pharm exam 2
what foods contain tyramine?
aged foods and avocados
atypical antipsychotics
blocks both dopamine and serotonin, blocks positive and negative symptoms of schizophrenia
typical antipsychotics
blocks only dopamine, treats symptoms of schizophrenia by blocking the things that shouldn't be there
action of fluoxetine
blocks the reuptake of serotonin (usually starter drug for depression)
acetylcholine
communicates between nerves and muscles
a client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. the nurse should teach the client that this combination may result in what adverse reaction?
dangerous drug interactions
narcolepsy
daytime sleepiness and sudden periods of loss of wakefulness
uses of fluoxetine
depression, OCDs, panic attacks, PMDD
uses of imipramine
depression, sleep disorders, enuresis, chronic pain
AE of fluoxetine
drowsiness, insomnia, tremor, anorexia, risk of suicidality, serotonin syndrome, increased risk of bleeding
do extrampyramidal effects go away?
no, once you develop these they don't go away even if you lower the dose
do psychotherapeutic drugs cure disorders?
no, they help patients carry on ADL
CI of diazepam
older adults, pregnant or lactating, other CNS depressants (alcohol), shock/coma
what does serotonin syndrome look like?
rapid heart rate and high blood pressure, dilated pupils, loss of muscle coordination or twitching muscles, rhythmic muscle contractions
CI of imipramine
recent MI, pregnancy, lactation, or myelography
goal of antipsychotics
reduce psychotic symptoms so patients have the ability to self-care
what is the reticular activating symptoms role?
regulating arousal and sleep-wake transitions
uses of phenobarbital
relieves anxiety that is through the roof, sedation
a nurse is caring for a patient with depression. which symptom should the nurse closely monitor for in the patient?
extreme sadness
bipolar disorders
extremes of depression followed by hyperactivity and excitement
how can you reverse the effects of benzodiazepines?
flumazenil (romazicon)
why are parents counseled to give children a break/vacation from methylphenidate when school is not in session?
gives their child the chance to get an appetite and gain weight
treatment of neuroleptic malignant syndrome
hold medication/notify the provider, cool with cooling blanket, fluids, antipyretics, administer dantrolene
2-2.5 lithium serum level
hyperreflexia, seizures
CI of methylphenidate
hypertension, hyperthyroidism, glaucoma, CAD, history of abuse, and agitation/anxiety
what happens if a patient is on phenelzine and consumes tyramine?
hypertensive crisis
serotonin
important in arousal and sleep and in preventing depression and promoting motivation
when should you administer methylphenidate, knowing it causes insomnia?
in the morning
attention deficit disorders
inability to concentrate on one activity for longer than a few minutes, state of hyperkinesis, usually diagnosed in school-aged children
action of diazepam
makes GABA more effective (slows the brain down, CNS depressant)
what are neurotransmitters?
messengers that stimulate the postsynaptic cells either by exciting or by inhibiting them
uses of phenelzine
used for patients who do not respond to newer, safer, antidepressants (last resort)
AE of phenelzine
anticholinergic effects and too much fight or flight, hepatotoxicity, risk of suicidality
AE of diazepam
anticholinergic effects, sedation, drowsiness
uses of diazepam
anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, status epilepticus
a nurse is working with a client who is taking an MAOI. what would be the most important instruction to the client?
avoid the use of soy sauce in the diet
neuroleptic malignant syndrome
lead pipe muscle rigidity (muscles don't relax)
half life of diazepam
20-80 hours, takes a long time for the body to get rid of it (need good reason to give for patients older than 65)
what drugs should you be careful with when taking fluoxetine?
NSAIDs, G herbs, antiplatelet/anticoagulation drugs because of bleeding
less than 1.5 lithium serum level
CNS: lethargy, slurred speech, muscle weakness, tremor, N/V/D
when should you administer methylphenidate, knowing it causes loss of appetite?
30 mins to an hour before you eat
half life of phenobarbital
79 hours
action of phenobarbital
CNS depressant, inhibits neuronal impulse conduction in the ascending RAS, depresses cerebral cortex
AE of phenobarbital
CNS depression, hypoventilation/apnea (have airway equipment), bradycardia, stevens-johnson syndrome
actions of methylphenidate
CNS stimulants act as cortical and RAS, by increasing the release of catecholamines (norepinephrine, epinephrine, and dopamine)
1.5-2 lithium serum level
ECG changes, polyuria
a client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. which represents the action of the medication?
SSRIs prevent serotonin from being reabsorbed
norepinephrine and epinephrine
catecholamines released by nerves in the sympathetic branch of the ANS
gamma-aminobutyric acid (GABA)
inhibits nerve activity and is important in preventing over-excitability or stimulation such as seizure activity
AE of methylphenidate
insomnia, loss of appetite, and schedule 2 drug (high abuse potential)
dopamine
involved in the coordination of impulses and responses
actions of phenelzine
irreversibly inhibits MAO, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft
what does it mean if you inhibit the reuptake of NE and 5HT?
more is available for use in the synaptic cleft
akathisia
most common, inability to relax/pacing
>2.5 lithium serum level
multiorgan toxicity
acute dystonia
muscle spasms of face, tongue, neck, back
nurses role for phenobarbital
must have additional training to give this drug, nurse's role is to care for someone after they get this drug
while reviewing the medication history of an older adult client, the nurse learns that the client is taking imipramine 25 mg three times per day. what adverse effect should the nurse prioritize when incorporating safety measures into the care plan?
orthostatic hypotension
CI of phenobarbital
other CNS depressants
the nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten?
phenelzine
CI of fluoxetine
pregnancy, lactating, impaired renal or hepatic function
CI of phenelzine
pregnant or lactating, pheochromocytoma, CV disease, renal or hepatic impairment
glutamate
primary excitatory neurotransmitter
a client has been prescribed phenelzine sulfate. when providing teaching, which food should the nurse instruct the client to avoid eating?
salami
AE of imipramine
sedation, orthostatic hypotension, anticholinergic effects, bone marrow depression, risk of suicidality
after teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?
selective serotonin reuptake inhibitors
what two neurotransmitters does imipramine work on?
serotonin and norepinephrine
what happens if you take imipramine and phenelzine together?
severe hyperpyretic crisis with severe convulsions, hypertensive episodes, and death
what are positive schizophrenia symptoms?
things that are present that shouldn't be: hallucinations, delusions
what are negative schizophrenia symptoms?
things that should be present but are not: lack of motivation, isolation, disinterest
uses of methylphenidate
treat ADD and narcolepsy
psychotherapeutic agents
treat schizophrenia, bipolar disorder, narcolepsy, attention deficit disorders
indications of lithium
treatment of acute manic episodes of bipolar maintenance, treatment of bipolar disorder
pseudoparkinsonism
tremors, stooped posture, muscle rigidity (shuffling)
tardive dyskinesia
wormlike movements of tongue, uncontrolled chewing/grimacing