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Medications Flashcards

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1
Q

Where is Serotonin Synthesized

A

in brainstem but also GI tract

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2
Q

What is Serotonin involved in?

A

Mood regulation (stabilization, happy, calm), sleep, appetite (primarily reduces) and cognition

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3
Q

What disorders are common with Serotonin Imbalances?

A

Depression, anxiety, Schizophrenia and OCD

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4
Q

Where is Dopamine produced?

A

Substantia nigra

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5
Q

What is Dopamine involved in?

A

motor control, motivation, rewards, and cognitive functions

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6
Q

What disorders are associated with dopamine imbalances?

A

Parkinson’s disease, schizophrenia, ADHD, and SUD

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7
Q

Where is oxytocin made and released?

A

made in hypothalamus and released by pituitary gland

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8
Q

What is oxytocin involved in?

A

social bonding, sexual reproduction, childbirth, and postnatal period

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9
Q

What disorders are associated with an oxytocin imbalance?

A

Autism, schizophrenia, mood disorders, anxiety, and eating disorders

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10
Q

Where are endorphins produced and released?

A

made in hypothalamus and released in pituitary gland

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11
Q

What are endorphins involved in and what do they mimic?

A

Function as endogenous opioids by binding to mu receptors (pain relief and euphoria)

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12
Q

What disorders are associated with endorphin imbalances

A

stress-related disorders like depression and PTSD

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13
Q

Where is norepinephrine synthesized?

A

in brainstem

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14
Q

What is norepinephrine involved in?

A

arousal, attention, and stress response

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15
Q

What disorders are norepinephrine imbalances associated with?

A

Depression, anxiety, PTSD, schizophrenia, and Alzheimer’s

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16
Q

What is GABA involved in?

A

It is the primary inhibitor of neurotransmitters in the CNS- reduces neuronal excitability

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17
Q

What disorders are GABA imbalances involved in?

A

Epilepsy, anxiety, schizophrenia, autism, and Alzheimer’s

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18
Q

What is the class of Fluoxetine?

A

SSRI (Selective Serotonin Reuptake Inhibitor)

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19
Q

What is the MOA of Fluoxetine?

A

Selectively blocks reuptake of serotonin in the synaptic space, thus intensifying the effects of serotonin

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20
Q

What are the therapeutic uses for Fluoxetine?

A

Depression, OCD, Bulimia, Premenstrual dysphoric disorder, Panic Disorder, GAD, social anxiety disorders, PTSD

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21
Q

What are the ADRs of Fluoxetine?

A

-SEXUAL DYSFUNCTION
-SEROTONIN SYNDROME
Weight loss
withdrawl syndrome
HypoNa
GI bleeding (decreased platelet aggregation)
Teeth grinding

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22
Q

What drug interactions with Fluoxetine would increase the risk for serotonin syndrome?

A

TCA, MAOIs, and St John’s Wort

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23
Q

What pregnancy category is Fluoxetine?

A

Pregnancy Category C
(Risk to fetus in animal studies but no human studies done)

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24
Q

What disorders/diseases should you use Fluoxetine cautiously in and why?

A

Liver and Kidney disease (impaired metabolism and excretion thus increasing serum levels)
Cardiac Dysfunction- Can cause QT prolongation
Seizure disorders-CNS excitation
Diabetes
Ulcers, GI bleeding- decreased platelet aggregation

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25
What are the signs of Serotonin Syndrome?
Confusion, agitation, poor concentration hostility, disorientation, hallucination, delirium Tachycardia, labile BP (fluctuates) leading to cardiac shock sweating/fever N/V/D, abdominal pain Coma leading to apnea
26
What are the nursing actions for a client who has serotonin syndrome?
Treat the symptoms (meds that block serotonin receptors, cooling blankets, anticonvulsants, mechanical ventilation)
27
What class of medication is Venlafaxine?
SNRI (serotonin/norepinephrine reuptake inhibitor)
28
What is the MOA of Venlafaxine?
Blocks reuptake of norepinephrine and serotonin with similar effects to SSRIs
29
What is the therapeutic uses of Venlafaxine?
Depression, GAD and social anxiety disorders, Panic disorders Fibromyalgia, OA and diabetic neuropathy pain
30
What are the ADRs of Venlafaxine?
-HA, insomnia, anxiety -HTN, tachycardia -Dizziness, blurred vision (both of these are due to norepinephrine, a vasopressor) -Nausea, wt loss, anorexia -Mania, increased seizures risk -SEXUAL DYSFUNCTION -SEROTONIN SYNDROME
31
When should clients take SSRIs and SNRIs?
take first thing in the morning to minimize sleep disturbances
32
What should nurse advise to clients newly taking SSRIs and SNRIs who have not seen effects within the first few days?
SSRIs and SNRIs can take 1-3 weeks to have noticeable effects
33
What class is Amitriptyline?
Tricyclic Antidepressant (TCA)
34
What effect will Amitriptyline have on neurotransmitters?
Increase serotonin and norepinephrine AND have anticholinergic effects
35
What is the MOA for amitriptyline?
Blocks the reuptake of NE and serotonin in the synaptic space, intensifying their effects. Also has anticholinergic effects.
36
What are the therapeutic uses for amitriptyline?
Depression, Depressive episodes of BPD, Anxiety disorders, ADHD, Fibromyalgia and neuropathic pain
37
What medication class is Phenelzine?
MOAI (Monoamine Oxidase Inhibitor)
38
What neurotransmitters do Phenelzine increase?
Increase NE, dopamine, serotonin and tyramine which enhance NE
39
What is the MOA of Phenelzine?
Blocks MAO enzymes in the brain thus increasing NE, dopamine, serotonin, and tyramine amount available for transmission of impulse. This intensifies responses of these transmitters.
40
What are the therapeutic uses for Phenelzine?
Depression Bulimia Panic and anxiety disorders OCD PTSD
41
What medication class is Bupropion?
Atypical Antidepressant Similar in structure to crystal meth
42
What is the MOA of Bupropion?
Believed to inhibit NE and dopamine uptake
43
What are the therapeutic uses of Bupropion?
Depression, aid for smoking cessation, prevention of SAD, alternative tx for ADD
44
What ADR can be avoided by giving atypical antidepressant like Bupropion when the client experiences the ADR in both SSRI and SNRIs?
Bupropion can be given when the ADR of sexual dysfunction in SSRIs and SNRIs cannot be tolerated
45
What pregnancy category is Bupropion?
Pregnancy Category B (No risk to fetus in animal studies, no adequate human studies)
46
What class is Diazepam?
Benzodiazepines
47
What is the MOA of Diazepam?
Enhances action of GABA in CNS
48
Therapeutic uses of Diazepam?
-SEIZURE DISORDER -ETOH WITHDRAWL Anxiety/Panic disorders Induction of anesthesia/pre-op sedation Muscle spasms Insomnia
49
What severe ADRs should we be worried about with Diazepam?
It is a sedative so respiratory depression and acute toxicity.
50
Why is diazepam contradicted in dementia clients?
Because there is a paradoxical response and can worsen agitation/sundowning symptoms
51
What should we be cautious about with diazepam in older adults?
They may need lower dosages to avoid toxicity due to decreased organ function like renal impairment
52
What class is Zolpidem?
Nonbenzodiazepine
53
What is the MOA of Zolpidem?
It enhances GABA in the CNS but is structurally unrelated to benzodiazepines
54
Therapeutic use for Zolpidem?
Short term insomnia management
55
What class is Lithium?
Mood stabilizer
56
MOA of Lithium?
Unclear, does produce neurochemical changes in brain like blocking serotonin
57
Therapeutic use of Lithium?
BPD
58
What pregnancy category is Lithium
Pregnancy category D Evidence of fetal harm in humans but maternal benefits outweigh the risk
59
What severe ADRs should nurse monitor for in Lithium?
Bradyarrhythmia, Hypotension, electrolyte imbalances lithium toxicity
60
What is the relation between sodium and lithium?
They are both ions that require active transport pump to move across membrane pump doesn't know difference between sodium or lithium thus the pump will take in lithium instead of sodium and can cause hyponatremia and lithium toxicity
61
What are the nursing actions in the early stages of lithium toxicity (1.5-2.0 mEq/L)
Administer new reduced dosages based on blood lithium levels If severe manifestations, may need to promote renal excretion
62
What symptoms might we see in early stage lithium toxicity (1.5-2.0)
GI distress (N/V/D) Confusion Tremors Sedation Increased in urine/thirst
63
What are the nursing actions for Advanced Stage Lithium Toxicity (2.0-2.5)
Administer emetic to alert client Gastric lavage or administer urea, mannitol, or aminophylline to increase rate of excretion
64
What are the manifestations of advanced stage lithium toxicity (2.0-2.5)
Polyuria and dilute urine Tinnitus Ataxia, muscle twitches seizures, blurred vision Severe hypotension
65
What are the nursing actions in severe lithium toxicity (2.5+)
Hemodialysis
66
What are the manifestations in severe lithium toxicity (2.5+)?
Oliguria Seizures Rapid progression of manifestations leading to death
67
What class is Divalproex and what is it's therapeutic action?
Antiepileptic used as a mood stabilizer 1st line Tx for BPD
68
What is the MOA for Divalproex?
Unclear, does produce neurochemical changes in brain including neuroprotection and increased GABA levels
69
What pregnancy risk is Divalproex?
Pregnancy risk D Evidence of fetal harm in humans but maternal benefits outweigh fetal risk
70
What is the MOA for Chlorpromazine and Haloperidol?
Blocks variety of receptors within and outside the CNS (Block dopamine, ACh, histamine, and NE receptors)
71
What is the class of Chlorpromazine and Haloperidol?
First-Gen Antipsychotics
72
What are the therapeutic uses of Chlorpromazine and Haloperidol?
Psychotic disorders, Tourette's, BPD, Schizophrenia, agitation
73
What severe ADRs should nurse watch for when giving Chlorpromazine and Haloperidol?
Extrapyramidal side effects (EPS) Neuroleptic Malignant Syndrome
74
What happens in days to weeks during EPS?
Acute dystonia (spasms of tongue, neck, face, back) If laryngeal muscles are affected, respiration can decrease
75
What are the nursing actions in the first days to weeks of EPS?
Monitor for acute dystonia after administering first days (few hrs-5days) Tx with anticholinergic agents (benztropine and diphenhydramine)
76
What happens in weeks to months during EPS?
Akathisia (unable to stand still or sit and is continually pacing/agitated) Parkinsonism-bradykinesia, rigidity, shuffling gait, drooling
77
What are the nursing actions for EPS that occur in weeks to months?
Akathisia-manage effects with beta blockers, benzodiazepine or anticholinergic medication Parkinsonism-Tx with benztropine, diphenhydramine, or amantadine
78
What happens in months to years in EPS?
Tardive dyskinesia- involuntary movements of tongue and face, lip smacking, invol. movements of trunk, extremities
79
What are the nursing actions to treat tardive dyskinesia in late EPS?
Admin lowest dose possible to control manifestations Evaluate client after 1yr therapy, then q3months, if TD appears, lower dose or switch to atypical agent Valbenazine for TD Tx in adults
80
What are the manifestations of Neuroleptic Malignant Syndrome?
F-fever E-Encephalopathy V-vitals unstable (tachycardia, dysrhythmia, BP fluctuations) E-Elevated Enzymes (CPK) R-Rigidity of muscles
81
What are the nursing actions for neuroleptic malignant syndrome?
Stop antipsychotic med Monitor vitals apply cooling blankets admin antipyretic Increase fluid intake Diazepam to control anxiety muscle relaxers Symptomatic treatment and wait 2 weeks before resuming therapy
82
What class is Olanzapine and Aripiprazole?
2nd gen antipsychotics
83
MOA of Olanzapine and Aripiprazole?
Antagonist at dopamine, serotonin, cholinergic, histamine, alpha1 adrenergic receptors in CNS
84
Therapeutic uses for Olanzapine and Aripiprazole?
Schizophrenia, Levodopa induced psychosis, BPD, Impulse control disorders
85
What is the MOA of Kava-Kava and what are the adverse effects?
possibly acts on GABA receptors in CNS to promote sleep and relaxation, ease anxiety It causes liver injury!... and dry skin
86
What is the MOA for ST. John's Wort and what ADR can it cause when combined with other antidepressants, amphetamines, or cocaine?
It affects serotonin producing antidepressant effects Can cause serotonin syndrome!

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