Exam 1 Review

Atypical neuroleptics take ___ towork and have less have ___ s/s.

2-3 weeks less EPS s/s

Serotonin syndrome begins

2-72 hours after med is taken

Client with bipolar disorder in manic phase, they have a mildly elevated hepatic level (ALT, AST) but valproic acid level is normal

check with the physician to see if they wants to continue the med

Metoclopramide: Anti or Chol?

cholinergic

___ compress before injection ___ compress after injection

cold warm

C2 substance stands for

controlled substance

Antiepileptic drugs (AED's) work by ___ the neuronal activity of seizure-generating cells in the brain by ___

decreasing inhibiting the influx of sodium

methylphenidate is similar to

dextroamphetamine

phenytoin is incompatible with many drugs and

dextrose solutions

drugs that increase phenytoin levels

diazepam isoniazid valproic acid

MAOI side effects

dry mouth N/V/D/C headache dizziness/lightheadedness muscle twitching peripheral edema weight gain drowsiness insomnia

TCA side effects

dry mouth constipation drowsiness/sedation fever tachycardia weight gain

baclofen works by

enhances the inhibitory effects of GABA on the spinal cord, suppressing hyperactive reflexes and muscle spasticity

Muscle relaxants work by

enhancing the inhibitory effects of GABA, which suppressed hyperactive reflexes

Typical neuroleptics are ___ and have ___ s/s.

fast acting more EPS s/s

2 examples of SSRI's for depression

fluoxetine (Prozac) sertraline (Zoloft)

If a woman becomes pregnant while taking valproic acid they should take ___ to prevent

folic acid neural tube defects

Antipsychotics monitor

glucose can cause DM, weight gain, dyslipidima

oxycarbazepine food interaction

grapefruit juice

Typical neuroleptics (1st gen)

haloperidol chlorpromazine

methylphenidate or dextroamphetamine doses are based off of

height and weight

Patients taking levodopa/carbidopa should avoid

high-protein food

methohexital sodium adverse effects

hypotension tachycardia abuse & suicide

when taking fluoxetine report

increased agitation, anxiety, worsening mood

Metroclopramide side effects

increased salivation increased urination urinary urgency everything is going to be wet

fluoxetine works by

increasing the concentration of serotonin in the synapse, minimizing the symptoms of depression

SOB in a client taking lisdexamfetamine is a concern b/c

it can cause rapid deep breaths leading to respiratory alkalosis

A patient on dantroline should report

jaundice abdominal pain diarrhea muscle weakness

oxcarbazepine education

keep a seizure chart to note the date, time and nature of all seizures.

carbidopa helps

levodopa get absorbed

Therapeutic range needs to be routinely evaluated with a blood test for

lithium

dantrolene contraindications

liver disease

High ALT & AST

liver disease watch intake of alcohol, acetaminophen

Lithium provides

long-term prophylaxis against recurrence of mania or depression

dantroline can be used to treat ___ by administering it via ___, ___ days pre-op.

malignant hyperthermia IV bolus 1-2 days

sumitriptan (Imitrex)

migraines cluster HA

cyclobenzaprine (Flexeril) is a

muscle relaxant

oxycodone antidote

naloxone (Narcan)

paroxatine & fluoxetine s/s

nausea headache insomnia nervousness sexual dysfunction weight loss

opiate antidote

naxalone (Narcan)

Akathisia

need for constant motion (can't sit still)

busporine classification

norepinephrine-dopamine reuptake inhibitor (NDRI) antidepressant

levodopa/carbidopa side effect

orthostatic hypotension dyskinesia

MAOI adverse effects

orthostatic hypotension suicidal ideation hypertensive crisis (tryamine)

Who is in charge of methylphenidate or dextroamphetamine administration at home

parents

pregabalin is used for

peripheral neuropathy (DM) nerve pain seizures

dantrolene (Dantium) is a

peripherally acting muscle relaxant

MAOI examples

phenelzine selegiline tranylcypromine

Morphine major side effect

respiratory depression

Atypical neuroleptics (2nd gen) (-ine, -done)

risperidone olanzapine lozapine quetiapine

Insomnia is usually ___, drug therapy should be

self-limiting short term

Hypertensive crisis s/s

severe headache nausea sudden episode of epistaxis

Acute dystonia

severe painful neck & body spasms

SSRI major side effect

sexual dysfunction

phenytoin other s/s

skin rash (SJS) Nystagmus drowsiness

Lithium has an inverse relationship with

sodium

If ___ levels ___, the body conserves lithium, causing lithium levels to rise.

sodium fall

Muscle relaxant administration

start at a low dose increasing in 5mg

baclofen (Lioresal) is a

centrally acting muscle relaxant CNS depressant

Lithium normal range

0.8 - 1.3 mEq/L

phenytoin range

10-20 mcg/mL

Liver tests: AST

10-34

Hypotension first and second intervention

1: Lower the head of the bed 2: administer epinephrine

4 types of meds that CANNOT be crushed?

1: XL, LA, CR, ER, EC 2: any capsules 3: anything with "Contin" 4: Depakote

busporin onset

2 - 4 weeks

methylphenidate or dextroamphetamine administration

30 min after after breakfast Early afternoon d/t effects on appetite and sleep

levodopa/carbidopa XR tablets work over ____ but can take up to ____ to begin working

4-6 hours 2 hours

Purpose of a psychotropic wash-out period

Prevents overlap of 2 meds

valprioc acid should be diluted in

50 mL of compatible solution

phenytoin administration rate via IV is

50 mg/min

valproic acid normal range

50-100 mcg/mL

Scopolamine is good for

72 hours

Liver tests: ALT levels

8-37

methylphenidate patch should be removed after

9 hours

donepazil works by

Prevents the breakdown of acetylcholine so more is available for transmitting nerve impulses so more is available to work and promote PNS effects

Peripherally acting muscle relaxants work by

Acting on spastic skeletal muscles by inhibiting the release of calcium

phenobarbital antidote

Activated charcoal

TCA OD treatment

Activated charcoal or lavoge (tube down throat w/ activated charcoal) Binds with TCA's and disposes of it so the body doesn't absorb it Sodium bicarbonate helps with dysrhythmias

drugs that decrease phenytoin levels

Alcohol Phenobarbital Carbamazepine

valprioc acid (Depakote) treats

All seizure types Controls mania in bi-polar Prevents migraines

Interferon A & B contraindications

Allergy to human albumin Mannitol

paroxetine works by

Allowing the brain to have increased levels of serotonin, which should decrease feelings of anxiety

carbamazepine is an antagonist or agonist?

Antagonist

Scopolamine: Anti or Chol?

Anticholinergic

MAOI: Chol or antichol?

Anticholinergic DRY

TCA: Chol or Antichol?

Anticholinergic DRY

Acute dystonia treatment

Anticholinergics Benzodiazepines

Lamigotrine

Anticonvulsant NEWER

oxcarbazepine (Trileptal) classification

Anticonvulsant NEWER

carbamazepine (Tegretol) classification

Anticonvulsant traditional

Should be used with mood stabilizers in the treatment of Bi-Polar

Antidepressants

A nurse in a mental health clinic is caring for a client who has bipolar disorder and a prescription for an antipsychotic medication. The provider and nursing staff suspect the client is not adhering to his medication therapy. Which of the following interventions should the staff use to encourage the client's adherence? (Select all that apply.) A. Perform mouth checks following the administration of the medication. B. Provide for once-daily dosing. C. Use sustained-release forms. D. Engage the client in conversation following medication administration. E. Rotate staff that administer the medications.

B. Provide for once-daily dosing. C. Use sustained-release forms. D. Engage the client in conversation following medication administration.

methohexital sodium (Brevital) classification

Barbiturate / Anesthetic

donepezil administration

Bedtime d/t sedative effects Giving w/ or w/o food Monitor for GI bleeding

midazolam classification

Benzodiazepine

alcohol withdrawal treated with

Benzodiazepines

Lithium is the preferred mood stabilizer for

Bipolar disorder

Benzodiazepines side effects

Blurred Vision Bladder retention Constipation Sedation/drowsy/dizzy Severe hypotension

Lithium toxicity: Levels 2.0 - 2.5

Blurry vision Polyuria Muscle hyperirritability Severe hypotension Ataxia (lack of muscle control) Dehydration

MAOI risk

Serotonin Syndrome Hypertensive crisis

baclofen adverse effects

CNS effects drowsy, dizzy N/V Constipation Urinary retention (rare)

dantrolene precautions

Cardiac disease Pulmonary disorders Neuromuscular disorders Over 35

Lithium: Chol or Antichol?

Cholinergic

donepezil classification

Cholinesterase inhibitor

Serotonin syndrome s/s

Cognitive agitation, confusion, Peripheral muscle incoordination, excessive sweating

levodopa/carbidopa education

Give at the same time every day Do not skip a dose Fall risk (orthostatic hypotension) works around the clock

Anticholinergic side effects

DRY! Can't see Can't pee Can't spit Can't poop

If the half-life is 24-hours when should the med be given?

Daily

Neuroleptic evaluation of effectiveness

Decline in the number of hallucinations

Extrapyramidal symptoms (EPS)

Drug-induced movement disorders associated with antipsychotics (neuroleptics)

Main side effect of atropine

Dry everything up May need catheter if cannot urinate

sumitriptan interactions

Ergotamine use w/in 24 hours Serotonin agonists

Taking ____ increases the risk of liver toxicity in women over 35

Estrogen

T/F: Interferon beta prevents infections by strengthening the immune system.

False

T/F: It is OK to use viscous forms of lidocaine in kids under 3

False

T/F: you should only rely on medications to aid in sleep disturbances

False

Interferon A & B adverse effects

Flu-like (esp. at first) Jaundice (Liver toxicity) Bruising, bleeding, fatigue Repression of all blood cell types

benzodiazepine antidote

Flumazenil (Romazicon)

when is an incident report needed?

Force feed a patient meds Refuse to educate patient regarding meds Refuse to give pain meds prior to activities Giving meds at the wrong time

phenytoin main normal side effect

Gingival hyperplasia

Benzodiazepines contraindications

Glaucoma Pregnancy Caffeine (stimulants w/ depressants negates effects)

phenytoin education

Good oral care Soft toothbrush Report rash immediately May need periodic blood level checks

sumitriptan contrainidications

HEART PROBLEMS CAD, Angina, HTN, MAOIs w/in 2 weeks CVA Use of another triptan w/in 24 hours

sumitriptan adverse effects

HEART PROBLEMS Coronary vasospasm Chest pressure/pain CNS effects (vertigo/tingling)

methylphenidate adverse effects

HTN tachycardia heart palpations Withdrawal (depression)

fentynal (sublimaze) nursing care

Have naloxone available Have resuscitation equipment available Monitor vital signs

NMS s/s

High fever High BP (unstable) "Lead pipe" muscle rigidity High HR

phenytoin (Dilantin) classifications

Hydantoin It is an antiepileptic and antidysrhythmic

methohexital sodium administration

IV injection IV infusion

Interferon A & B drug classification

Immunomodulator Stops leukocytes from breaking down myelin sheath

Adding epinephrine to lidocaine can

Increase the length of anesthetic effect Cause adverse effects like gangrene

Interferon A & B treats

Multiple Sclerosis and it decreases permanent damage to the myelin sheath

What can occur if cyclobenzaprine is given to pt taking SSRIs, SSNRI, and tricyclic antidepressants?

Serotonin syndrome

Benzodiazepines work by -pam, -lam

Increasing GABA concentrations, which decreases CNS activity

carbamazepine works by

Inhibiting the influx of sodium through channels Decreasing discharge of neurons

methylphenidate treats

Kids: ADHD Adults: narcolepsy

Lithium toxicity: Levels > 2.5

LEVELS > 2.5 Seizures, oliguria LEVELS > 3.5 ECG changes, blurred vision, coma, death

valproic acid is toxic to

Liver

Interferon A & B precautions

Liver disorder Seizures <18yo Alcohol abuse

dantrolene adverse effects

Liver toxicity Diarrhea Muscle weakness Drowsiness

fentanyl interaction

MAOI w/in 2 weeks Hypertensive crisis

baclofen contraindication

MAOI's (Hypotension, CNS depression) Antidepressants (serotonin syndrome)

What can increase plasma levels when taking carbamazepine?

MAOIs Antifungals Grapefruit juice

TCA: med contraindications

MAOIs cimetidine epinephrine/methylphenidate

TCA: physiologic contraindications

MI Seizures

donepazil (Aricept) treats

Mild - Mod Alzheimer's Improves cognitive functioning

Lithium expected side effects

Mild nausea Fatigue Dry mouth

Scopolamine is used for

N/V after anesthesia Motion sickness

Lithium toxicity: Levels 1.0 - 1.5

N/V/D Fine hand tremors Polydipsia (thirst) Muscle weakness Lethargy

memantine (Namenda) classification

NMDA receptor antagonist

donepezil contraindications

NSAIDS Hx of GI bleed

Is busporine sedative or not sedative?

Not sedative no potential for abuse

If a pt is taking phenytoin and sleeping w/ a serum level of 18, what do you do?

Nothing. Normal serum level range is 10-20.

carbamazepine adverse effects

Nystagmus Photosensitivity SJS, epidermal necrolysis Visual disturbances Headache Decreased bone density Teratogenic

memantine interactions

OTC antacids

baclofen route

Oral (food/milk) Itrathecal

Disease associated with levodopa/carbidopa

Parkinson's

Parkinsonism s/s

Parkinson-like symptoms Rigidity, tremors, sluggish movements usually resolves, can give meds to help

EPS types of movement disoders

Parkinsonism Akathisia Acute dystonia Tardive dyskinesia Neuroleptic Malignant Syndrome (NMS)

Drugs to treat bipolar

Paroxetine Lithium Valproate Carbamazepine

Lithium classification

Psychotherapeutic

Respiratory depression levels

RR > 12 O2 saturation > 90 Must meet BOTH criteria to have respiratory depression

methohexital sodium uses

Rapid induction of anesthesia and hypnosis for brief procedures

baclofen treats

Relieves muscle spasms SCI, MS, CP

lidocaine adverse effects

Respiratory arrest CNS stimulant effects (dizziness, tremors, confusion)

Most important assessment for a pt given nalaxone

Respiratory status assessment within 60 mins

methylphenidate brand name

Ritalin Concerta

Anticonvulsant similar adverse effect

SJS

Sympathomimetic inhaler trigger the ___NS, causing

SNS massive bronchodilation

MAOI contraindications

SSRI Stimulants (caffeine, chocolate, pseudophedrine) Renal/Liver/Heart dysfunction or failure

paroxitine is a ___ used for

SSRI anxiety

fluoxetine is a ___ used for

SSRI depression

St. John's wort contraindications

SSRIs MAOIs sumatriptan

Orthostatic hypotension treatment

Salt Water

Benzodiazepines education

Sedation should improve after 7 - 10 days Tolerance can develop so taper

sumitriptan classification

Serotonin Agonist

Alprazolam uses

Sleep aid Severe anxiety/agitation

Diazepam is used to treat

Status epilepticus b/c it is 1 continuous seizure. This med doesn't require loading and can treat the seizure immediately

oxycarbazepine adverse effects

Steven Johnson Syndrome (SJS) Dizziness/drowsiness

Psychotropic wash-out period

Stop 1 antidepressant Wait 14 full days before starting a new one MONTH BETWEEN STOPPING & STARTING PT AT HIGH SUICIDE RISK

Tardive dyskinesia treatment

Stop immediately if occurs (could become permanent) monitor vitals including ECG

If a patient develops a rash or hives

Stop medication

Sympatholytics

Suppress SNS activity

___ drugs should not be given to asthmatics b/c they

Sympatholytics beta-2 cause bronchoconstriction (wheezing will be worse)

baclofen education

Take w/ food or milk Fluids & fiber (reduce constipation) Careful driving Change positions slowly if dizzy

Phenytoin pregnancy concerns

Teratogenic (can causes birth defects) Interferes with effectiveness of oral contraceptives

EPS client education

There are drugs to manage early EPS. Antipsychotic drugs block several kind of receptors. EPS are movement disorders caused by antipsychotic drugs.

Half-life of medication

Time it takes 50% of the med to be metabolized A med has a 12-hr half life, that is the amount of time it takes for half the med to be metabolized

___ can occur with anxiolytics and the dose may need to be ___

Tolerance increased

Scopolamine application

Topically Behind ear (rotate sites)

Type of meds that might increase the tremors in a pt with Parkinson's disease

Traditional (typical) neuroleptic

If you cannot read a prescription

call the doctor to clarify

T/F: A patient on lithium should NOT consume a low-salt diet

True

T/F: Alprazolam (Xanax) is not long lasting

True

T/F: Baclofen is an agonist

True

T/F: Patients taking interferon A & B increase risk of infection

True

T/F: antidepressants and anxiolytics can be discontinued but need to be tapered

True

T/F: antiepileptics should not be withheld

True

T/F: baclofen should be tapered to avoid withdrawal

True

T/F: carbamazepine should be not be withheld even if CBC & WBC are within normal range

True

T/F: pregabalin is a controlled substance and must be counted

True

T/F: typical neuroleptics work quickly in a crisis with a non-compliant client and the goal is to switch meds.

True

T/F: valprioc acid is OK to take with lithium

True

T/F: valproic acid has a narrow therapeutic range, making it one to watch for toxicity

True

T/F: donepazil has cholinergic effects

True SLUDGE

Medication you can crush

Tylenol ES Aspirin

Monitor for EPS s/s mainly with

Typical neuroleptics haloperidol, chlorpromazine

Cholinergic side effects

WET! Salivation Lacrimation Urination Defecation GI distress Emesis

carbamazepine education

Wear sunscreen Fall precautions Report sore throats

donepezil adverse effects

Wheezes (from brochoconstriction) Incontinence related to bowel & bladder (diarrhea) CNS effects (bradycardia leading to SYNCOPE) N/V GI bleed

phenytoin administered too fast can cause

cardiac collapse

Is dantroline an antagonist or agonist?

agonist

When taking cyclobenzaprine, avoid

alcohol

Interferon A & B can decrease ___ leading to

all blood cell types bone marrow suppression

TCA examples

amitriptyline nortriptyline imipramine desipramine clomipramine doxepin amoxapine

atenolol treats

angina (heart pain) hypertension

A client with ____ should not take levodopa/carbidopa

angle-closure glaucoma

phenytoin is an antagonist or agonist?

antagonist

Atropine: : Anti or Chol?

anticholinergic

Parkinsonism treatment

anticholinergics dopamine replacements/agonists

pregabalin (Lyrica) classification

anticonvulsant

pilocarpine reversal agent

atropine sulfate

What can decrease plasma levels when taking carbamazepine?

barbituates Rifampin (TB med)

C2 must always be

be counted be prescribed by provider refilled w/ a new Rx

carbamazepine administration

bedtime to minimize adverse effects in the daytime

Akathisia treatment

beta-blockers benzodiazepenes lower dose/lower potency antipsychotic

SSRI's selectively

block the reuptake of serotonin

levodopa crosses the

blood brain barrier (BBB)

atenolol side effects

bradycardia hypotension low HR

Opioid major side effects

bradycardia respiratory depression depression

It important for drugs to have ease of administration because

there are fewer medication errors

It is important to collect baseline data for sleep disturbances

to determine the best route of treatment

oxcarbazepine (Trileptal) goal

to reduce the amount of seizures so the client can live a normal life

amitriptyline classification

tricyclic antidepressant (TCA)

Sympathomimetic Inhaler

type of inhaler that opens the airway

TCA adverse effects

urinary retention blurred vision confusion seizures suicidal thoughts

Metoclopramide is used for patients w/

urinary retention heartburn difficulty emptying stomach (DM)

Take valproic acid with or without food?

with food

Tardive dyskinesia

writhing tongue, cheek movements

busporine s/s

xerostoma nausea headache drowsy/dizzy/lightheaded tachycardia, palpitations