Modules 7-9 Drugs Flashcards
(33 cards)
What classifications/drugs are in the first gen antipsychotic agents?
Phenothiazines (chloropromazine) and butyrophenones (haloperidol)
Haloperidol
Class: butyrophenones; MOA: blocks receptors for dopamine, acetylcholine, histamine and norepinephrine; Need: schizophrenia, bipolar disorder, psychosis; AE: EPS (acute dystonia, parkinsonism, akathisia, tardive dyskinesia); NMS; orthostatic hypotension, sexual dysfunction, agranulocytosis, anticholinergic effects; prolonged QT;
Not recommend in older adults with dementia; TEACH SE, contrain in glaucoma, CV disease, caution with urinary hesitancy, CONSTIPTION, AVOID alcohol; intxn w/ anticholinergics and parkinsons drugs
Chlorpromazine
Class: phenothiazine; blocks receptors for dopamine, acetylcholine, histamine and norepinephrine; Need: schizophrenia, bipolar disorder, psychosis; AE: EPS (acute dystonia, parkinsonism, akathisia, tardive dyskinesia), NMS; orthostatic hypotension, sedation, sexual dysfunction, agranulocytosis, anticholinergic effects, dysrhytmias, prolong QT;
Not recommend in older adults with dementia; TEACH SE; contrain in glaucoma, CV disease, caution with urinary hesitancy, CONSTIPATION; AVOID alcohol ; drug intxn w/ anticholinergics and parkinsons
Clozapine (also olanzapine, quetiapine, risperidone, ziprasidone, aripiprazole)
second gen agents; blocks dopamine and serotonin, may also block norepi, histamine, and acetylcholine; SE: metabolic syndrome (diabetes, dyslipidemia, weight gain), sedation (blocks histamine), EPS (blocks dopamine), orthostatic hypotension (alpha blocking), anticholinergix effects; agranulocytosis ; same as first gen; drug intxn w/ anticholinergics, alcohol, antihypertensives
benztropine, trihexyphenidyl, diphenhydramine, amantadine
anticholinergics to tx EPS
Dantrolene
direct acting muscle relaxant; FOR NMS
SE: hepatotoxic, muscle weakness, drowsiness, and diarrhea
Monitor liver (AST/ALT)
Diphenhydramine
anticholinergic/antihistamine; for relief of acute dystonic reaction; intense dystonia symptoms resolve w/n 5 mins of IV dosing and within 15-20 of IM dosing
Amantadine
antiparkinsons agent;dopaminergic; for EPS; SE: confusion, light headed, anxiety peripheral effects, ; respones develops rapidly often within 2-3 days monitor for anticholinergic effects
Dantrolene
for NMS; reduces muscle metabolic activity which decreases muscle contractility; SE: hepatotoxic, muscle weakness, drowsiness, and diarrhea are the most comon SE; monitor AST/ALT
Bromocriptine
dopamine receptor agonist; for NMS; SE: orthostatic hypotenion, dizziness, nausea; caution in severe CV dz and monitor BP
Lithium Carbonate
mood stabilizer; for mania and BPD; SE: n/v/d, hand tremors, thirst and polyuria, renal toxicity, goiter and hypothyroidism, teratogenesis
Block box warning for narrow therapeutic index; monitor sodium, 3L fluid/day (dehydration), max effects in 2-3 weeks,
Divalproex Sodium
similar to lithium; for BPD; SE: n/v/d, thrombocytopenia, pancreatitis, liver failure
monitor labs and toxicitiy, check platelets, monitor for pancreatitis (pain, nv, jaundice, gray stool), liver failure teratogenic
Carbamazepine
for BPD; SE: visual, ataxia, vertigo, unsteadiness, HA and thrombocytonpenia; monitor labs; decreases risperidone levels; monitor cbc including platelets
Lamotrigine
for long term maintanince of BPD; SE: n/v, HA, dizziness, vision problems, SJS ; suicide precautions, assess rash, montior lab levels, teratongenic, drug intxn with antidysrhytmics
Clonazepam, lorazepam, alprazolam
benzodiasepines; for acute mngt of acute mania, psychosis/insomnia; SE: drowsiness, ataxia, anticholinergic effects; monitor falls, monitor/teach anticholiners rxn; drug inxtn with other CNS depressants and alcohol
Olanzapine, risperidone, aripiprazole, ziprasidone, quetiapine
SGA; for schizophrenia and BPD; SE: metabolic syndrome (wt gain, diabetes, dyslipidemia), sedation (blocks histamine), EPS (blocks dopamine), orthostatic hypotension, anticholinergic, agranulocytosis,
Bromocriptine
FOR NMS; SE: orthostatic hypotension, dizziness, nausea,
Caution in severe CV disease; monitor BP
Lithium Carbonate
mood stabilizer (for mania and BPD); SE: NVD, hand tremors, thirst polyuria, renal toxicity, goiter and hypothyroidism, teratogenesis
Black box warning r/t narrow therapeutic window
MAINTAIN NA AND NO NSAIDS (when na decreases kidn hold onto it and hold on to lithium as well increasing levels)
3L fluids/day
Divalproex Sodium
basically valproic acid; SE: NVD, thrombocytopenia, pancreatitis, liver failure
monitor labs and toxicity
monitor platelets for thrombocytopenia
Monitor pancreatitis (nv, jaundice, tea colored urine, gray stool) and liver failure (GI, jaundice, AST/ALT)
Teratongenic
Carbamazepine
SE: visual, ataxia, vertigo, unsteadiness, HA, and thrombocytopenia
Monitor labs
decreases risperidone levels
Lamotrigine
long term maintenance of BPD; prevents relapses; SE: NV, HA, dizziness, vision problems, SJS
NC: suicide precautions, assess rash, monitor labs, and drug drug intxn with antidysrhythmic meds
Clonazepam, Lorazepam, Alprazolam
for acute mngmt of mania; SE: drowsiness, ataxia, anticholinergic s/s, visual changes
ADDICTIVE
monitor anticholinergic s/s and falls
Inxtn with other CNS depressant (alcohol too)
Venlafaxine, Duloxetine
SNRIs ; SE: nausea, HA, anorexia, nervousness, sweating, somnolence, insomnia, sexual dysfunction, diastolic HTN
Monitor BP, MONITOR FOR SEROTONIN SYNDROME (especially with MAOIs)
Abrupt DC can lead to w/draw
Fluoxetine, sertraline, paroxetine, escitalopram, citalopram
SSRIs; SE: sexual dysfunction, nausea, HA, CNS stim (nervousness, insomnia, anxiety), wt gain; MAY CAUSE SEROTONIN SYNDROME
