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semester 4 > pharmacology 1 > Flashcards

pharmacology 1 Flashcards

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1
Q

Antidepressant Administration Notes

A

can be taken with food to avoid GI distress
will need to be tapered to avoid withdrawals
– someone switching from a TCA to an MAOI will need two weeks washout (no TCA for two weeks), SSRIs have a low potential for overdose so can be prescribed in normal quantities

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2
Q

What is the usual first line antidepressant?

A

SSRIs

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3
Q

Antidepressant Assessment

A

blood pressure (hypotension), 1-2 weeks to start taking effect, 4-6 weeks for full effect (educate patient to be patient), usually sedating so be careful with driving and alcohol until you know how you handle it

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4
Q

SSRI suicide risk

A

lowest risk for suicide so they are dispensed in normal quantities
can cause an increased suicide risk in some patients, often they will be happy about it
slight increase in teens and young adults however its not statistically significant

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5
Q

Examples of SSRIs

A

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine (Luvox)

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6
Q

SSRI adverse effects that affect compliance

A

sexual dysfunction and weight gain

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7
Q

SSRI adverse effects to monitor

A

withdrawal can occur, must taper drug to avoid syndrome
hyponatremia risk with thiazide diuretics
can alter bleeding avoid NSAIDs and aspirin

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8
Q

SNRI (serotonin norepinephrine reuptake inhibitors) Examples

A

Duloxetine (Cymbalta)
Venlafaxine (Effexor)

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9
Q

NASSAs Mechanism and Example

A

Increase norepinephrine and serotonin neurotransmission by blocking presynaptic alpha-2 adrenergic receptors & minimizing serotonin related side-effects by blocking certain serotonin receptors.

Mirtazapine (Remeron)

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10
Q

NDRIs

A

Inhibit the re-uptake of dopamine and norepinephrine
Bupropion (Wellbutrin, Zyban)

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11
Q

Bupropion (Wellbutrin, Zyban) Considerations and Other Uses

A

Hx of seizures - don’t exceed 300 mg
Seizure risk greatly increases if dose execeds 450 mg day
Also used for: smoking cessation, ADHD, alternative to stimulants

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12
Q

SARIs

A

Serotonin receptor antagonists and reuptake inhibitors:
Trazodone (Desyrel)

Higher does to treat depression (watch for hypotension) and lower doses for insomnia

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13
Q

Auvelity

A

Dextromethorphan/bupropion(DXM/BUP)

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14
Q

TCA Examples

A

Increases norepinephrine and serotonin levels but have more side effects than SSRI’s

Amitriptyline (Elavil)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Imipramine (Tofranil)
Nortriptyline (Pamelor, Aventyl)
Trimipramine (Surmontil)
Doxepin (Sinequan)
Protriptyline (Vivactil)

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15
Q

TCA Side Effects

A

Orthostatic hypotension, cardiac dysrhythmias, contraindicated in recovery of MI
Anticholinergic effects not as severe as antipsychotics
Decreased seizure threshold
Tapered withdrawal

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16
Q

TCA Withdrawal Symptoms

A

nightmares, N&V, cold sweats, anxiety, akathisia

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17
Q

TCA Interactions

A

Do not use with MAOI: hypertensive crisis
Do not use with SSRIs: ↑ Serotonin syndrome
Take at night - sedating effect, best for insomnia/agitation
Generally not used for older adults due to increased fall risk

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18
Q

MAOIs Examples

A

Inhibit monoamine oxidase breakdown of serotonin and norepinephrine

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Selegiline (EMSAM0) transdermal patch

Generally reserved for non-responders to other antidepressants

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19
Q

MAOI Side Effects

A

Risk for hypertensive crises with TCA’s (2 week washout)
food containing tyramine cheese
Risk for serotonin syndrome with SSRIs
Hypotension
Taper dose to prevent withdrawal

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20
Q

Foods Containing Tyramine

A

to avoid cheese effect
Dairy: aged cheese and cultured products
Fruit & Veg: avocado, banana, fava
Meat: lunch meat, pickled or potted meat, dried fish
Any high-protein food that has been aged, fermented, pickled or smoked
Other: chocolate, licorice, sauerkraut, soy, yeast

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21
Q

Hypertensive Crisis S/S

A

Obviously – high BP
Sudden onset
Stiff neck, headache
Palpitations
Dilated pupils, photophobia
N & V
Diaphoresis
Chest pain

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22
Q

Drugs for Hypertensive Crisis

A

Phentolamine IV
Nifedipine S/L in ER

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23
Q

Trazadone (Desyrel)

A

is classified as an antidepressant but is commonly used to treat insomnia (18 and older)

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24
Q

Escitalopram (Lexapro) Off Label Use

Study These Flashcards
A

generalized anxiety disorder

25
Fluoxetine (Prozac) Off Label Use
Obsessive-Compulsive Disorder (OCD)
26
Venlafaxine (Effexor) Is Approved For
FDA approved to treat GAD, Panic Disorder, and Social Anxiety Disorder
27
Serotonin Syndrome - Why Though
Caused by increased serotonin when things are combined, particularly with an SSRI Other antidepressants Lithium Opioids Other: copious caffeine, St. John’s Wort, migraine medication
28
Serotonin Syndrome - What Do
s/s: sudden onset of confusion, agitation, myoclonus muscle spasms, rigidity, diarrhea, increased HR, hyperthermia, changes in BP Untreated – seizures, apnea, death Interventions: inform PCP and stop meds Treat symptoms: i.e., propranolol, anticonvulsants, induce paralysis Cooling blankets
29
Anticholinergic Side Effects
Dry mouth Blurred vision, photophobia Tachycardia Constipation: may need immediate medical attention Urinary retention: may need immediate medical attention
30
Benzodiazepines administration
sublingual, PO or IV are used to prevent severe withdrawal, elevated VS, seizures, or DTs. Often ordered on a ‘sliding scale’ based on CIWA scores/VS benzodiazepines and opioids at the same time – high risk of respiratory depression must be tapered to avoid withdrawals
31
antidote for benzodiazepine overdose
Flumazenil IV
32
Alcohol Withdrawal Medications
decreased ICU admissions phenobarbital used with benzodiazpines phenobarbital use decreased readmissionin the first 3 days after discharged phenobarbital instead of benzodiazepines shortened LOS length of stay on inpatient services
33
Carbamazepine (Tegretol)
(alcohol withdrawal) decrease risk for seizures
34
Clonidine (Catapres)
(alcohol withdrawal) reduces high HR and BP Sedative and Hypotensive used to manage opioid withdrawal symptoms Also used for chronic pain DOES NOT REDUCE CRAVINGS Taper dose at end of treatment to prevent withdrawal
35
Propranolol (Inderal)
(alcohol withdrawal) reduces high HR and BP and decreases cravings
36
Atenolol (Tenormin)
(alcohol withdrawal) reduces high HR and BP and decreases cravings
37
Acamprosate (Campral)
“relief cravers” (minimize withdrawal discomfort first few months), FDA approved specifically for alcohol use disorder treatment; alternative to off label use of Gabapentin (Neurontin)
38
Naltrexone (Revia)
Reduces effects and craving for alcohol Used for Alcohol and Opioid Use Disorders
39
Disulfiram (Antabuse)
cause Acetaldehyde Syndrome when combined with alcohol use (aversion therapy), check liver function to avoid hepatotoxicity, effects can linger for 2 weeks after last dose
40
Acetaldehyde Syndrome
can cause death - wear a medical alert bracelet Cardinal - facial flushing nausea & severe vomiting (and thirst) headache (throbbing) tachycardia and cardiac palpations Diaphoresis Weakness and Vertigo Can occur in people (Asian) who lack aldehyde dehydrogenase (breaks down alcohol)
41
Opioid Notes
Heroin is made from Morphine but is 3x stronger and is faster Oxycodone (Percocet, Oxycontin) much stronger than hydrocodone (Vicodin, Norco) Fentanyl is 50x more potent than heroin, cheaper to manufacture for illegal drug trade
42
Reverse opioid overdose
Naloxone (Narcan)
43
Methadone
Opioid Agonist, synthetic similar to morphine – long half life Heroin/Opioid Replacement - has less euphoria and sedation, used in approved rehabilitation centers for manage opioid withdrawal symptoms and decrease cravings taper at the end of treatment to avoid withdrawals some people are methadone lifers
44
Buprenorphine (Buprenex)
Opioid partial agonist Higher doses for detox, then maintenance dose of 4-24mg/day, prevents withdrawal and decreases cravings Lower respiratory depression than methadone Be aware of sound alike/look alike: Bupropion (Wellbutrin, Zyban) – different med
45
Suboxone
combines naloxone (Narcan) and buprenorphine
46
Naltrexone (Revia)
Blocks euphoria Suppresses cravings Used for Alcohol and Opioid Use Disorders
47
Bupropion (Wellbutrin, Zyban)
An antidepressant used to decrease S/S withdrawal Decreases seizure threshold, avoid use in pts with seizure Dos
48
Varenicline (Chantix)
Increases dopamine (reword neurotransmitter) Reduces cravings Blocks nicotine effects Decreases S&S withdrawal
49
Lithium effective for
Effective for symptoms of hypomania and mania: elation, grandiosity, flight of ideas, irritability, manipulation, anxiety -- may take 7-14 days for full effect
50
lithium acts like
Acts like sodium – dehydration, diaphoresis, diuretics (hydrochlorothiazide), low sodium, and NSAIDS can cause lithium toxicity
51
lithium dosage
Dosage 300-600mg. BID-TID Narrow therapeutic Index 0.6-1.5 mEq/L (some say 0.8 to 1.2) Ideally – medication nurse documents daily on presence or absence of side effects and toxic effects (story geri-psych unit) Titrate up to blood, higher end to control mania, lower end for maintenance Need to obtain trough level (before AM dose) maintain water intake
52
Lithium side effects
Reassure pts that these side effects usually resolve in time Fine hand tremor Polyuria Mild thirst Mild nausea – TAKE WITH FOOD to minimize GI irritation Weight gain - because its acts like a salt
53
early lithium toxicity
Nausea Vomiting Diarrhea Increased thirst Increased polyuria Lethargy Slurred speech Muscle weakness
54
advanced lithium toxicity (time to admit)
Coarse hand tremor Persistent GI, Nausea and Vomiting Confusion Muscle irritability EEG changes Sedation Poor coordination
55
severe lithium toxicity
"drunk sailor" Worsening lack of coordination – ataxia, clonic movements Increased EEG changes - seizures Blurred vision Giddiness and or stupor Increased polyuria – dilute urine Hypotension Death secondary to pulmonary complications
56
lithium toxicity so bad you need dialysis
Oliguria (opposite of polyuria) Seizures Death
57
Anticonvulsants as Mood Stabilizers
Valproic acid (Depakene) & Valproate semisodium (Depakote) Carbamazepine (Tegretol) Lamotrigine (Lamictal)
58
Valproic acid (Depakene) & Valproate semisodium (Depakote) administration
BBW liver damage regularly do ammonia level and valproic acid levels
59
Lamotrigine (Lamictal) administration
Report rashes - usually benign - BUT Black Box Warning for Stevens-Johnson and other rash reactions that can cause death

semester 4 (11 decks)

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