Pharm Exam 3 Study Guide (Benzodiazepines)

What type of medication is methylphenidate?

A central CNS stimulant (used to treat (ADHD).)

Define Benzodiazepines

A chemical category of drugs most frequently prescribed as anxiolytic drugs and less frequently as sedative-hypnotic agents.

Dopamine

A neurotransmitter that deals with pleasure and reward in the brain."

When is the best time to administer extended release methylphenidate?

At breakfast every day

Akathisia

Continuous restlessness, inability to sit still. Constant moving, foot tapping, hand movements may be seen. (Motor restlessness)

Typical length of antipsychotic medication therapy

Could be a lifetime.

What behavior would the instructor explain people with psychosis exhibit?

Disorganized and often bizarre thinking

Characteristics of schizophrenia

Hallucinations, paranoia, delusions, speech abnormalities, and affective problems (depression and bipolar disorder.)

What is the priority nursing action during first few weeks of taking SSRI?

Implement suicide precautions.

CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?

Improving

Characteristics of ADHD?

Impulsivity, hyperactivity, short attention span

Where should the nurse find Methylphenidate?

In the controlled substance cabinet

Neuroleptic Malignant Syndrome (NMS)

a potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia.

Haloperidol

Antipsychotic (It can treat certain types of mental disorders.)

What does the administration of midazolam assist in minimizing?

Anxiety

Serotonin abnormalities are thought to be involved in the following disorders:

Mental depression and sleep disorders.

Therapeutic serum lithium levels range

0.6 to 1.2 mEq/L (assess for common adverse effects of toxicity, which include GI and CNS effects)

Foods to avoid while taking Monoamine Oxidase Inhibitors (MAOIs)

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

What is it important to avoid while taking MAOI?

Avoid use of soy sauce in the diet.

Adverse Effects

Central nervous system effects- Sedation, drowsiness amnesia, confusion. CV effects- blood pressure changes, arrhythmias. GI effects- dry mouth, constipation, nausea, vomiting. GU effects- urinary retention, loss of libido.

What aspect of a client's health is most likely to cause insomnia?

Chronic pain

The nurse administers diazepam (Valium) preoperatively for what purpose?

Decreased anxiety

What is the prototype for the classification of drugs referred to as benzodiazepines?

Diazepam

Prototype

Diazepam (note the -am ending!

Association with attention deficit disorders.

Difficulty concentrating and failing grades

Two teaching considerations

Do not stop taking drug suddenly, report any condition to health care provider and tell your health care provider that you are taking this drug.

Moderate CNS depression is characterized by:

Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold.

Common neurological effect of antipsychotic drugs.

Dystonia, Akathisia, Pseudoparkinsonism, Tardive dyskinesia

Extrapyramidal effects

Dystonia, akathisia, parkinsonism, and tardive dyskinesia

Characteristic of narcolepsy

Falling asleep suddenly

Consequence of the resident's drug lorazepam (benzodiazepines) regimen?

Increased risk for falls

Drug/drug interactions (those that would INCREASE their action- )

Increased- Cimetidine, oral contraceptives or disulfiram. Decreased- Theophylline

What other drug is used to treat bipolar disorder?

Lithium

Lithium

Lithium salts (Lithobid) are taken orally for the management of MANIC (a period of extreme high energy or mood associated with bipolar disorder) episodes and prevention of future episodes. These potentially toxic drugs can cause severe CNS, renal, and pulmonary problems that may lead to death. Despite the potential for serious adverse effects, lithium is used with caution because it is consistently effective in the treatment of mania. The therapeutically effective serum level is 0.6 to 1.2 mEq/L (Antimanic aganets)

Antipsychotic drugs are contraindicated in clients with:

Liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.

Clozapine

Management of severely ill patients with schizophrenia who are unresponsive to standard drugs; reduction of risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder.

Pseudoparkinsonism

Muscle tremors, cogwheel rigidity, drooling, shuffling gait, slow movements.

Adverse effect related to amitriptyline.

Orthostatic hypotension

Characteristics of mania

Overactivity and excitement

Barbiturates prototype

Phenobarbital

How would you evaluate for therapeutic outcome?

Relief of signs and symptoms of anxiety.

A contraindication for the use of barbiturates.

Respiratory distress

Why would the physician order an SSRI for a newly diagnosed patient?

SSRIs usually produce fewer and milder adverse effects than other antidepressants.

What food should you avoid eating while taking phenelzine?

Salami

Lip smacking, a darting tongue, and slow and aimless arm movement

Tardive dyskinesia.

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?

They may cause dangerous interactions with some foods and drugs.

Usual doses for phenobarbital?

30-120 mg/d PO, IM, or IV.

How should the nurse explain the major difference between normal and abnormal anxiety?

Abnormal anxiety is prolonged and impairs normal function.

Tardive Dyskinesia

Abnormal muscle movements such as lip smacking, tongue darting, chewing movements, slow and aimless arm and leg movements.

Actions (Brief description of where these work)

Act in the lambic system and the RAS to make gamma-aminobutyric acid (GABA) more effective, causing interference with neurons firing. GABA stabilizes the postsynaptic cell.

Cautions (besides allergy)

Psychosis, acute narrow-angle glaucoma, shock, coma, or acute alcoholic intoxication all of which could be exacerbated by the depressant effects of the drug. Also contraindicated in pregnancy and breastfeeding. Use with caution in elderly or debilitated patients.

Inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors

A client reports feelings of gloom and the inability to perform activities of daily living. What is most likely impaired?

Serotonin is most likely impaired.

Dystonia

Spasms of the tongue, neck, back, and legs. Spasms may cause unnatural positioning of the neck, abnormal eye movements, excessive salivation.

Common adverse effect of amitriptyline?

Use of TCAs may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea.