S3 Test 3 meds
how long does it take for TCA to start working
6-8 weeks anxiety, depression, neuropathy -Amitriptyline -Imapramine
lithium range
Bipolar and schizoaffective disorder -0.6 - 1.2 is range you want ->1.5 Toxic; over 2 is extremely toxic
lithium use
Bipolar and schizoaffective disorder •Long term treatment-think of lithium battery
NDRIs
Bupropion (Wellbutrin)
Prednisone (Deltasone)
Corticosteroid
MAOI uses
Depression, Social Phobia, & Panic Disorders •Phenelzine •Selegiline •Isocarboxazid
does 0.9% NaCl expand ICF or ECF
ECF
TCA side effects
EPS cant see, pee, spit, shit anxiety, depression, neuropathy -Amitriptyline -Imapramine
Mitoxantrone (Novantrone)
Immunosuppressant MS - modifies the disease course
Progressive MS does not respond to ___ but relapse and remitting do
Interferon beta and Glatiramer
S/S of MAOI reaction
M - Massive Headache, Hypertensive Crisis A - AVOID Tyramine O - OTC = Hypertensive Crisis(See C.A.A.N.) O - Other antidepressants = Serotonin Syndrome I - Increased Risk of Suicide
Phenelzine (Nardil) for depression
MAOI antidepressant ask pharmacist about OTC meds
most effective med for depression
MAOI but a lot of complications
what has the highest risk of putting someone into a hypertensive crisis with MAOIs
OTC meds
Nelfinavir (Viracept)
AIDS prevent the breakup of viral protein strand into smaller active viral particles.
Maraviroc (Selzentry)
AIDs Antiretroviral, CCR5 Antagonist block CCR5 receptors on CD4+ T cells
Antipsychotic SE
WASH MEN -weight gain -anticholinergic -sedation -HOTN -mvmt disorder -EPSE -neuroleptic malignant syndrome (NMS) photosensitivity anticholingeric effects decreased sexual function weight gain dizzy
Kayexalate (sodium polystyrene sulfonate)
a medication used to reduce high serum potassium; exchanges sodium for potassium in the intestine
oxybutynin for MS
anticholingeric prevent overactive bladder
Carbamazepine (Tegretol) use
anticonvulsant/mood stabilizer for bipolar, seizures, neuralgia
HCTZ (thiazide diuretic)
can cause hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia
teaching for antipsychotics
clozaril, zyprexa, risperdol, clozapine, danzapine, risperdone 1-4 weeks for therapeutic level sunscreen rise slow decrease weight gain increase fiber intake
antipsychotic physiological effects
clozaril, zyprexa, risperdol, clozapine, danzapine, risperdone blocks overactive dopamine receptors
all MS medications produce what
produce a slight form of immune problems
for all antidepressants what should be assessed
suicide and sexual function
lithium things to monitor and encourage
urine output dehydration increase fluids because toxicity affects kidneys
NRTIs for HIV
nucleoside reverse transcriptase inhibitors (given for HIV patients to inhibit retroviruses) trick HIV enzyme so replication is suppressed -avoid fatty fried foods -report flu-like symptoms -prevent injury -avoid or limit alcohol because drugs are hard on liver
truvada for HIV what to monitor, who cannot take it
once daily drugs for protection against HIV/combination drugs -have black box warnings to avoid in patients with Hep B because severe acute exacerbations can occur -for people who are at high risk for acquiring HIV -after starting kidney function and HIV tests are done every 3 months
what assessment would need to be checked before giving tricyclic antidepressants
oral contraceptives, antihypertensives, MOAIs, anticoagulants
what concentration of lithium would indicate advanced signs of lithium toxicity
over 1.8
What is saquinavir?
protease inhibitor that works by blocking the HIV enzyme protease; it is not a fusion inhibitor. Saquinavir prevents the viral protein strand from being lysed into active smaller fragments.
antianxiety meds antidote
romazicon
bethanechol for MS
stimulate bladder to contract cholinergic
what medication is given for HIV positive pregnant woman and when, what week of birth
zidovudine at 14-34 w gestation c section at 38 weeks
advanced S&S Lithium Toxicity and interventions
•Advanced (1.5 to 2 mEq/L) -Signs: Coarse hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritability, electroencephalographic (EEG) changes, incoordination -Interventions: Hold medication, obtain blood level, re-evaluate dose, treat more serious symptoms
Early S&S Lithium Toxicity and interventions
•Early (less than 1.5 mEq/L) -Signs: Increased nausea, vomiting, diarrhea, thirst, polyuria, slurred speech, muscle weakness -Interventions: Hold Medication, measure blood lithium levels, re-evaluate dosage
Toxicity S/S of Lithium
•Kidney - Creatinine >1.3 •Urine <30mL/hr •Ringing in the ears (Tinnitus)
Glatiramer
for MS decoy duck - in blood stream and looks like myelin so the body attacks the decoy myelin instead of real myelin ; not a lot of immune suppression
interferon beta
for MS like a bouncer at a club - prevent undesirables from entering and remove them; interferon does this to the blood brain barrier; allows increased anti-inflammatory agents to cross but prevents proinflammatory agents to cross ; not a lot of immune suppression
what medications can lower potassium by excreting them through urine
furosemide and lasix
Natalizumab (Tysabri)
given by IV infusion to treat relapsing forms of MS to delay disease progression and prevent exacerbations; used when inadequate response or intolerance to other agents
what antidepressant acts by increasing the avaliability of time of noradrenaline and serotonin at the postsynaptic receptors
imipramine tricyclic antidep causing mood elevation
all HIV medications are hard on what
kidneys and liver
aspirin can cause what acid base imbalance
metabolic acidosis from increased acid intake
when should SSRIs be taken
morning depression, anxiety, PTSD -Sertraline -Citalopram -Escitalopram -Paroxetine -Fluoxetine
Raltegravir (Isentress)
Antiretroviral, Integrase Inhibitor HIV
Trazodone (Desyrel) use and what to avoid
atypical antidepressant •depression and sleep. -Avoid ETOH (alcohol) and other sedatives
The nurse is preparing to teach a client recently diagnosed with multiple sclerosis about taking glatiramer acetate. Which statement by the client indicates a need for further teaching? "I will rotate injection sites to prevent skin irritation." "I need to avoid large crowds and people with infection." "I should report any flulike symptoms to my primary health care provider." "I will report any signs of infection to my primary health care provider."
"I should report any flulike symptoms to my primary health care provider." Glatiramer is given by subcutaneous injection. The first dose is administered under medical supervision, but the nurse teaches the client how to self-administer the medication after the initial dose, reminding the client about the need to rotate injection sites. Like other immunomodulators, this drug can make the client susceptible to infection. However, flulike symptoms occur more commonly with interferons rather than glatiramer.
Bupropion (Buspar) use and SE
atypical antidepressant •depression and to stop smoking -Insomnia, Headache, Weight Loss
when should TCA be taken
night anxiety, depression, neuropathy -Amitriptyline -Imapramine
A client with HIV-III asks the nurse why gabapentin is part of the drug regimen when the client does not have a history of seizures. What response by the nurse is best? "Gabapentin can be used as an antidepressant too." "I have no idea why you would be taking this drug." "This drug helps treat the pain from nerve irritation." "You are at risk for seizures due to fungal infections."
"This drug helps treat the pain from nerve irritation." Many classes of medications are used for neuropathic pain, including tricyclic antidepressants and anticonvulsants such as gabapentin. It is not being used to prevent seizures from fungal infections. If the nurse does not know the answer, he or she would find out for the client.
Spironolactone (Aldactone)
*class*: potassium sparing diuretics *Indication*: potassium loss, hypertension, edema, CHF *Action*: inhibits sodium reabsorption while sparing potassium and hydrogen *Nursing Considerations*: - contraindicated with hyperkalemia - monitor intake and output - monitor blood pressure - monitor potassium levels and renal panel
NNRTIs for HIV
- Non-Nucleoside Reverse Transcriptase Inhibitors - Bind to and later alter reverse transcriptase which is an enzyme HIV needs to make copies of itself -check for increased liver enzymes and decreased RBC -report sore throat, bruises, fever -some meds can cause birth defects
HIV PEP (post-exposure prophylaxis), when to start, how long do you take it, how often are you tested
-initiate prophylaxis as soon as possible! -recommendations for HIV PEP include a basic 4-week anti-retroviral regimen start within 36 hours of exposure following cART regime for 28 days, testing done 1, 3, 6 months after -best results when starting cART 2 hours after exposure
truvada for HIV protection
-protection begins after 7 days of use, if day is missed continue taking as regular but if 2 days are missed you need to start over and wait 7 more days before protection is reestablished
A client on antidepressant therapy develops hyperthermia, seizures, and a heart rate of 200 beats per minute. Which medication would the nurse suspect is responsible for the condition? 1 Sertraline 2 Asenapine 3 Risperidone 4 Fluphenazine
1 A heart rate of 200 beats per minute indicates cardiac dysrhythmias. Hyperthermia, seizures, and cardiac dysrhythmias in a client on antidepressant therapy indicate serotonin syndrome. Serotonin syndrome is an adverse effect of selective serotonin reuptake inhibitors such as sertraline. Asenapine, risperidone, and fluphenazine are antipsychotics that may cause drowsiness, neuroleptic malignant syndrome, extrapyramidal symptoms, and tardive dyskinesia as adverse effects.
how long does it take for SSRIs to work
2-6 weeks; usually within 4 weeks; some symptoms may improve within 1 to 2 weeks depression, anxiety, PTSD -Sertraline -Citalopram -Escitalopram -Paroxetine -Fluoxetine
Which statement is inaccurate regarding the mechanisms of antiviral medications to control human immunodeficiency virus (HIV) infections? 1 "Maraviroc blocks C-C chemokine receptor type 5 (CCR5) receptors on CD4 + T cells." 2 "Saquinavir blocks the fusion between HIV and the host cell." 3 "Zidovudine acts as a counterfeit base for reverse transcriptase." 4 "Nelfinavir prevents the breakup of viral protein strand into smaller fragments."
2
A client is lonely and extremely depressed, and the health care provider prescribes a tricyclic antidepressant. The client asks the nurse what the medication will do. Which response is the best would the nurse provide? 1 "This medication will help you forget why you're lonely and depressed." 2 "The medication will make you feel better." 3 "You'll start to feel much better after taking this medication for 2 or 3 days." 4 "This will decrease your social anxiety so you will be more comfortable developing relationships with others."
2 Tricyclic antidepressants create a general sense of well-being, increase appetite, and help lift depression. The client might not know the reason for depression, and the medication does not cause amnesia. Symptomatic relief usually begins after 2 to 3 weeks of therapy. Tricyclic antidepressants are not indicated for treatment of social anxiety; social anxiety disorder is treated with selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIS), and benzodiazepines.
A client with human immunodeficiency virus (HIV)-associated Pneumocystis jiroveci pneumonia is to receive pentamidine isethionate intravenously (IV) once daily. The nurse will monitor the client for which adverse effect? 1 Hypertension 2 Hypokalemia 3 Hypoglycemia 4 Hypercalcemia
3 Pentamidine isethionate can cause either hypoglycemia or hyperglycemia even after therapy is discontinued, and blood glucose levels should be monitored. Hypotension, not hypertension, occurs with pentamidine isethionate. Hyperkalemia, not hypokalemia, occurs with pentamidine isethionate. Hypocalcemia, not hypercalcemia, occurs with pentamidine isethionate.
antidote for lithium toxicity
none but can do a gastric lavage, emetic, urea, mannitol
Can you breastfeed with HIV?
nope. not in us
what to monitor with SSRIs
sodium levels depression, anxiety, PTSD -Sertraline -Citalopram -Escitalopram -Paroxetine -Fluoxetine
what to monitor with MAOIS
BP •Phenelzine •Selegiline •Isocarboxazid
things to avoid with MAOIs (CAAN)
Calcium, Antacids, Acetaminophen, NSAIDS
A nurse assesses a client with multiple sclerosis after administering prescribed fingolimod. For which common side effect would the nurse monitor? Peripheral edema Facial flushing Tachycardia Fever
Facial flushing Fingolimod is an oral immunomodulator that has two common side effects—facial flushing and GI disturbance, such as diarrhea. Peripheral edema, tachycardia, and fever are not common side effects of this drug.
what are patients who take natalizumab at risk for
opprtunistic viral infection that can lead to disability or death watch for s/s of neurological changes for MS
Emtricitabine/Tenofovir
HIV
Tenofovir
HIV
abacavir/lamivudine for HIV what to avoid
HIV avoid fried and fatty foods
Knock-offs or Integrase inhibitors Raltegravir (Isentress) use and SE
HIV ●GI upset ●Hyperglycemia ●Muscle breakdown ●Caution when used with "statins"
Fuseon & maraviroc (Selzentry) use and SE
HIV med ●Hypotension ●Liver toxicity ●Peripheral neuropathy
prophylaxis
prevention of disease
A nurse assesses a client who is prescribed furosemide for hypertension. For which acid-base imbalance does the nurse assess to prevent complications of this therapy? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Metabolic alkalosis Many diuretics, especially loop and thiazide diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. This situation is an actual acid deficit.
Antianxiety Side Effects
Sedation (no driving), confusion, hepatic dysfunction, resp depresstion, dependance xanax, librium, klonipin, tranxene, valium, vistaril, ativan, serax, buspar
Truvada (emtricitabine/tenofovir) and discovy
antiretroviral & reverse transcriptase inhibitor - HIV taken daily prevents HIV
HIV PrEP (pre-exposure prophylaxis)
Truvada (tenfovir/emtricitabine) combination anti-reverse transcriptase therapy recommended for sexually active HIV- negative people at high risk of HIV exposure taken daily (orally) can reduce the risk of contracting HIV (40- 80% reduction) not perfect, people may still become infected intended for use with other risk reduction strategies (condoms) $8,000 - $14,000 per year
Zidovudine (Retrovir)
Tx: HIV Class: antiretroviral AE: paresthesia, N/V, lactic acidosis, Teaching: monitor hemoglobin nucleoside reverse transcriptase inhibitor that acts as a counterfeit base for the HIV enzyme reverse transcriptase.
TCA uses
anxiety, depression, neuropathy -Amitriptyline -Imapramine can wean off
baclofen, zanaflex, and dantrium for MS
acts on the central nervous system to relieve spasms, cramping, and tightness of muscles caused by spasticity in multiple sclerosis. skeletal muscle relaxants
Carbamazepine side effects
anticonvulsant/mood stabilizer for bipolar, seizures, neuralgia SE: -Oral Contraceptives will be ineffective -Side Effect: Leukopenia (decreased WBC - increased risk for infection) Must report ASAP fever, sore throat etc
carbamazepine and valproates 2 functions
anticonvulsants and mood stabilization
drugs to treat paresthesia in MS
anticonvulsants, tricyclics
Zidovudine (Retrovir) use and SE
antiretroviral HIV ●Neuropathy ●Liver toxicity ●Pancreatitis ●Decrease fatty foods
drugs for cerebellar ataxia in MS
beta blockers benzos lower doses symptom management
drugs for acute attacks of MS
bone marrow suppression, GI irritation, skin/hair
HIV: what should be reported with atazanavir
bradycardia
Dolutegravir for HIV does what to pregnancy
cause birth defects
antipsychotic nursing implications
clozaril, zyprexa, risperdol, clozapine, danzapine, risperdone s/s of toxicity CNS depression restless agitation VS seizure precautions maintain airway
abrupt withdraw from tricyclic antidepressants (amitriptyline) can cause
cold sweats, nausea, tachycardia, nightmares
what are SSRIs used for
depression, anxiety, PTSD -Sertraline -Citalopram -Escitalopram -Paroxetine -Fluoxetine
SSRIs side effects
depression, anxiety, PTSD -Sertraline -Citalopram -Escitalopram -Paroxetine -Fluoxetine S/E : Wt. Gain Sexual Dysfunction Insomnia
TCA side effects
drowsy dizzy
common SE of tricyclic antidepressants in the beginning
drowsy, dizzy, postural hypotension but go away after a few weeks
trimethoprim with sulfamethoxazole for HIV: treats what and SE
drug of choice to treat P. jiroveci pneumonia hepatitis, hyponatremia, and thrombocytopenia
excessive aldosterone causes
excess ECV
SNRI
for Depression, Chronic Pain, & Fibromyalgia duloxetine
Natalizumab (Tysabri)
for MS - link onto immune cells that attack myelin and attacks bad immune system instead to prevent them from attacking myelin ; a little more immune suppression -mab = monoclonal antibody ; very specific ; report flu like symptoms
how is natalizumab given and what should be monitored
for MS IV monitor confusion, disorientation, liver enzymes
first sign of tyramine and MOAIS
headache then increased BP
do tube feeding pose a risk for hyper or hyponatremia
hyper
does hypo or hypernatremia cause LOC to decrease
hypernatremia
what does a positive trosseaus sign indicate
hypocalcemia and hypomagnesemia
what does weaker leg muscles than normal indicate
hypokalemia
what does too much ADH cause and what is the symptom
hyponatremia confused and lethargic
first line drug for mania and suicidal ideation
lithium mood stabilizer
mood stabilizing medications nursing implications
lithium, tegretol, neurontin, calan, depakene, depakote blood levels monitored 3x/week airway for toxicity BP frequently no grapefruit if taking a calcium channel blocker
mood stabilizing medications SE
lithium, tegretol, neurontin, calan, depakene, depakote memory problems N/V diarrhea weight gain dizzy blurred vision
mood stabilizing medications toxicity what to do
lithium, tegretol, neurontin, calan, depakene, depakote narcan is reversal severe toxicity is treated with hemodialysis
mood stabilizing medications therapeutic effects
lithium, tegretol, neurontin, calan, depakene, depakote reduces frequency and intensity of manic and depressive episodes used for opioid and alc withdraw symptoms
Furosemide (Lasix)
loop diuretic can cause hyponatremia, hypokalemia, hypocalcemia used for hypermagnesia
what symptoms does lithium control
manic
loop and thiazide diuretics cause what acid base imbalance
metabolic alkalosis
Valproic Acid (Depakote) use and SE
mood stabilizer -Side Effect: Liver Toxicity •Monitor Liver Panel Labs -Decreases Platelets (Thrombocytopenia)
what does the renal system excrete as compensation for respiratory acidosis and it retains more what
more hydrogen ions and retains bicarb
high dose corticosteroids for MS
never maintenance meds bc tons of SE and can knock out immune system; used for exacerbation short term;
Mitoxantrone (antineoplastic) for MS use and SE
suppressing the body's immune system for the period of treatment, depleting the number of cells that are attacking the myelin around nerves. This effectively gives the body a chance to 'restart' and sort out what has gone wrong with the immune system. decrease relapses in MS bone marrow suppression, GI irritation, skin/hair
what would be prescribed for a patient with bipolar disorder and a history of alcohol abuse
valproic acid
antidepressants therapeutic effects
wellbutrin, prozac, zoloft, paxil, elavil, toframil, tetracyclic, remeron, MAOI, parnate, desyrel decrease depressive symptoms 10-14 days to start working full effect in 4-6 weeks
antidepressants side effects
wellbutrin, prozac, zoloft, paxil, elavil, toframil, tetracyclic, remeron, MAOI, parnate, desyrel dry mouth, blurred vision, urinary retention, constipation, CNS effects, orthostatic HTN, high HR, weight gain, sexual dysfunction
antidepressant teachings
wellbutrin, prozac, zoloft, paxil, elavil, toframil, tetracyclic, remeron, MAOI, parnate, desyrel hard candy or ice for dry mouth increase fluid intake
Antidepressant physiological effects
wellbutrin, prozac, zoloft, paxil, elavil, toframil, tetracyclic, remeron, MAOI, parnate, desyrel increase avaliable neurotransmitters by inhibiting neurotransmitter reputake by inhibiting MAO or blocking receptors
antidepressants things to monitor
wellbutrin, prozac, zoloft, paxil, elavil, toframil, tetracyclic, remeron, MAOI, parnate, desyrel labs for toxicity VS I and O weight hydration mental changes
what can you not take with antianxiety meds
xanax, librium, klonipin, tranxene, valium, vistaril, ativan, serax, buspar antacids
antianxiety physiological effects
xanax, librium, klonipin, tranxene, valium, vistaril, ativan, serax, buspar calming, skeletal muscle relaxation, anticonvulsant
antianxiety meds therapeutic effects
xanax, librium, klonipin, tranxene, valium, vistaril, ativan, serax, buspar decrease anxiety help with alcohol withdraw convulsive disorder
s/s of overdose with antianxiety meds
xanax, librium, klonipin, tranxene, valium, vistaril, ativan, serax, buspar resp depression, cold clammy skin, hypotension, weak rapid pulse, dilated pupils, coma
when at what med is given to infant of HIV positive mom
zidovudine 6-12 h after birth for 6 weeks oral syrup
severe s/s of lithium toxicity and interventions
•Severe (2 to 2.5 mEq/L) -Signs: Ataxia, serious EEG changes, blurred vision, clonic movements, large output of dilute urine, tinnitus, blurred vision, seizures, stupor, severe hypotension, coma; death is usually secondary to pulmonary complications -Interventions: No known antidote for lithium poisoning. -Stop drug and facilitate excretion: •If alert, give emetic •Gastric lavage •Treatment with urea, mannitol - osmotic diuretic and can help with seizures, and aminophylline to hasten excretion
Re-packaging or Protease Inhibitors Saquinavir (Invirase)
●Liver toxicity ●High lipids ●Pancreatitis HIV a class of antiretroviral drugs that prevent HIV replication and prevent the release of HIV particles from infected cells -do not crush or chew -report jaundice, nausea, abdominal pain -drugs can induce liver toxicity -avoid st. johns wort
Pharm for MS
❖Anti-inflammatory drugs and immunosuppressive drugs ❖Immunosuppressants can be general or selective ❖Goal: self-reacting tissue damaging actions slow or stop ➢symptoms of disease are reduced ➢ patient retains enough immunity to prevent serious infection.
