NUR 144 - UNIT 2 MEDS

Question 1

Amitriptyline

Answer 1

• Class: Tricyclic Antidepressant (TCA)
• Indication: Depression, neuropathic pain, insomnia
• MOA: Inhibits reuptake of serotonin and norepinephrine
• Adverse Effects: Sedation, anticholinergic effects (dry mouth, constipation), orthostatic hypotension, cardiotoxicity (arrhythmias)
• Teaching/Considerations: Monitor for suicidal ideation, avoid other CNS depressants, overdose can be fatal due to cardiotoxicity.

Question 2

Escitalopram, Fluoxetine

Answer 2

• Class: Selective Serotonin Reuptake Inhibitors (SSRIs)
• Indication: Depression, anxiety disorders
• MOA: Inhibits reuptake of serotonin, increasing availability in synapses
• Adverse Effects: Sexual dysfunction, weight changes, insomnia or sedation, risk of serotonin syndrome
• Teaching/Considerations: May take several weeks to work, avoid alcohol, do not stop abruptly, monitor for increased suicidal thoughts initially

Question 3

Aripiprazole, Risperidone

Answer 3

• Class: Atypical (Second-Generation) Antipsychotics
• Indication: Schizophrenia, bipolar disorder, adjunct for depression
• MOA: Dopamine D2 and serotonin 5-HT2A receptor antagonists/partial agonists
• Adverse Effects: Weight gain, metabolic syndrome, EPS (especially risperidone), sedation
• Teaching/Considerations: Monitor glucose/lipids, watch for EPS symptoms, encourage adherence.

Question 4

Chlorpromazine, Haloperidol

Answer 4

• Class: Typical (First-Generation) Antipsychotics
• Indication: Schizophrenia, acute psychosis, agitation
• MOA: Strong dopamine D2 receptor antagonists
• Adverse Effects: Extrapyramidal symptoms (EPS), tardive dyskinesia, neuroleptic malignant syndrome, anticholinergic effects (more with chlorpromazine)
• Teaching/Considerations: Monitor for EPS and NMS, use lowest effective dose, avoid alcohol.

Question 5

Clozapine

Answer 5

• Class: Atypical Antipsychotic
• Indication: Treatment-resistant schizophrenia
• MOA: Blocks dopamine and serotonin receptors
• Adverse Effects: Agranulocytosis, weight gain, seizures, sedation
• Teaching/Considerations: Requires frequent WBC monitoring (REMS program), report signs of infection, sedation is common early.

Question 6

Diazepam, Lorazepam

Answer 6

• Class: Benzodiazepines
• Indication: Anxiety, seizures, alcohol withdrawal, sedation
• MOA: Enhances GABA activity at GABA-A receptors
• Adverse Effects: Sedation, respiratory depression, dizziness, dependence
• Teaching/Considerations: Short-term use only, avoid alcohol/CNS depressants, taper to avoid withdrawal, risk for falls in elderly.

Question 7

Buspirone

Answer 7

• Class: Anxiolytic (non-benzo)
• Indication: Generalized anxiety disorder (GAD)
• MOA: Partial agonist at serotonin 5-HT1A receptors
• Adverse Effects: Dizziness, headache, nausea
• Teaching/Considerations: Not for PRN use—takes 2-4 weeks to take effect, no sedation or dependence risk.

Question 8

Donepezil

Answer 8

• Class: Cholinesterase Inhibitor
• Indication: Alzheimer’s disease (mild to moderate)
• MOA: Inhibits breakdown of acetylcholine, increasing availability at synapses
• Adverse Effects: GI upset (nausea, vomiting, diarrhea), dizziness, bradycardia
• Teaching/Considerations: Take at bedtime, monitor for fainting or GI symptoms, not a cure but may slow progression.

Question 9

Lithium

Answer 9

• Class: Mood Stabilizer
• Indication: Bipolar disorder (manic episodes, mood stabilization)
• MOA: Affects sodium transport in nerve and muscle cells, alters neurotransmitter levels
• Adverse Effects: Tremor, polyuria, hypothyroidism, renal toxicity, lithium toxicity
• Teaching/Considerations: Narrow therapeutic index—monitor levels, maintain hydration, avoid NSAIDs and dehydration.

Question 10

Phenelzine

Answer 10

• Class: Monoamine Oxidase Inhibitor (MAOI)
• Indication: Atypical depression
• MOA: Inhibits monoamine oxidase, increasing levels of norepinephrine, serotonin, dopamine
• Adverse Effects: Hypertensive crisis with tyramine, orthostatic hypotension, weight gain
• Teaching/Considerations: Avoid tyramine-rich foods (cheese, wine, cured meats), many drug interactions, monitor BP.

Question 11

Buprenorphine

Answer 11

• Class: Opioid Partial Agonist
• Indication: Opioid use disorder, chronic pain
• MOA: Partial agonist at mu-opioid receptors
• Adverse Effects: Constipation, sedation, respiratory depression (less than full agonists)
• Teaching/Considerations: May precipitate withdrawal if taken too soon after full opioid, typically combined with naloxone in Suboxone.