants

- tricks the brain, gives them stimulation that allows them to think in a rational, calm manner - used for ADD and narcolepsy

actions of phenytoin (Dilantin)

stabilize nerve membranes throughout the CNS directly by influencing ionic channels in the cell membrane thereby decreasing the excitability and hyperexcitability to stimulation

dilantin therapeutic level

10-20 mcg/ml

expected side effects of dilantin

teeth staining and hypertrophy of the gums

actions of succinamides

suppress the normal electrical activity in the brain that is associated with absense seizures

actions of GABA modulators

stabilize nerve membranes: - directly by altering Na+ and Ca+ channels - indirectly by increasing activity of GABA (inhibitory transmitter) thereby decreasing excessive activity

side effects of valproic acid (Depakene)

- BBW for increased suicidality | - can be directly toxic to bone marrow and liver

therapeutic level of carbamazepine (tegretol)

4-12 mcg/ml

side effects of carbamazepine (Tegretol)

suicide, SJS (look for skin issues)

actions of levodopa (Dopar)

treats movement disorders | -crosses the BBB because dopamine normally can't, so meds have to be used to stimulate existing dopamine in the brain

antidote for EPS from neuroleptics

benztropine (Cogentin)

actions and uses of baclophen (Lioresol)

- work in the CNS to interfere with the reflexes that care causing spasm (spasmolytics) - used for spasms/ tension

antidote to morphine overdose

naloxone (Narcan)

actions of Ergots

block adrenergic and serotonin receptor sites in the brain to cause a constriction of cranial vessels and decrease in cranial artery pulsations and decrease in hyperfusion of the basilar artery

big side effect of Ergots

pulselessness, parasthesias, muscle pain

drug interactions of Ergots

beta blockers (risk for peripheral ischemia and gangrene

succinylcholine (Anectine) actions

attaches to the acetylcholine receptor site on the muscle cell causing a prolonged depolarization of the muscle

antidote for succinylcholine (Anectine)

a cholinesterase inhibitor