✅FINAL Flashcards
(167 cards)
1
Q
Wa are the two different phases of inflammation?
A
Vascular phase
Delayed phase
2
Q
Vascular phase
A
Histamine is release, which causes vasodilation which allows all of the healing products and blood to get to the area
Occurs 10-15 mins post injury
Vasodilation, capillary permeability increase, blood substances move from plasma to injury
Why causes swelling
3
Q
Delayed phase
A
Leukocytes infiltrate the tissues and tries to ingulf all the dead tissues to. Get rid of them
4
Q
What are the chemical mediators that are relased during inflammatory response?
A
Prostaglandins
Cyclooxygenase (COX-1, COX-2)
5
Q
Prostaglandins
A
Part of the histamine response as well, causes vasodilation, relaxation of smooth muscle, ↑capillary permeability(so all of those healing products can through the site of injury/infection), ↑ pain sensation (allow body to feel pain)
6
Q
Cycloooxygenase
A
There are cox-1 & cox-2
A shorter pathway that causes inflammation and pain as well
Medications are used to inhibit these
7
Q
COX-1
A
Protects the stomach lining, regulates platelets
8
Q
COX-2
A
Triggers inflammation and pain
9
Q
What is the problem when we use a medication that inhibits COX-1?
A
GI upset, clotting problems because the platelets aren’t being regulated
GI ulcers/ bleeding
If someone has GI problems or bleeding, we would want to use a med that doesn’t inhabit COX-1.
We want to use a med to only inhibit COX-2, because we would want to protect the stomach.
10
Q
What are the different types of Non-steroidal anti-inflammatory Drugs (NSAIDs)?
A
1st generation Salicylates:
Aspirin,Diflunisal (Dolobid)
Salicylate Derivatives:
Dipentum, sulfasalazine
Parachlorobenzoic Acids (Indoles):
Indomethecin(Indocin), Clinoril, Tolectin
Phenylacetic Acid: Voltaren, Voltaren XR, Toradol
Propionic Acid:
Nalfon, Ansaid, Motrin, Advil, Naprosyn, Daypro
Anthranilic acids. (Fenemates):
Meclomen, ponstel
Oxicams:
Feldene, Mobic
Naphthylalkanones:
Relefan
COX-2 Inhibitors 2nd generation NSAIDs:
Celebrex
(Remeber if we onlyinhibit COX-2, doesnt inhibits COX-1, this will help protect the stomach or causes less damage to the stomach while relieving pain and inflammation)
11
Q
Aspirin (ASA)
A
Class: anti-inflammatory , analgesic
Salicylates prototype: Aspirin(ASA), Bayer, Ecotrin, Astrin
Also known as an Antiplatlet, decreases fever
Reduces inflammation & fever and inhibits aggregation of platelets
MOA: inhibit prostaglandins synthesis, inhibits COX 1&2 (so we need to worry about ulcers and gastritis because of inhibit of COX-1), inhibition of hypothalamic heat regulator center
12
Q
What are the contraindications of using Asprin?
A
Remebr if anyone has an allergy to salicylate; should not be using
If anyone is allergic to aleve, Motrin, ibuprofen, should not be using asprin
In children that are younge than 13 yrs old, we do not give them asprin; could be deadly, organ failure,
Also shouldn’t use in pregenat omen in their 3rd trimester
Caution in those who has renal failure
13
Q
what are the side effects of Asprin
A
N/V/D, dizziness, confusion, hearing loss, heartburn, rash, stomach pains, drowsiness, anorexia
Advers: *tinnitus (could be a sign of asprin toxicity), urticaria , ulceration
Life threatening: *hemolytic anemia, *bronchospasm and *anaphylaxis if they an allergy, *thrombocytopenia, hepatotoxity, leukopeniam agranulocytosis
14
Q
Why would someone experience drowsiness with Asprin?
A
Bleeding; someone can experience slow bleeds;if someone is taking it everyday , lead to bleeds and they can experience drowsiness and fatigue. Anemic
15
Q
What are the nursing considerations of Salicylates ASA, Ecotrin, Bayer, Astrin?
A
Do not take with ETOH (its very irritating to the stomach; at risk for ulcers)
Discontinue 5-7 days prior to surgery (if indicated; especially if they have cardiovascular disease; we will continue to take med)
Keep out of reach of children
Do not give to children with flu-like symptoms (Reyes
syndrome can cause death)
May cause GI upset: take with food
Report side effects such as drowsiness, tinnitus, HA,
flushing, dizziness, GI symptoms
16
Q
Ibuprofen (Advil, Motrin)
A
Class: non steroidal anti-inflammatory (NSAID), Propionic Acid derivative
Very good inflammatory
They still inhibit COX-1, however they do not inhibit that much and not as acidic as Asprin; this can be be less upsetting for someone that has gastritis or hxs of ulcers
MOA: inhibition of prostaglandins synthesis, relieve pain and inflammation, *less GI effects than ASA
Therapeutic effects: to reduce pain anti inflammatory effect of arthritic conditions, reduces fever
17
Q
What are the contraindications of Ibuprofen (Advil, Motrin)
A
Severe renal or hepatic disease, asthma, peptic ulcer
Can go into renal failure
Caution: bleeding disorders, pregnancy/lactation, SLE (systemic lupus)
18
Q
What is the BLACKBOX warning with Ibuprofen (Advil, Motrin)?
A
Pts that have a hxs of cardiovascular disease or strokes; shouldn’t be taking this because it will increase risk of getting a stroke or heart attacks.
19
Q
Side effects of Ibuprofen (Advil, Motrin)
A
N/V/D, anorexia, tinnitus , fatigue, dizziness,lightheadedness, anxiety, confusion, fluid retention with edema, rash
Take with food to avoid GI upset
Adverse: GI bleed
Life threatening: blood dycrasias, cardiac dysrhythmias, nephrotoxicity, anaphylaxis
20
Q
What are the nursing considerations of NSAID’s (Ibuprofen)?
A
Observe for signs of bleeding especially with AC use
Take with food to reduce GI discomfort Avoid concomitant use with ASA and acetaminophen
Avoid ETOH to reduce ulcer risk
Inform dentist or surgeon of use prior or procedures
Do not take if pregnant or breast feeding
21
Q
Celebrex
A
Class: NSAID COX-2 inhibitor
(Doesn’t inhibit COX-1; it’ll be better for pts with hxs of gastritis or stomach ulcers).
Indications: to treat osteoarthritis, rheumatoid arthritis, relieve dysmenorrhea
MOA: inhibits COX-2 (inhibits prostaglandin synthesis and inflammation)
PO 100mg-200mg daily or BID
22
Q
What is the BLACKBOX warning for Celebrex?
A
Increase risk of stroke and MI
23
Q
what are the contraindications of Celebrex?
A
Hypersensitivity, severe hepatic disease, anemia advance real disease, concurrent use of diuretics and ACE inhibitors
Caution: those who has renal or hepatic dysfunction, HTN, fluid retention, HF, infection, H/O bleeding or ulcer, concurrent AC/steroid or ETOH
24
Q
Side effects of Celebrex?
A
HA, dizziness sanity’s, nausea, flatulence, diarrhea, rash
AdversE: peripheral edema
25
What are the drug interactions with Celebrex?
↓ effect of ACE inhibitors, ↑ INR and GI bleeding when combined with warfarin, may↑ toxicity when used with lithium, fluconazole, ↑ celecoxib levels
26
Indomethacin (Indocin)
Class: anti-inflammatory agent, Para-Chlorobenzoic Acid
(A group of meds that treats gout, Rheumatoid arthritis or osteoarthritis)
Think of “Indo Gout”
These are hIGHLY protein bound, can result in toxicity
Irritating to the stomach ; take with food
Medications with less side effects: Sulindac (clinoril), tolemtin (Tolection)
27
Diclofenac sodium (Voltaren)
Class: anti inflammatory agent, phenylacetic acid derivatives
Decreases inflammation RA, OA, ankylosis spondylitis
PO, extended release
28
Ketorolac Acud (Toradol)
Class: ant inflammatory, phenylacetic acid derivative
Inhibits prostaglandin synthesis, greater anti-inflammatory effects
Indicated for post-surgical pain
29
Piroxicam (Feldene)
Class: anti inflammatory, an oxicam
For long-term arthritic conditions such as RA, OA
Lower incidence of GI distress than other NSAID’s
May take effect after 1-2weeks of using
We can usually use corticosteroids to help the pt feel better ; usuallly have to taper them off
30
Immunoladulator (tumor necrosis factor blocker)
Changes the immune response; use for pts that have autoimmune disorder; decreases the inflammatory response by descresing the immune response
Ex: rheumatoid arthritis
31
Infliximab (Remicade)
Class: immunomodulator
Use to treat moderate to severe rheumatoid arthritis and Crohn’s disease
32
Side effects of infliximab (Remicade)
HA, dizziness, coughing, fatigue, hot flashes, anxiety,m insomnia, D/V/C, rash, alopecia, urinary frequency
Adverse: severe infections (because of the decrease in immunity), chest pain, hypotension, HTN, increase LFT
33
Contraindications of infliximab (Remicade)
Hypersensitivity, Heart failure
Pts can go into renal or renal failure
Caution; renal or hepatic dysfunction, immunosuppression, MS, elderly
34
Concurrent immunosuppressives may increase _____?
Risk of infections
Have to stay away from large crowds, be
35
Tumor necrosis factor blocker/immunomodulator decrease the effect of what?
Decreases the effectiveness of vaccines
36
Gout
Inflammatory condition that attacks joints, tendons and other tissues
/ basically arthritis in the smaller joints (ex:big toe)
Most common site of attack is the great toe
Increased uric acid levels due to:
Uric acid metabolism disorder
Defect in purine metabolism
Appears as bumps (tophi) in Hands elbows and large toe
Can evolve into gouty arthritis, urinary calculi, gouty neuropathy
37
What to do when have gOUT
↑ Fluid intake
Avoid foods rich in purine ( etoh(beer), organ meats, sardines, salmon, gravy)
Avoid ASA
Increase uric acid production)
38
Allopurinol (Zyloprom, Aloprim, Apo-allopurinol)
Class:anti gout drug; uric acid biosynthesis inhibitor
Indication: to treat gout and hyperuricemia, prevent urate calculi, prophylaxis treatment for gout. Can be used for renal impairment pts, renal obstruction (stones)
MOA: reduction of urc synthesis, lowers uric acids levels preventing gout attack
39
What are the side effects of Allopurinol (Zyloprom, Aloprim, Apo-allopurinol)
Stomatitis, metallic taste in their mouth, anorexia, N/V/D, rash, HA, dizziness
Adverse: cataracts, retinopathy
Life threatening: bone marrow depression, aplastic media, thrombocytopenia, agranulocytosis, leukopenia
40
What are mainly concern about when taking allopurinol (Zyloprom, Aloprim, Apo- allopurinol)
Increases the formation of cataracts if they are taking it for long periods of time
41
What are the contraindications of allopurinol (Zyloprom, Aloprim, Apo- allopurinol) ?
Hypersensitivity, severe renal disease
Caution: hepatic disorder
42
Colchicine
Class: anti gout drug
MOA: inhibits the migration of leukocytes to the inflamed site
Indications: relief of acute gout symptoms, it is. Used for prevention
Contraindications: severe renal, cardiac or GI issues
Side effects: GI irritation; take with food
43
What are the nursing considerations of Antigout?
Monitor I&Os (pts can cause kidney stones; which causes urinary retention; pay attention to urine outflow)
Report GI symptoms (gastric pain, N/V/D)
Take with food to avoid GI upset
Monitor Cr and LFT’s
Increase fluid intake to promote drug and uric acid excretion
Aoid ETOH ,caffeine, avoid large doses of Vitamin C
Avoid foods high in purine sardines, salmon, organ meats, gravy, legumes)
44
What is the bigges side effect pts complain about while on colchicine?
GI upset; take with food
45
Nociceptors
Sensory receptors that are activated by painful or noxious (harmful) stimulation in the peripheral tissues
(Mechanical. Thermal Chemical)
46
What does pts have to be careful about when taking anti cancer drugs?
Can compromise the immune system:
Becareful with taking vaccines
Cant take LIVE vaccines
Cant be around people for weeks if they just received a live vaccine
Cant be aroud people
Use aseptic techniques
Cant be around people that are sick
RBC and WBCs can be destroyed because of meds, consider giving blood
N/v
47
What is the big picture for ALL AntiCancer meds?
Drop in WBCs RBC & platelets (we would worry about infections; always have good hygiene)
Worry about the IV site; can cause necrosis if infiltrate
Cardio toxicity
Pregnancy category D
Nausea, vomiting and diarrhea (may have to give an antiemetic or Antidiarrheal)
48
Cyclophosphamide (Cytoxan)
Class: AntiCancer med
The big picture to remember is Cytoxan causes hemorrhagic Cystitis
Think of “Cytoxan Cystitis”
Means the bladder gets inflamed and starts to bleed;
49
What do we tell pts who are taking Cytoxan?
To urinate frequently, so the metabolized meds are not sitting in the bladder. Also, drink lots of fluid to dilute their urine so it wont be so irritating to the bladder.
50
What do we have to MAINLY look out for with Cyclophosphamide (Cytoxan)?
cardio toxicity in HIGH doses
We have to watch the heart function via Echo
51
Nursing considerations of Cyclophosphamide (Cytoxan)
Assess CBC, plts (may hold med if levels are too low)
Handle drug with care( avoid direct contact with skin, eyes, mucous)
Monitor IV site frequently for irritation and phlebitis
Administer Anti-emetic 30-60 mins before giving Drug
Hydrate pt with IV and oral fluids prior to administration
Monitor bun/cr
Dont give the drug at night; nocturia
52
What do we teach the pt taking Cyclophosphamide (Cytoxan)?
Maintain good hygiene Take early in the day to prevent accumulation of drug in bladder at night Consult with oncologist before getting vaccines Drug is excreted in breast milk
Testicular atrophy and reversible oligospermia/azoospermia may occur in men Avoid pregnancy for 3-4 months after completing treatment Avoid others with respiratory infections Report signs of infection immediately
53
Doxorubicin (Adriamycin)
Class: Antitumor Antibiotic
54
Vincristine (Oncovin)
Class: Plant alkaloids; AntiCancer
We have to worry about peripheral neuropathy
And loss of DTR (deep tendon reflexes)
55
Liposomal Chemotherapy
AntiCancer
New med
Packed in a fat capsule and taking orally’ slow release
Allows drug to remain the system longer, decreased side effects ; increased. Therapeutic effects
56
Corticosteroids
Class: hormonal angent
Help slow the growth of a tumor through anti-inflammatory effects /decrease the inflammation of the tumor; and that can help prevent the tumor from hurting so much
Give pts a sense of euphoria; gives them energy.
57
Bio therapy agents
Monoclonal antibodies
Vaccines
58
Monoclonal antibodies
Help treat against cancers
It recognizes proteins on specific cancer cells
59
Vaccines
Used to prevent ca
Ex: he B, Gradisil, Cervarix
60
Fluorouracil, 5 fluorouracil, 5-FU (Adrucil)
Class: antimetabolites; AntiCancer
Worried about tots getting cardiotoxicity as well
61
rituximab (Rituxan)
Class: monoclonal antibody; AntiCancer
Cardiotoxicity we worry a bout as well
62
Biological Response Modifiers
These are med that will helo us increase those blood cells that were destroyed during chemotherapy
Enhance host immunologic function Destroy or interfere with tumor activities
Promote differentiation of stem cells
63
Erythropoietin (Epogen, Procrit, Eprex)
Class: biological response modifiers
Originally produced in the kidneys
Help increase the RBC and WBC
while on chemotherapy
We dont try to get them back to normal Hemoglobin levels, just to level 10 no higher than 12 ; If increased too high, risk for MI/CVA
/
Serious cardiovascular and thromboembolic events if target Hemoglobin of 12g/dl exceeded
64
Neurogenic/Neulasta
Class: Biological Response Modifiers
Increase the WBC
May use for pts who has leukopenia while taking chemotherapy meds
65
What do you need to worry about with pts who are taking Epogen?
SOB, fatigue, HTN, and seizures
Life therenating : MI, CVA
66
Nursing considerations for erythropoietin (Epogen)
DO NOT SHAKE bottle, shaking may denature the preparation
Vial has no preservatives only one use per vial/ one time use vials
Use smallest amount per injection
Do not use the same needle to draw or put through the stopper and inject medication.
Change needle in between.
67
Filgrastim (Neupogen)
Class: Granulocytes colony-stimulating factor
Increase WBC; helps with pts that have leukopenia
68
What are the side effects of taking Filgrastim (Neupogen)?
*Pain, shakes
Give acetaminophen or benadryl for pain and shakes
69
Sargramostim (Leukine)
Classs: Granulocytes macrophage colony stimulating factor
Increase of bone marrow activity
For pts that are taking chemotherapy drugs that decreased their bone marrow activity
Fatigue, chills,
Worry about pleural/pericardial effusion
70
What are the nursing considerations for pts who take biological response modifiers?
Monitor temperature at onset of chills, meperidine maybe given to decrease rigors Pre-medicate with acetaminophen, diphenhydramine(Benadryl) to reduce chills, fever, nausea
Maintain hydration Only one dose per vial
71
Neuropathic pain
When pts have problems with nerve endings
Often describe it as Burning, tingling or electric shocks (usually see in pt with diabetic neuropathy)
May be place on anticonvulsants to stabilize pathways and decrease pain.
72
What are the natural suppressors of pain?
Endorphins
(Can be relased during excerise (gives a high))
Cortisone’s
73
Endorphins
Suppresses pain conduction (opioids)
74
Cortisone
Decreases the production of prostaglandins and Leukotrienes/ decrease phospholipase
75
Acetaminophen (Tylenol, Robigesic)
Class: Non-opiod analgesics
Indications: decrease pain and fever
MOA: inhibition of prostaglandins synthesis, inhibition of hypothalamic heat regulator center.
Side effects: anorexia, N/V, rash
Adverse reaction: severe hypoglycemia, oliguria, urticarial
76
What do we worry about when someone takes Tylenol inappropriately?
Hepatotoxicity / over disease
They can die within 4 days
77
What are the contraindications in acetaminophen (Tylenol, robigesic)
severe hepatic or renal disease, alcoholism,
hypersensitivity
78
What are the nursing considerations of acetaminophen (Tylenol,robigesic)?
• Keep out of reach from children high doses cause
hepatoxicity
• Do not take loner than 10 days, 5 days for children
• Call poison control when child has taken large or unknown
amount
• Death from hepatotoxicity within 1-4 days
• Do not take more than 3,250mg/day (adults)
79
Opioid analgesics
They are narcotics
High incidence of addiction & tolerance & respiratory failure we worry about
Act by suppressing pain impulses as well as respiration and cough centers in the medulla, Antidiarrheal effect (can cause constipation)
80
Morphine sulfate (MS Contin, Roxanol)
Class: opiod analgesic
Indications: relieve severe pain
Its ually a PRN med
MOA: depression of CNS, depression of pain impulse by binding with the opiate receptor in the CNS
Crosses the placenta and excreted in breast milk
81
What do we worry about with Morphine sulfate (MS contin, roxanol)
Respiratory depression , constipation & increase intracranial pressure
82
Side effects of Morphine sulfate (MS contin, roxanol)?
Anorexia, *N/V/C, drowsiness, dizziness, sedation, confusion (it is centrally acting), urinary retention, bradycardia, flushing, euphoria
Adverse: hypotension, urticaria, seizures
83
Drug interactions with Morphine sulfate (MS contin, roxanol)
↑ effects of etoh,
sedatives, hypnotics ↑ effects of etoh,
sedatives, hypnotics, Antipsychotics, muscle relaxants
And any other meds that decreases CNS cause a major effects
84
Contraindications of
Morphine sulfate (MS contin, roxanol)
asthma with
respiratory depression, increased
intracranial pressure, shock
Caution: respiratory renal or
hepatic disease, myocardial
infarction, older adults and young
children (they have increase effec of medication)
85
What are the nursing considerations of Morphine Sulfate (MS Contin, Roxanol)
• Administer before pain reaches peak
• Monitor vital signs, RR< 10 can
indicate distress
• Measure urine output
• Monitor for constipation
• Narcan is an antidote for
overdose
• Avoid ETOH and other CNS
depressants
86
What is the antidote for morphine?
Narcan
It is and antidote for overdose
87
Meperidine (Demerol)
Class: Opioids
Indications: pain relief, beneficial in GI procedures
Not that much CNS depressant
Can decrease the bP significantly
Less constipation and urinary retention
Do not use for longer than 48-72 hrs
Monitor for hypotension
88
Hydromorphone (Dilaudid)
Class: semisynthetic opioid
Analgesic effect 6Xs MORE potent than morphine; fewer hypnotic effects and less GI distress
PO/SQ/IM/IV
Quick acting
This is the only med that you dont talk about in their generic name because the spelling is similar to morphine; call them ‘Dilaudid’ the brand namein the hospital.
89
Naluphine (Nubian)
Class: opioid
Indications: to relieve moderate to severe pain
Utilize in procedures
IV/IM
MOA: inhibition of pain impulse transmitted in CNS by binding with opiate receptor and increasing pain threshold
Narcan can be used to reverse the overdose
90
What are opioids contraindications across the board?
Be careful with anyone with hxs of drug abuse
91
What are the side effects of Naluphine (Nubian) ?
Dizziness, confusion, hallucinations, blurred vision, HA, flushing, sedation, nervousness, bitter, hypotension, dyspnea
Adverse: bradycardia. Tachycardia, resp. Depression
Life threanting: resp. Depression
Caution: H/O drug abuse, emotional instability, impaired respirations, increased ICP, Hillary tract surgery, renal or hepatic dysfunction
Drug interactions: CNS depression
92
Patient controlled analgesic (PCA)
Constant delivery of pain meds ; theres a prescribed amount
Typically has morphine, fentanyl, and Dilaudid
Maintains constant analgesic level, avoiding episodes of
severe pain and over sedation
93
Duragesic (fentanyl)
Class: opioid analgesic
Transdermal
For chronic pain 24hr pain control
Change patch every 24 hours
Also available IV/IM
94
When should pts stop taking opioids across the board?
After 48-72 hours
95
What are the prophalatic meds for migraines?
Prevention:
Beta-adrenergic blockers (Inderal, Tenormin)
Anticonvulsants (valporic acid), Neurontin
TCA (Elavil, trofranil)
96
What are the treatment or cessation for migraines?
Analgesics, opioid analgesics (last resort), ergot alkaloids, SSRA (Triptans)
97
Sumatriptan (imitrex)
Class: 5-HT1 receptor agonist;
Utilize to help relieve migraines symptoms
Not used for everyday use
MAO: causes vasoconstriction of the cranial arteries (pts with stroke, HTN, cardiovascular, glaucoma, and diabetes shouldnt use)
PO/SUBQ/Intra nasal
Patients that have aura/or know when they are getting a migraine, they should take one; easier to treat
98
What are the side effects of Sumatriptan (imitrex)?
Dizziness, fainting, tingling, numbness, drowsiness, muscle cramps, N/V/D, abdominal cramps
Adverse: hypotension, HTN, heart block, dysrhythmias, angina, thromboembolism, seizures
Life threatening: coronary artery vasospasm, MI, cardiac arrest
99
what are the contraindications of Sumatriptan (imitrex)?
hypersensitivity, CAD , HTN, obesity, DM, smoking
Caution: liver or renal dysfunction
100
Schizophrenia
There are positive symptoms and negative symptoms
101
Positive symptoms of schizophrenia
Exaggeration of normal function/
Incoherent speech Hallucinations
Delusions
paranoia
102
Negative symptoms of schizophrenia
Decrease or loss of function or motivation/Withdrawing form interactions
Loss of speech
Poor self-care (not brushing their hair, bathing ect.)
Social withdrawal
103
What are the different types of antipsychotic agents?
Typical antipsychotics
&
Atypical
These meds are CNS acting; sedation
All antipsychotics block D2
104
Typical antipsychotics
Example: Phenothiazines /
Nonphenothiazine
Blocks norepinephrine causing sedative hypotensive effects when started
Ex: chlorpromazine HCL (Thorazine) Fluphenazine HCL (Prolixin) Trilafon, Mellaril
(Yes they all end in ‘azine’ but these has different structures than the antiemetics)
105
Atypical Antipsychotics
Example: Clozapine
1st line treatment for schizophrenia due to *decreased side effects
Good for use in other psychotic disorders that doesn’t respond to typical antipsychotics
Less EPS than typical
(Weak affinity for D2; strong affinity for D4)
Ex: Clozaril, Zyprexa, Risperdal, Abilify, Seroquel
106
Dopaminergic antagonists
Block the action of dopamine
There are 5 types of dopamine receptors (D1-D5)
D4 helps decrease the antipsychotics (serotonin receptor)
107
D2 receptor promotes what?
D2 receptors promotes Extrapyramidal Syndrome (EPS)
108
Extrapyramidal Syndrome
Resembles Parkinson’s / pseudoparkinsonism
Stooped posture Mask-like face Rigidity Rest tremors Shuffle gait Pill rolling Bradykinesia
109
What are the adverse reactions of antipsychotics?
EPS
Acute dystonia: muscle spasms of face, tongue, back and neck, facial grimacing, abnormal upward eye movement, laryngeal spasms that can impair respiration.
Akathisia: difficulty standing still, restless, paces floor
Tardive dyskinesia: protrusion and rolling of tongue, sucking and smacking movements of lips, chewing motion, involuntary movement
Neuroleptic malignant syndrome: Rare, potentially fatal condition associated with antipsychotic drugs (Symptoms Muscle rigidity Sudden high fever Altered mental status *Labile Blood pressure -bp gets really high and low* Rhabdomyolysis, ARF, RF, coma)
110
Phenothiazine
Class: typical antipsychotic
111
Fluphenazine (prolixin)
Class: typical antipsychotic, phenothiazines
Indications: to mange symptoms of psychosis/schizophrenia
MOA: blocks dopamine receptors in the brain and control psychotic symptoms
Po/IM
112
What are the contraindications of Fluphenazine (Prolixin)?
Brain damage, renal/liver damage, coma (we are further depressing the CNS)
113
What are the side effects of Fluphenazine (Prolixin)
Sedation, dizziness anticholinergic side effects (dry mouth, blurred vision, N/C, urinary retention, nasal congestion
Remember this is a typical antipsychotic so you will see more of the EPS syndrome (look at cared 109
Advers reaction: HTN, hypotension (see more of this), tachycardia, EPS symptoms (tar dive dyskinesia), impaired thermal regulation, convulsions
Life threatening: agranulocytosis
114
What are the drug interactions of Fluphenazine (Prolixin) ?
Remeber this med is already decreasing CNS; we dont want the to take another CNS depressant to further depress it.
EX: ETOH
Kava kava may increase dystopia
115
Kava Kava increases what when taken with Fluphenazine (Prolixin) ?
Increases dystonia
116
Nonphenothaizine
Class: Typical antipsychotic
117
Haloperidol (Haldol)
Class: typical antipsychotic, nonpenothiazine
Indications: to treat acute and chronic psychoses, to treat children w/ severe behavior problems, to treat schizophrenia resistant to other drugs, to treat Tourette syndrome, treat symptoms of dementia in older adults.
MOA: alteration of the effect of dopamine on CNS
118
What are the side effects of Haloperidol (Haldol) ?
*Sedation; CNS depression
EPS symptoms, *orthostatic hypotension, HA, photosensitivity, dry mouth and eyes, blurred vision (anticholinergic effcets and CNS depression effect
Adverse: tachycardia, seizures, urinary retention
Life threatening: larnygospasm, resp. Depression, cardiac dysrhythmias, *neuro malignant syndrome, agranulocytosis
119
What group of medications do you see less ESP symptoms?
AtypicalPsychotic medications
120
Risperidone (Risperdal)
Class: atypical antipsychotic
Indications: to manage symptoms of schizophrenia/psychosis
MOA: interferes with the binding of dopamine to D2 and 5-HT2 receptors
This medications causes LOTS of sedation
PO
121
Whats the issue with Risperidone (Risperdal)?
Its very very sedating; even family members complain that they sleep for a few days
Think of Ris for Rest
122
Aripiprazole (Abilify)
Class: atypical antipsychotics
Indication: manage symptoms of psychosis and schizophrenia
MOA: interferes with the binding of dopamine to D, and the serotonin 5-HT receptors
A med taht can be used everyday
123
What are the side efcts of Aripiprazole (Abilify) ?
Again, sedation and confusion, anticholinergic effcts; Sedation, weight gain, HA, fatigue, photosensitivity, blurred vision, sexual dysfunction, alopecia, amenaorrea, agitation
Since this med can be used everyday, they will experience thes side effects but will get used to it after awhile or develop a tolerance on the side efcts
Adverse: Orthostatic hypotension, HTN,bradycardia, tachycardia, EPS, convulsions
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What is the life threatening reaction of
Suicidal ideation; will increase the risk of them actually committing suicide
&
Neuroleptic malignant syndrome
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What is neuroleptic malignant syndrome?
Rare,
Potentially fatal condition associated with antipsychotic drugs
Symptoms: muscle rigidity, sudden high fever, altered mental. Status, labeled blood pressure, rhabdomyolysis 9the destruction of muscle cells), coma
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What are the drug interactions of Aripiprazole (Abilify)?
Antidiabetic agents name cause hypoglycemia
People who are taking anti hypertensive meicyaions or other antipsychotics can increase the risk of exacerbating the hypotension and
taking lots of antipsychotics can intensify the neuroleptic malignant syndrome, anticholinergic effects, sedation effects, EPS symptoms
Grape juice may increase blood levels, ST johns wort may decrease blood levels.
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What’s re the nursing considerations of antipsychotics?
Monitor for orthostatic hypotension
Make sure patient has swallowed pill
Observe for EPS
Make take 6 weeks or longer for full clinical effect
Do not discontinue abruptly
Avoid CNS depressants, ETOH
Maybe be excreted in breast milk Wear medi-alert bracelet
Tolerance to sedative effect develops over a few weeks
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Benzodiazepines
Class: anxiolytic
Used for severe or prolonged anxiety
ex: alprazolam (Xanax), clorazepate HCL (Librium), diazepam (valium) Ativan
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Lorazepam (Ativan)
Class: anxiolytic, benzodiazepine
Indications: to control anxiety, treat status epileptics, preoperative sedation
MAO: inhibiting GABA
Think of lora’ZE’pam in benzodia’ZE’pines
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What are the side effcts of lorazepam (Ativan)
Central acting
Drowsiness, dizziness, weakness, confusion, blurred vision, N/V/A, sleep disturbance, restlessness, hallucinations
Adverse: hypotension
Cautions in those who hae a hepatic or renal dysfunction, suicidal
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what are the contraindications on those who are taking lorazepam (Ativan) ?
If they have CNS depression; dont want to further depress it with the med., shock, coma, narro-angle glaucoma, pregnancy, lactation
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What we cannot do with benzodiazepines?
We cannot give anymore refills to pts; Can be abused or commit suicide with
Only a 30 day supply;
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ISTOP
It is a tool when prescribing narcotics; and it pulls up hxs of narcotics they had in periods of time. Have to document. Stops them form hopping form different physicians to get prescriptions
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What are the drug interaction with lorazepam (Ativan) ?
Drugs taht increases CNS depressioN; EX; ETOH
CNS DEPRESSANTS, ANTICONVULSANTS
Kava may potent the sedation
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What is an antidote for lorazepam (Ativan) ?
Flumazenil (Mazicon)
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Buspirone (Buspar)
Class: anxiolytic
May take up to 1-2 weeks to become effective
Less sedating and dependency
Has interaction. With grapefruit juice
Limit 8 oz grapefruit juice to avoid toxicity
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What are the nursing considerations of anxiolytics?
Do not use for more than 2-4 months (dependence/tolerance) Use lower doses for elderly, children
Monitor for orthostatic hypotension
Avoid operating vehicle or dangerous equipment
Avoid ETOH and other CNS depressants
Make take 1-2 weeks for drug to take effect Do not stop abruptly
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what are the herbal supplements for depression?
St. John’s wort
Ginkgo Bilbao
Discontinue both 1-2 weeks before surgery
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What are the different type of antidepressants?
Tricyclic Antidepressants Amitriptyline(Elavil), clomipramine (anafranil), imipramine(Tofranil)
Selective Serotonin Reuptake Inhibitors (SSRI’s) Citalopram (Celexa), fluoxetine( Prozac), fluvoxamine (luvox), Paxil, Zoloft
Atypical (Heterocyclic) Antidepressants Amoxapine (Asendin), bupropion (Wellbutrin), venlafaxine (Effexor), MAOIs
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Tricyclic antidepressants
Used to treat major depression
Action: block the uptake of neurotransmitters norepinephrine
and serotonin in the brain
Takes 2-4 weeks to have therapeutic effcts
Discontinue gradually. To avoid withdraw symptoms such as nausea, vomiting and anxiety
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Amitriptyline HCL (Vanaptrip, Apo-Amitriptyline, Elavil)
Class: Tricyclic Antidepressants
Indications: treat depression with or without melancholia, manic and depressive phases of bipolar disorder, depression associated with organic disease, alcoholism, migraine headaches, mixed symptoms of anxiety and depression, or urinary incontinence
Think of amiTRIptyline in TRIcylic
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There are lots of drug-to-drug interactions with which med?
Tricyclic antidepressants
&
MAO
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What are the common side effect with amitriptyline HCL (Vantarip, Amitriptyline)
*Sedation *drowsiness, (slowing brain activity) anticholinergic-like side effects: nervousness, blurred vision, metallic taste, dry mouth, and eyes, urinary retention, constipation, weight gain, N/A increased intraocular pressure
Adverse Reactions: Orthostatic hypotension, cardiac dysrhythmias, extrapyramidal symptoms
Life-threatening: Agranulocytosis, thrombocytopenia, leukopenia, seizures
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Majority of antidepressants treat….
Depression with or without melancholia, manic and depressive phases of bipolar disorder, depression associated with organic disease, alcoholism, migraine headaches, mixed symptoms of anxiety and depression, or urinary incontinence
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What are we worried about with TCAs?
EPS symptoms, as well
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What are the contraindications of Amitriptyline HCL (Vantatrip, Apo-Amitriptyline) ?
Anyone that has a acute MI, taking MAOIs (there has to be a 14 days of not taking), cardiac dysrhythmias
Caution: *Severe depression w/suicidal tendency, cardiovascular, liver or kidney dysfunction, narrow angle glaucoma, seizures, prostatic hypertrophy, DM, hyperthyroidism
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Hat so we worry about with ALL antidepressants?
Suicidal ideation
Once they are treated, they may get the energy to commit suicide
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What are the drug interactions of Amitriptyline HCL (Vantatrip, Apo-Amitriptyline)
Any other medications that ↑CNS respiratory depression, hypotension with ETOH ↑ sedation and anticholinergic effects with phenothaizines and Haldol
Hypertensive crisis and death may occur with MAOI’s
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What two meds taken together can cause hypertensive crisis?
MAOIs and Tricyclic antidepressants
Do NOT take with MAOI, wait 14 days after discontinuing MAOI’s before starting
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Selective serotonin reputable inhibitors
Block the reuptake of serotonin into the terminal nerve of the CNS
More commonly used than TCA’s because less side effects
Can be used for: Major depressive disorder Anxiety disorder
OCD
Panic/Phobias PTSD
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Fluoxetine (Prozac)
Class: Selective Serotonin Reuptake Inhibitors (SSRI)
Indications: to treat depression with or without melancholia, manic and depressive phase of bipolar disorder, depression associated with organic disease alcoholism, migraine headaches, mix symptoms of anxiety depression or urinary incontinence
PO onset 2-4 weeks
SSRI ends in “oxetine”
“SIR OXETINE!!”
“Prozac Mood Brightener :D”
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What are the side effects of Fluoxetine (Prozac)?
Headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, sexual dysfunction
Adverse: Adverse Reactions: Seizures, *hyponatremia, palpitations, chest pain
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Anyone that has an MI cannot take what?
Antidepressants in general
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Venlafaxine (Effexor)
Class: antidepressant, serotonin and norepinephrine reuptake inhibitor
Treats major depression, & anxiety
MOA: Serotonin and Norepinephrine are increased in nerve cells because of blockage from nerve fibers
Do NOT take with MAOI, wait 14 days after discontinuing MAOI’s before starting
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MAOI
Class: antidepressant
Relieve symptoms of depression
MOAI’s inhibit monoamine oxidase therefore increases levels of norepinephrine, dopamine, epinephrine and serotonin
Haas LOTS of drug-to foood- to-drug interactions
Usually the LAST result
Increase risk of hypertensive crisis `
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Side effects of MAOIs
agitation, restlessness, insomnia, orthostatic hypotension
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Hat do we worry about with MAOI
They cannot take other meds that are sympathomimentic; can lead to MI or hypertensive crisis
Ex: taking a cough medicine
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What to worry about with MAOIs?
Hypertensive Crisis resulting from food and drug interactions
DO NOT TAKE WITH TCA’s
Do not mix with sympathomimetics or CNS stimulants (vasoconstrictors, cold medicines containing phenylephrine and pseudoephedrine)
Frequent BP monitoring for hypertensive crisis
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Food to avoid with MAOIs
Cheese
• Bananas, Raisins
• Pickled foods
• Red wine, beer
• Cream, yogurt
• Chocolate, coffee
• Italian green beans
• Liver
• Yeast
• Soy sauce
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What are the nursing considerations of antidepressants?
Observe for signs and symptoms of depression/suicidal
ideation
Monitor for orthostatic hypotension If pt taking anticonvulsant monitor for seizures (decrease
effectiveness)
Tell pt to avoid certain foods if taking MAOI’s (see previous
slide)
When taking MAOU’s monitor BP for hypertensive crisis
Avoid ETOH
Check with MD/pharmacist before taking herbal drugs
Do not drive until drug stabilized
Do not stop abruptly
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Mood stabilizer
Used to treat bipolar disorder
Lithium is most used
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Lithium (Eskalith, Lithane,Lithonate, Lithobid)
Class: mood stabilizers
Lithium is mostly used
Calming effect w/o impairing intellectual activity
Controls evidence of flight or ideas and hyperactivity
PO desired effect may take 5-6 days Therapeutic Drug range 0.5-1.5meq/L
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What happens when stop taking lithium?
Manic behavior occurs
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What are the side effects of lithium?
Side Effects: HA, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, D/V, polyuria, hypotension, abdominal pain, muscle weakness, restlessness
We are slowing down that brain activity
Adverse Reactions: urinary incontinence, *hyponatremia, clonic movements, stupor, azotemia, leukocytosis, nephrotoxicity
Life threatening: Cardiac dysrhythmias, circulatory collapse
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What type of losses happen while taking lithium?
Sodium and urine loss
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What are the contraindications of Lithium?
Liver and Renal disease, pregnancy, lactation, severe cardiac disease, severe dehydration, brain tumor or brain damage, sodium depletion, children<12
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What are the nursing considerations of lithium?
Watch for S&S toxicity Monitor for depression/suicidal tendencies When drawing blood levels check immediately before next dose (8-12hrs after last dose)
Monitor weight and urine output
Maintain adequate fluid intake (2-3L/day initially, then 1-2L maintenance) Take with meals to decrease GI distress
Full effect may not before 1-2 weeks Compliance with med is important
