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
