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Flashcards in Neuropharmacology Deck (42)
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1
Q

Parkinson’s drugs

A
Levodopa
Carbidopa
Pramipexole
Entacapone 
Selegiline
2
Q

Levodopa

A
  • absorbed by GI System and peripheral tissues
  • always combined with carbidopa or carbidopa/entacapone
  • levodopa given by itself = 2% absorption in brain & 98% in GI causing the SA (ex: n/v)
  • give with carbidopa to decrease SA
  • NO FOOD w/ INCREASED SALT (avoid high salt)
  • AVOID high PROTEIN meals
  • “LevoDDDDopa!!” DDDD (adverse reactions: dose dependent, dyskinesias, dark urine and sweat, dyrhythmias)

Class: Dopamine replacement

MOA: converted to dopamine, activates dopamine receptors

D/R: PO, either with carbidopa or carbidopa and entacapone

ADR: (DDD) - dose dependent, dyskinesias, dark urine and sweat.
Early effects of treatment: insomnia, postural hypotension,

Interactions: carbidopa and entacapone increase effects, first gen antipsychotics decrease effects, MAOI increase toxicity, risk for hypertensive crisis

Contraindications: given w/o carbidopa, caution in renal failure, avoid in narrow angle glaucoma

Patient counseling: avoid protein meals, pyridoxine, MAY WEAR OFF between doses, give W/ FOOD, DECREASE NA intake

Monitor: dyskinesias, and ADR

3
Q

Carbidopa

A
  • 2% becomes 10% absorption in brain if combined with Levodopa.
  • Given with Carbidopa
  • AVOID high protein meals

CLASS: Dopamine Agonist

MOA: inhibit decarboxylation of levodopa in GI/peripheral tissues

USES: combined with levodopa to increase therapeutic effects, lowers levodopa doses

D/R: PO

ADR: none

DINT: increases beneficial effects of levodopa

CONTRA: should be given with levodopa

PC: avoid high protein meals, eat consistent amount of protein, might WEAR off

MONITOR: dyskinesias, and ADR

4
Q

Pramipexole

A
  • “Pecs…pramiPEXole” –> so you don’t work out legs –> restless leg syndrome –> always wants to work out (compulsive behavior), so gets daytime sleepiness
  • Movements are more steady
  • Screen children, alcohol abusers, novelty seekers, gamblers, and binge eaters.
  • Compulsive behavior show up after 9 months from starting.

CLASS: Nonergot dopamine receptor agonist

MOA: Binds to dopamine D2 and D3 receptors, activating dopamine receptors, mildly blocks serotonergic and alpha-adrenergic receptros

USES: Monotherapy, movement performance improved, motor fluctuations, with levo for RLS,

D/R: PO

ADR: CONSTIPATION, IMPULSIVE CONTROL (ex: gambling, binge eating, novelty seeking), n/v, dizziness,

DINT: Cimetidine

CONTRA: Compulsive behaviors

PC: Several weeks to see maximum effects

MONITOR: Screen for impulsive control (gambling, binge eating, novelty seeking)

5
Q

Entacapone

A
  • Put a “cap” on levodopa
  • Improve symptoms
  • STABLIZES Levodopa
  • ADR yellow -orange discolored urine

CLASS: Catechol-O-methyltransferase (COMT) inhibitor

MOA: Selectively inhibits enzyme COMT, resulting in decreased metabolism of levodopa GI/peripheral tissues

USES: INCREASES half-life of levodopa, PREVENT “wearing off” of levodopa

DOSE: PO 200mg each dose of lev/carb

ADR: yellow-orange discolored urine, increased levodopa levels may lead to dyskinesias, orthostatic hypotension. GI problems (vomiting, diarrhea)

DINT: increases drug levels of COMT

CONTRA: Give in combo with levodopa

PC: importance of levodopa/carbidopa

MONITOR: adverse effects

6
Q

Selegiline

A
  • Adverse reaction Hypertensive Crisis.
  • Avoid giving after noon to prevent insomnia
  • NO TYRAMINE (aged cheese, deli meat, sausage, soy sauce, aged meat, packed fish, tofu, sauerkraut, beer)
  • WITH Breakfast and Lunch ONLY (sounds like “LINGUINE” – so pasta that you like to eat for breakfast and lunch BUT no aged cheese or meats.
  • If you eat your pasta with tyramine youll get HTN CRISIS.

CLASS: MAO-B Inhibitor

MOA: Selectively and irreversibly inhibits MAOB inhibitor enzyme that inactivates dopamine

USES: improves motor function, prolong effects of levodopa

D/R: Tabs and capsules WITH breakfast and lunch

ADR: Hypertensive crisis, buccal mucosa irritation

DINT: Tyramine (aged cheese, deli meat, sausage, soy sauce, aged meat, packed fish, tofu, sauerkraut, beer)

CONTRA: Meperidine, SSRIs

PC: last dose before noon to avoid insomnia, avoid foods containing tyramine

MONITOR: BP, kidney function, older patients

7
Q

Alzheimer’s Meds

A

Donepezil

Memantine

8
Q

Donepezil

A
  • elderly could faint/dizziness
  • increase slowly after 1-3 months
  • Caution with Heart and Respiratory Problems
  • Sick sinus syndrome (arrhythmia), Bronchoconstriction, bradycardia, Asthma, COPD (monitor airway)

Class: cholinesterase inhibitor

MOA: inhibit breakdown of acetylcholine by acetylcholinesterase, increases acetylcholine at synapses

USES: mild –> severe AD

DOSE: PO, ODT, titrate slowly

ADR: most serious - brochoconstriction, bradycardia, sick sinus syndrome (most dangerous)

INT: first gen antihistamines, tricyclic antidepressants, conventional psychotics

CONTRA: asthma, COPD, Liver disease, heart disease,

Counseling: not cure AD but slow progression, risk of ADR with high doses

Monitor: titrate carefully go slow

9
Q

Memantine

A
  • prevents toxic levels of Ca from blocking memory formation
  • keep on 3 months
  • can be added with donepezil
  • NOT beneficial for MILD AD
  • can also have HTN crisis
  • can get bronchospasms

Class: NMDA receptor antagonist

MOA: regulates Ca uptake into cells, prevent toxic levels

USES: moderate –> severe AD

DOSE: PO

ADR: dizziness, HA, confusion, constipation, diarrhea, HTN, hypotension (in ER - extended release)

INT: other NMDA antagonists, sodium bicarbonate

CONTRA: drugs that alkanilize urine, renal or hepatic impairment

Counseling: improved symptoms

Monitor: BUN and Creatinine

10
Q

Antiepileptic seizures

A
phenytoin 
phenobarbital
carbamazepine
Valproic Acid (Depakote)
Gabapentin
Levetiracetam
  • ALL mainly CONTAIN*
  • screen for: suicide risks, BUN, Creatinine
11
Q

Phenytoin

A

phenyt-O-in “O” as in ORAL –> ADR (gingival hyperplasia), DrugINT (ORAL contraceptives, anything that goes in the mouth like CNS depressant drugs, and ALCOHOL), Counseling (take 0.5 g of folic acid in the ORAL, good ORAL hygiene)

On a bell curve– (10-20) therapeutic range
short dose = short 1/2 life
long dose = long 1/2 life

Class: AED

MOA: blocking sodium into neurons to decrease activity produced seizures

USES: Partial/general TC seizures

DOSE: PO

ADR: gingival hyperplasia, measles like rash,

INT: ORAL contraceptives, CNS depressants, alcohol

CONTRA: HLA-B genes (ASIAN descent), Pregnancy Category D

Counseling: good ORAL hygiene, 0.5mg folic acid daily, avoid alcohol and CNS depressing drugs

Monitor: suicide risks, LFTs, excessive drug levels.

12
Q

Phenobarbital

A

“phen-O-BARB-ital…”

  • O is the same as phen-O-toin (oral contra. interaction).
  • 8 yr old Barb talk too much asking for more alcohol (addiction) ‘gaba gaba gaba gimme gimme gimme’… shes very hyper (PARADOXICAL)
  • We don’t wanna kick Barb out or else she’ll die alone (respiratory depression)
  • So we need to slowly get her sober (dont stop med abruptly)
  • Can cause addiction

Class: Anticonvulsant barbiturate

MOA: Binds to GABA receptors, leading to receptors to respond to GABA more….GABA GABA GABA

USES: Partial/General TC seizures, IV form can treat status epilepticus, sedation and sleep.

DOSE: IV, IM, PO

ADR: Lethargy Depression, learning impairment, agitation, confusion in elderly, dependence, PARADOXICAL response in children, intermittent porphyria

INT: ORAL contraceptives, warfarin, CNS depressants, alcohol,

CONTRA: hx of intermittent poryphyria, suicidal tendencies, pregnancy risk D

Counseling: can cause ADDICTION, limit alcohol, dont stop abruptly, weeks to reach therapeutic levels

Monitor: CNS depression, ataxia, nystagmus, BUN, Creatinine, LFTs

13
Q

Carbamazepine

A

“CARB-amazepine”

  • Grapefruit juice has CARBS (avoid cause we tryna get abs)
  • Larger dose taken @ bedtime
  • Take with meals…“carbs”
  • ADR: Bone marrow suppression & photo sensitivity
  • ADR lessen after couple of weeks

Class: Traditional AED

MOA: suppress high frequency neuronal discharge

USES: Partial and TC seizures, NOT ABSENCE seizures, symptomatic control for bipolar disorders, trigeminal and glossopharyngeal neuralgia

DOSE: LARGER dose @ BEDTIME, take WITH MEALS

ADR: decrease after couple of weeks, SJS, CNS (nystagmus, blurred vision, diplopia, ataxia, vertigo, unsteadiness, headache) Blood/fluid (leukopenia, anemia, thrombocytopenia, hypo-osmolarity, rash,

INT: GRAPEFRUIT juice, ORAL contraceptives, warfarin, phenytoin, phenobarbital,

CONTRA: Pregnancy risk D, HLA-B (asian gene)

Counseling: ADR decrease after few weeks, LARGE DOSE at bedtime, avoid grapefruit juice, WITH MEALS

Monitor: suicide LFTs, CBC, BMP

14
Q

Valproic Acid (Depakote)

A
    • for Increased ammonia levels
    • DON’T CHEW “ACID”
    • IV to PO ASAP (can come with extended release)
    • all kinds of seizures

Class: Trad AED

MOA: Suppress high frequency neurons targeting sodium channels, prevent calcium form entering, enhance GABA

USES: Seizure disorders, bipolar disorder, migraines

DOSE: PO, start low go slow

ADR: GI (n/v, indigestion, hepatoxicity, pancreatitis, hyperammonemia) rash, weight gain, hair loss, tremor, blood dyscrasia, well tolerated

INT: epileptic drugs, topiramate, , carbapenem antibiotics, avoid, meropenem and imipenem

CONTRA: Preg Risk D, avoid combo w/ other drugs children under 2 years of age with a preexisting liver dysfunction.

Counseling: WITH FOOD, S&S of liver failure and pancreatitis, birth control, women of childbearing age, take with folic acid, don’t chew or crush

Monitor: suicide, LFT, lipase, amylase, therapeutic effects, switch IV to PO ASAP

15
Q

Gabapentin

A

“GAB-a-PEN-t-IN”

  • Gabby got a pen in her foot, so she needs Gabapentin for the tingling (neuropathy)
  • Can take a nap with the ADR (somnolence, dizziness, fatigue)

Class: Newer AED

MOA: May enhance GABA release – UNKNOWN

USES: FDA approved mostly given for nerve pain rather than AED, especially neuropathy (nerve tingling or damage)

DOSE: PO, 3 divided doses

ADR: Somnolence, dizziness, ataxia, fatigue, nystagmus, peripheral edema

INT: No known

CONTRA: Preg Risk C, caution with breast feeding,

Counseling: diminish with longer use, avoid driving.

Monitor: suicide, BUN, Creatinine

16
Q

Levetiracetam

A
  • Given for seizures
  • Europe has this drug faster
  • Used a fair amount in hospitals

Class: Newer AED

MOA: Unknown

USES: FDA approved, adjunctive therapy for myoclonic, primary gen TC seizures.
Off label use: migraine, bipolar disorder, pediatric epilepsy, approved in Europe for partial seizures.

DOSE: PO, reduce dose if renal impairment

ADR: drowsiness, weakness, suicidal ideation

INT: None

CONTRA: dose reduced with renal impairment, avoid breast feeding since Pregnancy Risk C

Counseling: about ADR

Monitor: suicide risk BUN, Creatinine

17
Q

Status Epilepticus Treatment

A
  • FIRST line –> Lorazepam (Ativan) IV
  • SECOND line –> Diazepam (Valium)
  • Long term controlled with Phenytoin (Dilantin) but can cause dilantin toxicity (CNS adr)
  • continious TC seizures lasting 20-30 min
  • LOC, hypoglycemia, and acidosis occurs
  • START TREATMENT IN 5 MINS
18
Q

Local Anesthetic Information

Med: Lidocaine

A
  • non selective (numbs everything)
  • quick onset, long duration
  • topical or IM
  • PHYSICIANS and CRNA’s ONLY
  • LAST ( local anesthetic systemic toxicity) –> DEATH
  • Sensations lost in order
    1) Pain
    2) Temperature
    3) Touch and Deep pressure
19
Q

Lidocaine

A
  • wash hands if patch
  • put over INTACT skin
  • can be given with epinephrine BUT avoid when patient is tachycardic.
  • put in DIFFERENT location each time
  • watch out for TOXICITY

Class: Amide-type local anesthetic

MOA: blocks conduction by preventing sodium from entering sodium channels

USES: suppresses locally topically or by injection, given IV for dysrythmias

DOSE: Patch 0.5%-5% , injectable preparation contain epinephrine, cream, ointment, jelly, solution

ADR: CNS excitation with depression, seizures, respiratory depression, bradycardia, heart block, decreased contractility, cardiac arrest, hypersensitivity reactions, burning at site

INT: EPINEPHRINE

CONTRA: avoid epinephrine with tachycardia, pregnancy Risk B, caution if bradycardic

Counseling: use smallest amount needed, don’t apply to broken skin, avoid strenuous activity, wrapping or heating the site, remove first patch before applying another, wash hands after patch

Monitor: VS, s&s of toxicity, LFTs

20
Q

General Anesthetic Drugs

produce unconsciousness and lack of response to painful stimuli

A

Propofol

Isoflurane *not on module

21
Q

Propofol

A
  • Given @ OR/ICU/ER
  • for SEDATION
  • make sure AIRWAY safe
  • quick acting, slowly titrate
  • patient waking up scared, A&O them
  • lipid substance
  • Change vials Q6H = don’t want to spoil
  • Rhabdomylosis (an ADR) = muscle tissue breaks down and block kidney function
  • ACTUAL HEART MONITOR in room

Class: IV anesthetic

MOA: Releases GABA for CNS depression

USES: Sedation

DOSE: IV Max dose 4mg/hr, Change open vials Q6H

ADR: Respiratory depression, hypotension, bacterial infection, propofol infusion syndrome (metabolic acidosis, HF, Renal failure, rhabdomylosis)

INT: Analgesics, CNS Depression, CNS stimulants, Opioids,

CONTRA: caution with older adults, hypovolemia, cardiac dysfunction, breastfeeding, requires intubation, preg Risk B

Counseling: Education and support from families
Monitor:VS with continuous cardiac Monitoring, CPK for pain

22
Q

Isoflurane *not on module

A
  • keep close eye on respirations
  • antiematics on the side for N/V
  • Patient waking up will be frightening for them, familiar face will help (such as family member

Class: inhalation anesthetic (gas)

MOA: theory of selectively alter synaptic transmission

USES: general anesthesia for surgery, combo with other agents

DOSE: inhaled, administer by MD or CRNA

ADR: Hypotension, respiratory depression, n/v, decreased urinary output, hepatotoxicity, malignant hyperthermia

INT: analgesics, CNS depressants, CNS stimulants, opioids, succinylcholine

CONTRA: advise in pregnancy and lactation, INTUBATION

Counseling: prepare families when patient wakes up form surgery

Monitor: VS, ADR, LFTs

23
Q

Opioids

A
Morphine 
Fentanyl
Hydromorphone 
Codeine
Hydrocodone
Naloxone 
Tramadol 

All mostly Contain (except Naloxone)

MOA: (all except Naloxone and Tramadol) –> Mimic action of opioid peptides at mu receptors

ADR: respiratory depression, constipation, sedation, hypotension, n/v, urinary retention, miosis, cough suppression, euphoria

INT: ETOH, benzos, barbituates, anesthetics, other CNS depressants, anticholinergics, antihypertensives, MAOIs, pentazocine, buprenorphrine, naloxone, phenothiazine type antiemetics, amphetamines, clonidine, dextromethorphan

CONTRA: hypotension, Pregnancy Risk C

Monitoring: VS before giving, respiratory assessment, effectiveness

24
Q

PCA PUMPS

A
  • allow patient to deliver own med
  • does not let patient overdose
  • 7 minute intervals? Confusing
  • 4 hour intervals?
  • family members CAN’T PUSH but CAN ENCOURAGE
25
Q

Morphine

A
  • start low and go slow
  • watch out for respiratory depression
  • Avoid pushing fast = euphoria
  • get bowel regimen

Class: Opiod

MOA: Mimic action of opioid peptides at mu receptors

USES: reduce pain, sedation

DOSE: IV 1-4mg (4mg pretty high), IM, PO, Rectal, PCA Pump, low and go slow

ADR: respiratory depression, constipation from fecal impaction, bowel perforation, rectal tearing and hemorrhoids, hypotension, urinary retention, cough suppression, biliary colic, n/v, elevated ICP, euphoria, sedation, miosis, delirium, agitation, hyperalgesia, neurotoxicity, coma

INT: ETOH

CONTRA: Hypotension, liver impairment, asthma, emphysema, kkyphoscoliosis, chronic cor pulmonale, head injuries, infants and elderly, IBD, Preg Risk C

Counseling: Bowel Regimen; s&s of overdose, Narcan if needed

Monitor: VS before giving, respiratory assessment, LFTs

26
Q

Fentanyl

A
  • short acting
  • document date/time
  • can touch the outer part of the patch (unlike lidocaine)

Class: Strong Opioid analgesic

MOA: mimic actions of opioid peptides at mu receptors

USES: breakthrough pain, chronic pain, surgical procedure

DOSE: IV 25-100mcg, transdermal, transmucosal (lozenges on stick, buccal film, buccal tablets, sublingual), intranasal

ADR: Sedation, r depression, euphoria, rigidity, hypotension

INT: ETOH, benzos, CNS depressants…..

CONTRA: Hypotension, asthma, emphysema, kyphoscoliosis…

Counseling: Bowel regimen, s&s of overdose, Narcan at home

Monitor: VS before giving

27
Q

Hydromorphone

A
  • Dilauded –> drug seekers try to get

Class: Strong opioid

MOA: “””””””

USES: Reduce pain, sedation

DOSE: IV 0.25-1mg PO tabs or liquids, rectal solutions, IM, subQ

ADR: “”””””

INT:”””””””

CONTRA:””””””

Counseling: Bowel regimen, Narcan

Monitor: VS before giving, respiratory assessment

28
Q

Codeine

A

Class: Moderate -> Strong opioid

MOA: “”””””

USES: Treat pain, cough suppressant

DOSE: IV, IM, PO 30mg for pain, 10mg for cough suppression, often combined with other drugs

ADR: Respiratory depression, constipation, urinary retention, cough suppression, miosis, euphoria

INT: CNS depressants “”””

CONTRA: People who lack CYP2D6, Preg Risk C, breastfeeding, infants and elderly

Counseling: lower potential for abuse than stronger opioids, important for multiple treatment modalities

Monitor: effectiveness, respiratory status, VS, LFTs

29
Q

Hydrocodone

A
  • pill form
  • be careful when giving Tylenol (easy to overdose)

Class: Mod-Strong opioid, most prescribed drug in US

MOA: “”””

USES: Relieve pain and Suppress cough

DOSE: PO 5-10mg, always combined with other drugs

ADR: Respiratory depression, constipation, urinary retention, cough suppression, miosis, euphoria, n/v

INT: CNS depressants, “”””””

CONTRA: Preg Risk C, use caution in breastfeeding, hypotension, infants and elderly

Counseling: lower potential for abuse than strong opioids, importance and modalities, rationale for bowel regimen, S&S of overdose

Monitor: effectiveness, respiratory status, LFTs

30
Q

Naloxone

A
  • educate family and patient how to use Narcan

Class: Opioid antagonists

MOA: blocks opioid receptors, preventing from opioids to be effective

USES: Antidote to opioids, reversing respiratory depression, sedation, euphoria, analgesia

DOSE: IV, IM, SQ

ADR: Nothing significant

INT: Opioids

CONTRA: Preg Risk B

Counseling: Patients and families need to know how to administer if taking home opioids, s&s for opioid overdose

Monitor: monitor for response, s&s of withdrawal

31
Q

Tramadol

A
  • used for Elderly instead of using stronger narcotics
  • barely has respiratory depression, but watch out for
    -avoid alcohol and CNS depressants.
    Class: Nonopioid centrally acting analgesic

MOA: Weak activity at mu receptors, blocks norepinephrine and serotonin uptake which results in spinal inhibition of pain.

USES: Mod to mod severe

DOSE: PO, ODT (orally disintegrating tablet)

ADR: Sedation, dizziness, constipation, HA, dry mouth, rarely respiratory depression seizures

INT: CNS depressants, MAOI, SSRIs, SNRIs, tricyclic antidepressants, triptans

CONTRA: Epilepsy, neurological disorders, avoid MAOI, hx of drug abuse, suicidal ideations, Preg risk C

Counseling: Avoid alcohol and CNS depressants

Monitor: LFTs, BUN, Creatinine, effectiveness, adverse effects

32
Q

Headaches Goals

A
  • decrease pain and GI upset
  • antiemetics are adjunctive therapy
  • Metoclopramide is preferred
  • Prochlorperazine is 2nd line
33
Q

Headache Meds

A

Sumatriptan
Ergotamine
Depakote ER

34
Q

Sumatriptan

A
  • pt with vasospasms will contraindicate Sumatriptan

Class: Serotonin receptor agonists (triptans)

MOA: Vasoconstriction results after acting on intracranial blood vessels which lead to decreased inflammatory neuropeptides and diminished perivascular inflammation

USES: Abortive migraine relief

DOSE: PO, nasal inhalation, SQ, transdermal

ADR: symptomatic coronary vasospasms, “heavy arm” feeling or chest pressure, angina

INT: Ergot alkaloids, other triptans, MAOI, SSRI, SNRI

CONTRA: CAD, hx of heart disease, uncontrolled HTN, MI, vertigo, malaise, fatigue, tingling sensation, cation in hepatic and renal impairment, Preg Risk C

Counseling: Birth control methods, avoid taking other triptans, or ergot alkaloids

Monitor: LFTs, effectiveness, frequency of use

35
Q

Ergotamine

A
  • DON’T use DAILY = just as needed
  • Pregnancy Risk X
  • 2nd line abortive therapy for migraines

Class: Ergot alkaloids

MOA: complex actions that are not fully understood

USES: Second line abortive therapy for migraines

DOSE: PO, Sublingual, rectal

ADR: N/V, weakness in legs, myalgia, numbness and tingling in fingers and toes, angina-like pain, tachycardia, bradycardia, overdose (ischemia)

INT: Triptans, CYP3A4 inhibitors

CONTRA: Daily use, hepatic or renal impairment, sepsis, CAD, PVD, uncontrolled HTN, use of CYP3A4 inhibitors, use caution with children and elderly, Pregnancy Risk X

Counseling: S&S of overdose, withdrawal symptoms, birth control, risk to potential fetus

Monitor: LFTs, BUN, creatinine, pregnancy, vitals, effectiveness

36
Q

Depakote ER

A
  • similar to Valproic acid
  • Extended release form
  • for PROPHYLACTIC treatment of migraine

Class: Antiepileptic drug (form of valproic acid)

MOA: suppresses high freq neurons targeting sodium channels, prevents calcium from entering calcium channels, may enhance GABA

USES: Prophylactic treatment of migraines for those with 3+ attacks/month, or attacks that dont respond to abortive agents.

DOSE: PO 500-1000mg/day

ADR: Nausea, fatigue, weight gain, tremor, bone loss, reversible hair loss, pancreatitis, hepatitis

INT: Phenobarbital, phenytoin, topiramate, carbapenem antibiotics, avoid, administration with meropenem and imipenem/cilastatin

CONTRA: Preg Risk D, avoid in combo with other drugs in children under 2 with pre-existing liver dysfunction

Counseling: Take WITH FOOD, s&s of liver failure/pancreatitis, birth control, women of childbearing age should take folic acid, do not chew or crush tablet

Monitor: screen for suicide risk, LFTs, lipase, amylase, therapeutic effects, switch IV to PO quickly

37
Q

Sedative-Hypnotic Drugs treat what?

A

anxiety and insomnia
-same drug can be used in different doses for anxiety and insomnia

  • benzo 1st line
  • benzo like drugs 2nd line
  • barbiturates (CNS depressant) 3rd line but not freq
38
Q

Sedative-hypnotic drugs

A

Lorazepam
Diazepam
Midazolam
Zoplidem

39
Q

Lorazepam

A
  • For status epilepticus (Lorazepam IV)
  • dont administer Lorazepam and Opioids @ same time BUT give separately throughout day
  • Watch LFTs (liver impairment)
  • CAN abruptly stop medicine; no need to wean

Class: Benzodiazepine

MOA: enhance GABA effects

USES: decrease anxiety, promote sleep, seizure disorders, alcohol withdrawal, preanesthesia

DOSE: PO, IV, IM

ADR: Confusion, amnesia, hypotension, cardia arrest, drowsiness, lightheadedness, incoordination, trouble focusing, paradoxical response, respiratory depression when IV, abuse

INT: other CNS depressants (opioids)

CONTRA: caution with respiratory disorders, reduce dose with liver impairment, pregnancy risk D

Counseling: Avoid combining with alcohol, opioids, barbiturates, don’t sleep drive, drowsiness may occur, caution using machinery

Monitor: LFT, VS, effectiveness, ADR, tolerance

40
Q

Diazepam

A
  • Readily available
  • Short acting (can leave system quickly)

Class: Benzo

MOA: ehance GABA effects

USES: initiation of sedation, anxiety, seizures, muscle spasms, anxiety, alcohol withdrawal

DOSE: PO, IV, IM

ADR: “"”same as Lorazepam - confusion, amnesia, hypotension, cardiac arrest, drowsiness, lightheadedness, incoordination, trouble focusing, paradoxical responses, respiratory depression given IV, abuse

INT: Other CNS depressants

CONTRA: use caution with respiratory disorders, reduce dose with liver impairment, preg risk D

Counseling: Avoid combining with alcohol, opioids, barbiturates, some people report sleep driving, drowsiness may occur, use caution operating machinery

Monitor: VS, have respiratory readily available if not intubated , LFTs

41
Q

Midazolam

A
  • Mostly used before surgeries/procedures
  • given IV usually
  • kids can have a flavored syrup
  • Shorter acting half life

Class: Benzo

MOA: Enhance GABA effects

USES: initiation of sedation, conscious sedation

DOSE: IV, PO, IM

ADR: Respiratory depression, respiratory and cardiac arrest, hyptension

INT: CNS depressants
Antidote: flumasenil

CONTRA: caution with respiratory disorders, reduce dose with liver and impairment and age, Pregnancy risk D

Counseling: Avoid combining alcohol, opioids, barbiturates, sleep driving, drowsiness, operating machinery

Monitor: VS, continuous monitoring during conscious sedation having respiratory support easily available if not intubated. LFTs

42
Q

Zolpidem

A

-not concerning of respiratory depression as the others

Class: Hypnotic/benzo like drug

MOA: binds to benzodiazepine receptor sites on GABA receptors

USES: Insomnia

DOSE: PO, regular is rapid acting –> help fall asleep, ER (extended release)–> maintains sleep

ADR: Paradoxical response, amnesia

INT: other CNS depressants

CONTRA: Preg Risk C

Counseling: ADR s&s, avoid operating heavy machinery

Monitor: adverse effects, BUN, creatinine