quiz 1 Flashcards by Callie Wanek

Lithium Carbonate
Anticonvulsants (certain antiepileptic meds used)
Atypical Antipsychotics (many atypicals have mood-stabilizing properties
Antidepressants

mood stabilizing meds

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Alters sodium transport in nerve and muscle cells
Exact mechanism of action is unknown
May inhibit the release of norepinephrine and dopamine, but not serotonin

Lithium (lithobid, eskalith)

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Follows same distribution pattern in the body as water
Excreted from the kidney, 80% reabsorbed
If sodium depletion or dehydration, the kidney reabsorbs more Lithium into the serum—often leading to Lithium toxicity
Crosses placenta and enters breast milk
absorbed from GI track

pharmacokinetics of lithium

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GI distress (nausea, diarrhea, abdominal pain)
Fine hand tremors
Polyuria, mild thirst
Renal toxicity
Goiter and hypothyroidism
Bradydysrhythmias, hypotension
Electrolyte imbalances

These are directly related to serum levels of drug
The more lithium the more A/E

S/E A/E of Lithium

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acute mania lithium level

1.0-1.5 mEq/L

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maintenance of lithium level

0.6-1.2 mEq/L

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Diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine tremors, slurred speech

Early indications (Li level less than 1.5 mEq/L – 1.2-1.5

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Confusion, poor coordination, coarse tremors, GI distress, EKG changes

Advanced indications (Li level 1.5 to 2.0 mEq/L

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Polyuria, dilute urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma, possible death from respiratory complications

Severe Toxicity (Li level 2.0 to 2.5 mEq/L)

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Multiple organ toxicity, rapid progression of symptoms leading to coma and death

Extreme Toxicity (Li levels > 2.5 mEq/L)

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Known allergy
Pregnancy and lactation
History of leukemia
Use cautiously with renal dysfunction, heart disease, thyroid disorder, sodium depletion, dehydration, diuretic use
Caution if alcohol use, concurrent CNS depressant, or NSAID use

contraindications of lithium

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Pre-Lithium work up before first dose of Lithium given (baseline liver and renal functioning tests, thyroid functioning tests, CBC, EKG, etc)
Monitor serum Lithium levels
Take with food to decrease GI distress
Adequate fluid and sodium intake needed
Make sure diet doesn’t change – if they alter fluid/sodium intake that they’re used to it will effect how Lithium is distributed into their body
Monitor for signs/symptoms of Lithium toxicity

nursing considerations of Lithium

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follows water distribution

sodium alters it

lithium

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Thought to manage and treat Bipolar Disorder through various mechanisms including slowing the entrance of sodium and calcium back into the neuron; potentiating inhibitory effects of gamma aminobutyric acid (GABA); and inhibiting glutamic acid which suppresses CNS excitation

Exact mechanism of action in Bipolar Disorder not known

anticonvulsants used for mood stabilization

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Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Draw levels but we don’t need to know levels for exam
Lamotrigine (Lamictal)
Topiramate (Topamax)

anticonvulsants used for mood stabilization

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Absorbed from GI track
Metabolized in liver
Excreted in urine
Cross placenta and enter breast milk

pharmacokinetics from anticonvulsants for mood stabilization

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CNS (nystagmus, double vision, vertigo, headache, staggering gait); Blood dyscrasias (leukopenia, anemia, thrombocytopenia); Hyperosmolarity (can lead to edema, decreased urine output, hypertension); Skin disorders (rash, Stevens-Johnson Syndrome); GI (nausea and vomiting)

carbamazepine (tegretol)

anticonvulsant mood stabilization S/E

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GI (nausea, vomiting); Hepatotoxicity; Pancreatitis; Thrombocytopenia; Increased liver enzymes; tremor; Stevens-Johnson Syndrome (mememory sluffs off and presents in purple/red rash)

valporic acid (Depakote)
anticonvulsant for mood stabilization S/E

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Double or blurred vision; Dizziness; Headache; Nausea, Vomiting; Skin rashes including Stevens-Johnson Syndrome

lamotrigine (lamictal)

anticonvulsants used for mood stabilization S/E

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Fatigue; Weight loss; Dizziness; Visual Disturbances; Nausea; Abdominal pain; Tremor; Metabolic acidosis; Stevens-Johnson Syndrome

topiramate (Topamax)

anticonvulsant used for mood stabilization S/E

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Known allergy
Pregnancy
Bone marrow suppression or bleeding disorders
Liver disorders

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contraindications for anticonvulsants for mood stabilization

Oral contraceptives used concurrently with Carbamazepine (Tegretol) or Lamotrigine (Lamictal) decreases effectiveness of both meds – education for patient
Grapefruit juice increases levels of Tegretol
Concurrent use of Phenytoin (Dilantin) and Phenobarbital with Valproic Acid (Depakote) or Carbamazepine (Tegretol) requires monitoring of Dilantin and Phenobarbital levels
Monitor serum levels of Tegretol and Depakote

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nursing considerations for anticonvulsants for mood stabilization

Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)

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Select Atypical Antipsychotic Meds for mood stabilization

work mainly by blocking serotonin and, to a lesser extent, dopamine receptors

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Atypical Antipsychotic Meds for mood stabilization

Counteract neurotransmitter deficiencies: Norepinephrine (NE), Serotonin (5HT), Dopamine Accomplished in a variety of ways, e.g. blocking reuptake of neurotransmitters, boosting synthesis of neurotransmitters, blocking degradation of neurotransmitters

Antidepressant meds

Main groups of antidepressants

1. Tricyclic Antidepressants (TCAs) 2. Monoamine Oxidase Inhibitors (MAOIs) 3. Selective Serotonin Reuptake Inhibitors (SSRIs) 4. Atypical/Multiple Mechanism Meds

Amitriptyline Clomipramine (Anafranil) Imipramine (Tofranil) Nortriptyline (Pamelor, Aventyl)

Select TCA's

Block reuptake of norepinephrine and serotonin

pharmacological action of TCA - 1st generation agents

Absorbed from gastrointestinal (GI) track Distributed widely in tissues including brain Metabolized in liver Excreted in urine Relatively long half-lives (8-46 hours) Cross the placenta and enter breast milk

pharmacokinetics of TCA

``` Change in sexual function Weight gain Orthostatic hypotension Anticholinergic effects Sedation ```

S/E of TCA

Use cautiously in CV disease; diabetes; liver, kidney, respiratory disorders; urinary retention or obstruction; angle closure glaucoma; BPH; hyperthyroidism; and Bipolar Disorder Known allergy; recent myocardial infarction; myelography; seizure disorder; pregnancy and lactation Concurrent use with MAOIs, alcohol, benzodiazepines, opioids, antihistamines, oral anticoagulants

precautions/contraindications of TCA

MONITOR SUICIDE POTENTIAL – BLACK BOX WARNING There is a very narrow range between therapeutic and toxic levels with Tricyclics

TCA

block MAO in the brain, thus increasing the amount of norepinephrine, dopamine, and serotonin available for transmission of impulses (which results in relief of depression)

MOAI pharmacological action

Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Selegiline (Emsam)

MAOI drugs

Rarely prescribed because of dietary restrictions and med-to-med interactions

MAOI

Absorbed from GI track Metabolized in liver Excreted in urine Cross the placenta and enter breast milk

MAOI pharmacokinetics

CNS stimulation Orthostatic hypotension Hypertensive Crisis—from dietary intake of tyramine Rash from transdermal Emsam patch

S/E of MAOI

Known allergy If taking SSRIs or other antidepressants Pheochromocytoma Cardiovascular and cerebral vascular disease Renal or hepatic impairment Use cautiously if diabetes or seizure disorder, or if pregnant or breast-feeding Many medications interact with MAOIs—check with PCP before taking other meds

contraindications MAOI

Dietary (tyramine) Restrictions -Age cheese, raisins, Italian beans, red wines, smoked/processed meats, caviar, pickled haring, chicken/beef liver, soy sauce, meat tenderizer Consequences if tyramine consumed (hypertensive crisis) headache, n/v, fever, sweating, nuchal virginity

MAOI

block reuptake of serotonin with little to no effect on NE

SSRI

Absorbed from GI track Metabolized in liver Excreted in urine and feces Associated with congenital abnormalities

pharmacokinetics of SSRI

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

SSRI

Sexual dysfunction CNS stimulation—insomnia, agitation, anxiety Weight loss early in therapy then weight gain Drowsiness, dizziness, headache GI effects—nausea, vomiting, diarrhea, dry mouth, constipation Bruxism – teeth clinching or grinding

SSRI side effects

more psychical body effects Too much serotonin in body – prescribed too high Change in mental status, restlessness, myoclonus twitching, tachycardia, diaphoresis, tremors, flu like symptoms

serotonin syndrome | complication of SSRI

more mental mood changes Occur with abrupt discontinuation of SSRI, esp after long time Increase anxiousness, depressed mood and irritability

withdrawal syndrome and discontinuation syndrome | complication of SSRI

Known allergy Concurrently taking MAOI or TCA Pregnancy, lactation Use cautiously with liver/renal dysfunction; cardiac disease; seizure disorder; diabetes; ulcers; or history of GI bleeding Monitor for med-to-med interactions, e.g. if concurrently taking antiarrhythmic, anticoagulant, or other psychotropic med

contraindications of SSRI

block reuptake of norepinephrine, and/or serotonin, and/or dopamine

pharmacological action of atypical / multiple mechanism antidepressants

Absorbed from GI track Metabolized in liver Excreted in urine May pass into breast milk

pharmacokinetics of atypical / multiple mechanism antidepressants

``` Bupropion (Wellbutrin, Zyban) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Mirtazapine (Remeron) Trazadone (Desyrel) Venlafaxine (Effexor) Note: Wellbutrin and Remeron used as alternatives to SSRIs if patient experiences sexual side effects ```

MMR

Headache Dry mouth, constipation GI distress, nausea, poor appetite, weight loss Restlessness, insomnia Increased heart rate Priapism (prolong/painful eruption)—serious adverse effect with Trazadone

S/E of MMR

``` Known allergy Pregnancy and lactation Concurrent use with MAOI Seizure disorder May be contraindicated for patient with anorexia or bulimia ```

contraindications of MMR

quiz 1 Flashcards

(51 cards)