Exam 4 Pharm Spring 2019 Review
GI adverse effects of SGAD
Nausea Diarrhea Constipation Dry mouth
Acute dystonia
Painful muscle spasms
Akathisia
Distressing muscle restlessness
bupropion (Zyban)
Used for smoking cessation
Potential complications (patient risk)of AED use
- Barbiturates: phenobarbital, primidone Dizziness, drowsiness, lethargy, paradoxical restlessness, GI upset -Hydantoins: phenytoin, fosphenytoin Nystagmus, ataxia, drowsiness, rash, gingival hyperplasia, thrombocytopenia, agranulocytosis, hepatitis, GI upset -Iminostilbenes: carbamazepine, oxcarbazepine Nausea, headache, dizziness, unusual eye movements, visual change, behavioral changes, rash, abdominal pain, abnormal gait, GI upset -valproic acid and derivatives, including valproate sodium and divalproex sodium Dizziness, drowsiness, GI upset, weight gain, hepatotoxicity, pancreatitisethosuximideNausea, abdominal pain, dizziness, drowsiness -gabapentin Dizziness, drowsiness, nausea, visual and speech changes, edemapregabalinDizziness, drowsiness, peripheral edema, blurred vision -lamotrigine Drowsiness, ataxia, headache, nausea, blurred or double vision -levetiracetam Dizziness, drowsiness, hyperactivity, behavior changes such as anxiety, hostility, agitation, or suicidal ideation -tiagabine Dizziness, drowsiness, agitation, asthenia, GI upset, abdominal pain, rash, tremor -topiramate Dizziness, drowsiness, GI upset, ataxia -zonisamide Drowsiness, anorexia, ataxia, confusion, agitation, cognitive impairment (Lilley 222) Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby, 022016. VitalBook file. The citation provided is a guideline. Please check each citation for accuracy before use. (Lilley 222) Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th Edition. Mosby, 022016. VitalBook file. The citation provided is a guideline. Please check each citation for accuracy before use.
What is one major risk of starting pts on antipsychotic therapy?
Worsening their symptoms and increasing social ideation
How do you treat serotonin syndrome?
Abrupt cessation of drug/cause of syndrome
What is the mechanism of action of buspirone (miscellaneous anxiolytic)?
Activity at serotonin and dopamine receptors, non-sedating, non-habit forming, don't give with MAOIs
Tyramine containing foods
Aged, mature cheeses Smoked/pickled or ages meats, fish, poultry Yeast extracts Red wines Italian broad beans
Interactions with ginseng
Anticoagulants, immunosuppressants, anticonvulsants, antidiabetic drugs
What are 3 main mental disorders?
Anxiety Affective disorders Psychoses
What are indications of anxiolytic drugs?
Anxiety Ethanol withdrawal Insomnia Muscle spasms Anesthesia adjunt Depression adjunct
What drugs can be used with lithium?
Benzodiazepines, antipsychotic drugs, antiepileptic drugs, dopamine receptors agonists
What should serum lithium levels be during treatment?
Between 0.6-1.2 mEq/L
What is the mechanism of action of antipsychotics?
Block dopamine receptors in the brain limbic system and basal ganglia which are the ares associated with emotion, cognitive function, and motor function Result - tranquilizing effect, decreased levels of dopamine
What is the mechanism of action of atypical antipsychotics?
Block specific dopamine-2 (D2) receptors and specific serotonin-2 (5-HT2) receptors
What is OD on TCAs?
Can be lethal (70-80% mortality) and the CNS and cardiovascular systems are mainly affects. Death results from seizures or dysrthythmias (prolonged QT) and it's dose related
Pt education about SSRIs
Can take 4-6 weeks to reach maximum clinical effectiveness
What are affective disorders?
Changes in mood that range from mania to depression or both
What do all anxiety disorders have in common?
Common symptoms of heightened awareness of state they are in
A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. Drowsiness b .Palpitations and anxiety c. Dry mouth d. Constipation
Correct answer: B Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. -interacts with anticoagulants,immunosupressants, anticonvulsants, and antidiabetic drugs -used for more than 5000 years -used for stress reduction, increase physical endurance, and increased concentration
The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey
Correct Answer:C Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur.
A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.
Correct answer: A Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. **acute mania level 1.0-1.5 Levels above 1.5 cause toxicity, GI issues, tremor, confusion, seizures, somnolence ***(Lithium is the drug of choice in treatment of mania)
A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation
Correct answer: A, C, E Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. St. John's Wort is used for depression, anxiety, sleep disorders, and nervousness
A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation
Correct answer: ANS:C Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy.
While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite
Correct answer: B In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed.
Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? a.The patient needs to avoid caffeine while on this drug. b.The patient needs to wear sunscreen while outside because of photosensitivity. c.Long-term therapy may result in nervousness and excitability. d.The medication may be taken with an antacid to reduce gastrointestinal upset.
Correct answer: B Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats
The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.
Correct answer: C Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects
A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding
Correct answer: C Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias
A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a."I can't sleep at night." b."I feel hungry all the time." c."Look at how red my hands are." d."My mouth has been so dry lately."
Correct answer: D Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation.
A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."
Correct answer: D The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors.
The nurse reads in the patient's medication history that the patient is taking Buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder
Correct answer:A Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.
The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a . "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c ."It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."
Correct answer:B Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. It can take 4-6 weeks*
When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a .Fewer panic attacks b .Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia
Correct answer:B The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs.
Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs
Correct answer:B Anticoagulants Use of SSRI antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed.
A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b ."Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."
Correct answer:D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Hypertensive crisis may occur.
What is the mechanism of action of benzodiazapines?
Decrease anxiety by reducing overactivity in the brainstrem and the limbic system and increasing the action of GABA, sedating
Symptoms of serotonin syndrome
Delirium, tachycardia, hyperreflexia, shivering, agitation, sweating, muscle spasm, coarse tremors
What are the indication of SSRIs/SNRIs?
Depression BPD Obesity Eating disorders OCD Panic disorders Social anxiety disorders PTSD Myoclonus Substance abuse
What are the indications of TCAs?
Depression (sometimes) Insomnia Childhood enuresis (imipramine) Neuropathic pain syndromes OCD (clomipramine)
What are indication of MAOIs?
Depression esp with reverse vegetative symptoms of increased sleep and appetite Depression that doesn't respond to other drugs such as tricyclics
Integumentary adverse effects of antipsychotics
Dermatologic photosensitivity, skin rash, hyperpigmentation, pruritus
What are contraindications of TCAs?
Drug allergy Used of MAOIs within 14 days Pregnancy
What are contraindications of anxiolytic drugs?
Drug allergy, narrow-angle glaucoma, pregnancy
Lithium
Drug of choice for the treatment of mania by potentiating serotonergic neurotransmission
What are mood-stabilizing drugs?
Drugs used in the treatment of schizophrenia and mania that have a narrow therapeutic range. These drugs can predispose pts to electrolyte imbalance and have nasty side effects
What are antipsychotics?
Drugs used to treat serious mental illness such as behavioral problems or psychotic disorders
GI adverse effects of antipsychotics
Dry mouth, constipation
Adverse effects of ginseng
Elevated BP, chest pain, palpitations, anxiety, insomnia, headache, GI symptoms
Metabolic/endocrine adverse effects of antipsychotics
Galactorrhea, irregular menses, increase appetite, polydipsia
Adverse effects of St. John's Wort
GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity
CNS adverse effects of SGAD
Headache Dizziness Tremor Nervousness INSOMIA Fatigue
Ginseng
Herbal product used for stress reduction, improvement of physical endurance and concentration
What are MAOIs?
Highly effective second-line treatment for depression Downside - They cause the "cheese effect"
Severe symptoms of serotonin syndrome
Hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, DIC
MAOIs and tyramine
Ingestion of foods or drinks with tyramine leads to HTN crisis, which mat lead to cerebral hemorrhage, stroke, coma, or death
What is the mechanism of action of SNRIs?
Inhibit reuptake of both serotonin and norephinephrine
What is the mechanism of action of MAOIs?
Inhibit the MAO enzyme system in the CNS which inhibits the breakdown of amines and alleviates of symptoms of depression
What is tardive dyskinesia (TD)?
Involuntary contractions of oral and facial muslces, choreoathetosis that occurs with continuous long-term antipsychotic therapy
What is extrapyramidal symptoms (EPS)?
Involuntary muscle symptoms similar to those of PD including akathisia, acute dystonia Treatment - benztropine (Cogentin) and trihexyphenidyl (Artane)
Hematologic adverse effects of antipsychotics
Leukopenia, agranulocytosis
What are common mood-stabilizing drugs?
Lithium carbonate and lithium citrate
What are 6 major anxiety disorders?
OCD PTSD GAD Panic disorder Social phobia Simple phobia
Cardiovascular adverse effects of antipsychotics
Orthostatic HTN, syncope, dizziness, ECG changes
What are adverse effects of MAOIs?
Orthostatis HoTN Tachycardia Dizziness Insomnia Anorexia Blurred vision Palpitations Drowsiness Headache Nausea Impotence
What are adverse effects of anxiolytic drugs?
Over expression of therapeutic effects Decreased CNS activity Sedation HoTN Drowsiness Loss of coordination Dizziness Headaches N/V Dry mouth Constipation
What are antidepressant drugs?
Pharmacologic treatment of major depression, dysthymia, adjunct schizophrenia treatment, eating disorders, and personality disorders
What is neuroleptic malignant syndrome (NMS)?
Potentially life threatening syndrome of high fever, unstable BP, myoglobinemia
Treatment of MAOI OD
Protect brain and heart, eliminate toxin, hemodialysis
Pt education with psychotherapeutic drugs
Provide simple explanations about drug, effects, and length of time before therapeutic effects are expected AVOID ABRUPT WITHDRAWAL Change positions slowly to avoid postural HoTN and possible injury Don't use with alcohol and other CNS depressants Small amounts of med dispensed to minimize risk of suicide
What are anxiolytic drugs?
Reduce anxiety by reducing overactivity in CNS
Other adverse affects of SGAD
SEXUAL DYSFUNCTION WEIGHT GAIN WEIGHT LOSS Sweating
What have replaced TCA as first line antidepressant drugs?
SSRIs, TCAs are used for pts who fail with SSRIs or as adjunct therapy with new generation antidepressants
What are adverse effects of TCAs?
Sedation Impotence Orthostatic HoTN Older pts - dizziness, postural HoTN, consipation, delayed micturation, edema, muscle tremors
CNS adverse effects of antipsychotics
Sedation, delirium
What are interactions with anxiolytic drugs?
Sedative drugs, alcohol, pts with hepatic impairment
What is the mechanism of action of SSRIs?
Selectively inhibit serotonin reuptake resulting in increased serotonin concentrations at nerve endings
What is psychosis?
Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in ADLS, loss of contact with reality
How do you treat TCA OD?
Symptomatic and supportive, activated charcoal, speed elimination by alkalinizing urine, IV bicarb infusion, basic life support
OD on MAOIs
Symptoms appear 12 hours after ingestion resulting in tachycardia, circulatory collapse, seizures, coma
What is serotonin syndrome?
Syndrome especially when buspirone and SSRIs are mixed, that results in hyperthermia, HTN, unresponsiveness, agitation, shivering, twitching of muscles, increase DTRs, and fine motor tremors
What is the mechanism of action of tricyclic antidepressants?
They correct imbalance of neurotransmitter concentrations of serotonin and norepinephrine at the nerve endings in the CNS by blocking presynaptic uptake
How do you treat OD of anxiolytic drugs?
Treatment is symptomatic and supportive, Flumazenil
Why are psychotherapeutic drugs used?
Treatment of emotional and mental disorders
buspirone (BuSpar)
Unknown mechanism of action, not overly strong, can have opposite effects so monitor pt for a week, administer on a scheduled basis Can cause paradoxical anxiety, blurred vision, headache, dry mouth, nausea
What is anxiety?
Unpleasant state of mind, characterized by a sense of dread and fear which may be based on actual anticipated experiences/past experiences and may be exaggerated responses to imaginary negative situations
GU adverse affects of antipsychotics
Urinary hesitancy or retention, impaired erection
St. John's Wort
Used for depression, anxiety, sleep disorders, nervousness
Choreoathetosis
Wavelike movements of extremities
Pt education about phenothiazines
Wear sunscreen d/t photosensitivity Avoid antacids or antidiarrheal preps within 1 hour of dose Avoid alcohol and other CNS depressants Long term haloperidol tx can result in tremors, nausea, vomiting, uncontrollable muscle shakes
What are emotional/mental disorders?
When emotions significantly affect an individual's ability to carry out normal daily function
Interactions with St. John's Wort
When taken with MAOIs and SSRIs, tyramine-containing foods
What can cause OD of anxiolytic drugs?
When taken with other sedatives or alcohol
What are common anxiolytics?
alprazolam, diazepam, buspirone, lorazepam
What are common atypical antipsychotics?
clozapine (Clozaril) risperidone (Riperdal) olanzapine (Zyprexa) quetiapine (Serquel)
Neutropenia precautions
decreased WBC places pt at increased risk for infection -limit visitors to family member - wash hands -Educate patients on the importance of performing oral care frequently (see discussion of stomatitis) and to turn, cough, and deep breathe to help prevent stasis of respiratory secretions. -prohibit fresh flowers in pt's room
What are common SSRIs?
fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) citalopram (Celexa) escitalopram (Lexpro)
What are common MAOIs?
phenelzine (Nardil), selegiline (Emsam)
What are common antipsychotics?
thiothixene (Navane) haloperidol (Haldol) - can induce delirium in older pts molindone (Moban) loxapine (Loxitane)
What are common SNRIs?
venlafaxine (Effexor) trazodone (Desyrel, Oleptro) burpropion (Wellbutrin)
