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Pharm > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What drug class is amitriptyline in?

A

Tricyclic antidepressant

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2
Q

What is an example of a tricyclic antidepressant?

A

Amitriptyline

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3
Q

What is the MOA of amitriptyline?

A

It blocks the reputake of serotonin and norepinephrine

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4
Q

What are the indications for amitriptyline?

A

Depression
Chronic pain
Enuresis in children over 6

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5
Q

What does amitriptyline work well for as well as the other indications?

A

Sleep disturbances related to depression and anxiety

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6
Q

What are some precautions for tricyclic antidepressants (TCAs)?

A

Black box warning for children
Anticholinergic effects in older adults- can’t pee, can’t see, can’t spit, can’t have BM
May cause insomnia

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7
Q

What are some labs to keep an eye on with amitriptyline?

A

ECG
Urine output
Drug levels

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8
Q

What are some common side effects of TCAs and which drug is a TCA?

A

Amitriptyline

Side effects: sweating, seizures, dysrhythmia, sedation, orthostatic hypotension

Anticholinergic effects

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9
Q

What are some vitals to monitor while a patient is on amitriptyline?

A

Blood pressure
Heart rate
Respiratory rate

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10
Q

What are some assessments to do on patients taking amitriptyline?

A

Mood improvement
Increase in activities?
Sleeping through the night?
Weight
Appetite
Level of consciousness

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11
Q

What drug class is Fluoxetine in?

A

SSRI

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12
Q

What is the example of an SSRI?

A

Fluoxetine

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13
Q

What are some indications for Fluoxetine?

A

Depression
Anxiety
Bulimia
Sleep disturbances r/t depression and anxiety

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14
Q

What is MOA of Fluoxetine?

A

Blocks reabsorption of serotonin to help elevate mood

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15
Q

What are contraindications for Fluoxetine?

A

Suicide attempts
Breast feeding

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16
Q

What does Fluoxetine interact with?

A

St. John’s wart
MAOI- serotonin syndrome- Sweaty and febrile, restless and rigid muscles, increased heart rate infection
Breast feeding

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17
Q

Who is Fluoxetine the drug of choice for?

A

Older adults

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18
Q

What are some SSRI (Fluoxetine) side effects?

A

HEAD RED FED

insomnia and anxiety, GI upset and risk of GI bleeding, weight gain and hypoglycemia in diabetics

Serotonin syndrome- sweaty and febrile, restless and rigid muscles, increased heart rate

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19
Q

What are some labs to keep an eye on with patients who take Fluoxetine?

A

Liver enzymes
Renal labs (BUN and creatinine)
Blood glucose

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20
Q

What are some monitoring rules with Fluoxetine?

A

Monitor heart rate and blood pressure for hypertensive crisis
Monitor temperature to watch for serotonin syndrome

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21
Q

What is some client education for SSRIs?

A

Takes 8-12 weeks to build up
Do not take with St. John’s wart and MAOIs

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22
Q

When should Fluoxetine be given?

A

In the morning to prevent sleep disruption

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23
Q

What is a contraindication for Amitriptyline?

A

Do not give to patients who are hospitalized post MI

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24
Q

What drug class is Diazapam in?

A

Benzodiazepines

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25
Q

What drug is the example for benzodiazepines?

A

Diazapam

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26
Q

What are the indications for Diazapam?

A

Anxiety disorders
Acute alcohol withdrawal
Mood stabilizer
Muscle relaxer
Anticonvulsant
Sedative

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27
Q

What is Diazapam concurrent with?

A

Antidepressants, antipsychotics, and mood stabilizers because they can take a while to become effective

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28
Q

What is the MOA of Diazapam?

A

Enhances the inhibitory effect of GABA

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29
Q

Where is Diazapam metabolized and excreted?

A

Metabolized in the liver and excreted in the urine

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30
Q

What are some precautions for Diazapam?

A

Kids more sensitive so they get smaller doses; may cause paradoxical CNS stimulation in kids

Risk of paradoxical reaction in older adults with a hx of psychosis; fall risk medication

Infants under 1 month do not get

Caution in giving to the critically Ill because it’s a myocardial depressant

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31
Q

What are some interactions r/t to Diazapam?

A

Alcohol and CNS depressant drugs
Caffeine or stimulant drugs

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32
Q

What are some labs to watch when someone is on Diazapam?

A

Liver and renal panels

Heart rate and blood pressure

33
Q

What are signs of overdose of Diazapam?

A

Blurred/double vision
Labored breathing
Weakness
Stupor (coma)

34
Q

How do you evaluate if Diazapam is working?

A

Pt reports decrease in anxiety
Heart rate and blood pressure have lowered
Pt is relaxed but easily aroused

35
Q

What is the anecdote for Diazapam overdose?

A

Flumazenil

36
Q

What are patient education topics r/t amitriptyline?

A

Avoid MAOIs and St. John’s wart
Avoid grapefruit juice and alcohol
Take at bedtime

37
Q

What are patient education topics r/t Diazapam?

A

Avoid caffeine or stimulant drugs because they counteract the medication

Avoid alcohol or CNS depressant drugs because they increase the sedative effect

It is a fall risk medication

Take with food if GI upset occurs

38
Q

What is the metabolism pathway for all antidepressants?

A

Oral - GI absorption- liver metabolizes- excreted urine

39
Q

What occurs when antidepressants are stopped suddenly?

A

Antidepressant discontinuation syndrome

40
Q

What are some nursing pearls for antidepressants?

A

Initial increased risk of suicide

Slow onset and taper off

Never mix: SSRI with St. John’s wart; MAOI and antidepressant

All psych drugs decrease BP so do slow position changes

Cause weight changes- mostly increase

41
Q

What drug class is Venlafaxine in?

A

SNRI

42
Q

What is the drug example for SNRI?

A

Venlafaxine

43
Q

What is the MOA of Venlafaxine?

A

Inhibits the reabsorption of serotonin and norepinephrine

44
Q

What is the pathway for Venlafaxine?

A

Metabolized in the liver and excreted in the urine

45
Q

What are the indications for Venlafaxine?

A

Depression
Anxiety
Neuropathic pain

46
Q

What are some precautions for Venlafaxine?

A

Black box warning for children and can cause weight loss

Risk of weight loss in older adults and can cause hyponatremia (low sodium levels in the blood caused by SIADH)

47
Q

What are some SNRI adverse effects?

A

Insomnia
Weight loss

Serotonin syndrome

48
Q

What are contraindications for Venlafaxine?

A

Use of an MAO inhibitor
Sensitivity to drug
Pregnancy

49
Q

What are some patient teaching topics r/t to Venlafaxine?

A

Serotonin syndrome

Take with food to decrease GI upset

Take at the same time every day

XR capsules can be sprinkled, but not chewed

50
Q

How do you evaluate if Venlafaxine is working?

A

Improved mood
Improvement in pain if using for neuropathic pain
Decreased anxiety

51
Q

What are some things to keep an eye on/do when a patient is taking Venlafaxine?

A

EKG and sodium levels
Urine output
Level of consciousness/insomnia
Skin assessment
Weight loss

52
Q

What are some vital signs to watch when a patient is taking Venlafaxine?

A

Heart rate and blood pressure

53
Q

What drug class is Phenelzine in?

A

MAOI

54
Q

What is the drug example for MAOIs?

A

Phenelzine

55
Q

What are the indications for an MAOI?

A

Depression

Last resort due to major food and drug interactions

56
Q

What is the MOA for Phenelzine?

A

Binds irreversibly to MAO increasing norepinephrine, serotonin, and dopamine

57
Q

What are some precautions and contraindications for Phenelzine?

A

Children: contraindicated
Risk of hypertensive crisis in adults
Pregnancy/lactation: contraindicated

58
Q

What is the pathway for Phenelzine?

A

Metabolized in the liver and excreted in the kidneys

59
Q

What are some assessment questions for Phenelzine?

A

Irritability/insomnia?
Improved mood?

60
Q

What are some things to keep an eye on when a patient is taking Phenelzine?

A

Tyrosine levels (high levels can cause a hypertensive crisis)
EKG
heart rate and blood pressure
Renal and liver functions

61
Q

What are some patient education topics r/t Phenelzine?

A

Too much tyrosine in the diet can lead to hypertensive crisis

Hypertensive crisis symptoms: blurred vision, severe headache, photophobia, neck stiffness, sweating, nausea, vomiting

Don’t take OTC cold meds, interacts with most drugs and tyrosine containing foods

62
Q

What is the treatment drug for hypertensive crisis?

A

Phentolamine

63
Q

What drug class is Bupropion in?

A

Atypical antidepressant

64
Q

What is the drug example for atypical antidepressants?

A

Bupropion

65
Q

What is the MOA of Bupropion?

A

Inhibits reabsorption of dopamine, serotonin, and norepinephrine

66
Q

What are the indications for Bupropion?

A

Depression
Seasonal affective disorder
Smoking cessation

67
Q

Why are some precautions/contraindications for Bupropion?

A

Not recommended for children
Caution in pregnancy; don’t use during lactation
Black box warning for smoking: may cause neuropsychiatrics reaction

68
Q

What are some assessments r/t Bupropion?

A

Mood baseline
Activity and energy
Appetite

69
Q

What are some things to watch when a patient is taking Bupropion?

A

Weight
Blood pressure
Renal panel

70
Q

What may Bupropion need to be taken with?

A

CNS depressant

71
Q

What drug class is lithium carbonate in?

A

Mood stabilizing agent

72
Q

What drug is the example for the drug class mood stabilizing agent?

A

Lithium carbonate

73
Q

What is an important consideration for Lithium carbonate?

A

Not metabolized
Excreted entirely by kidneys

74
Q

What are the indications for lithium carbonate?

A

Treatment of manic episodes d/t bipolar

75
Q

What are some nursing considerations for lithium carbonate?

A

Has a narrow therapeutic window
Need baseline renal, cardiac, thyroid levels, electrolytes
Serum drug levels 2-3 times a week; then every 3 months
Peaks and troughs of medication; don’t give before pt is getting blood levels measured
Doses increase gradually

76
Q

What are some teaching points for lithium carbonate?

A

Don’t take the medication before getting blood levels checked
Caution in those who sweat a lot and/or are diabetic; maintain hydration
Continue birth control if on it to prevent pregnancy

77
Q

Why are some assessments appropriate for lithium carbonate?

A

Normal/abnormal behaviors
Mania
Unkempt appearance

78
Q

What are some things to watch for when someone is given lithium carbonate?

A

Blood pressure and weight
EKG
I&O

79
Q

What are signs of lithium carbonate overdose?

A

vomiting, drowsy, stupor (coma), tremors, unsteady gait, muscle weakness, diarrhea

Pharm (9 decks)

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