Pharm 4 - Mood DO
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What is used for benzodiazepine withdrawal?
Valium (less addictive than Xanax)
What is used for emergencies, or first line treatment of anxiety (not for long-term use)?
- Lorazepam (Ativan) &
- Alprazolam (Xanax)
- -both benzodiazepines
What should the nurse do prior to injecting Ativan?
aspirate to make sure it's not in an artery
________ inhibits metabolism of alprazolam (Xanax).
______ doses of Xanax are given to older adults.
Drug given for low level anxiety, such as stage freight, or nursing school!
Inderal (a BB)
________ increases the effects of BuSpar.
The safest group of antidepressants. Why?
- fewer sympathomimetic effects (HR, HTN)
- fewer anticholinergic effects
Which disorders does Zoloft treat?
- Social anxiety
Which disorders does Paxil treat?
- Social anxiety
Which disorders does Prozac treat?
Which disorders does Lexapro treat?
SSRIs (Paxil, Zoloft, Prozac, Lexapro) may cause ____ , and ______ dysfxn.
Common AE with TCAs (Tofranil).
- anticholinergic effects
- (dry mouth, blurred vision, urine retention, hypertension)
Contraindications for TCAs (Tofranil).
- Heart block or dysrhythmias
- history of alcoholism
What should you avoid with MAOIs (Nardil)?
- foods with tyramine
- -also potentiates insulin (=hypoglycemia)
MAOIs (Nardil) commonly cause?
- orthostatic hypotension
- (high incidence of AE, rarely used)
Tofranil increases the action of what?
Off-label common use for imipramine (Tofranil).
overactive bladder (nocturesis)
Contraindication of imipramine (Tofranil).
- seizure DO
- (Tofranil = TCA)
Increased sedation effects from imipramine (Tofranil) if taken with what?
- other CNS depressants
- (alcohol, barbituates, benzos)
- *Tofranil = TCA
Decreased sedation effects from imipramine (Tofranil) if taken with what?
- oral contraceptives
- *clonidine (given for HTN)
- *Tofranil = TCA
What should you NOT mix TCAs (Tofranil) with? Why?
- MAOIs or
- *Seratonin Syndrome!
______ are the drugs of choice for treating depression due to their LOW incidence of serious SE.
SSRIs (Prozac, Paxil, Zoloft, Lexapro)
Ataxia, weakness, restlessness, dizziness, or other motor problems can occur with ______.
lorazepam (a benzodiazepine for anxiety)
Abrubtly stopping Xanax (benzo) may cause withdrawal symptoms such as?
- abdominal cramps,
Symptoms similar to alcohol withdrawal, such as weakness, delirium, or seizures, may occur if ________ are abruptly discontinued.
benzodiazepines (Valium, Xanax, Ativan, Versed)
Contraindications to Prozac (SSRI).
Drug interactions for Prozac (SSRI)?
- Serotonin Syndrome if mixed with MAOIs
- Increased risk of bleeding with coumadin, aspirin, NSAIDS
Pts on Prozac (SSRI) have an increased risk of toxicity if taken with what drugs?
- phenytoin (Dilantin)
If a pt taking an SSRI (Prozax, Paxil, Zoloft, Lexapro) develops a fever (especially with confusion & restlessness), what should you tell them?
Stop taking the med - could be a sign of seratonin syndrome
What kind of drug is Effexor?
A contraindication with venlafaxine (Effexor)?
- concurrent use with MAOI
- *Effexor = SNRI
Why would you not want to give venlafaxine (Effexor) to children or adolescents?
- increased risk of suicide
- *Effexor = SNRI
The last-resort antidepressant.
Contraindications of phenelzine (Nardil), an MAOI.
- hepatic/renal impairment
Drugs that interact with phenelzine (Nardil), an MAOI.
MANY other drugs! (take complete drug hx)
Serious AE of phenelzine (Nardil), an MAOI.
HTN crisis with tyramine foods
Tell patients taking ______ NOT to change their diet, because it is an ion salt.
Contraindications for Lithium.
- severe dehydration
- Na+ depletion
- (duh, it's an ion salt!)
Which drugs can increase lithium levels?
Which drugs, when taken with Lithium, may result in serious side effects?
- -haloperidol = increased neurotoxicity
Pt has been on steady state of Lithium and a new drug is added or a dose change is made - what to assess for?
- kidney impairment
Take Lithium with food or empty stomach?
Depakote, Tegretal, & Lamictal - what kind of drugs?
Antiseizure agents given for bipolar DO
_______ are sometimes provided IM to relax a pt & allow initial dose of antipsychotic to be reduced.
- -lorazepam (Ativan)
First-generation antipsychotics also called ________ and have ______ side effects than the 2nd-generations.
- TYPICAL antipsychotics
Drugs used to control bipolar DO.
- atypical antipsychotic agents, &
A dopamine system stabilizer antipsychotic drug.
Symptoms of EPS.
- fever, HTN,
- tremor, lack of muscle coordination
_______ are effective at treating schizophrenia symptoms but exhibit a high incidence of AE.
- phenothiazines (1st generation antipsychotic)
Selection of antipsychotic drugs (phenothiazines- Thorazine, Nonphenothiazine- Haldol) is determined by _________.
severity or extent of SE
Adjunct in treatment of tetanus & inretractable hiccups.
- Thorazine (1st gen antipsychotic)
- *Haldol (2nd gen antipsychotic)*
What is Thorazine (a phenothiazine) used to treat?
- *symptoms of schizophrenia & other psych D.O.
- -tetanus & hiccups
What would cause additive anticholinergic SE with Thorazine?
tricyclic antidepressants (Tofranil)
What drugs would decrease serum levels of Thorazine?
Which drugs would cause additive sedation with Thorazine?
What drug would increase serum levels of Thorazine?
What drug would inhibit therapeutic effect/sedation of Thorazine?
- wt gain
- blurred vision, dry eyes, glaucoma
- MOST LIKELY TO PRODUCE EPS
SERIOUS AE of Thorazine.
- "mostly cardiac"
- -cardiac arrest
- -respiratory depression
- -bld stuff
What does Haldol treat?
acute AND chronic psychotic DO
If you take Haldol with ______ it will precipitate dementia.
- (pts with Parkinsons)
Haldol is MOST LIKELY to produce _____.
What is Risperdal used to treat?
Precautions/Contraindications for Risperdal.
- *Orthostatic hypotension
What is abilify?
- atypical antipsychotic
- dopamine system stabilizer
- controls symptoms of schizophrenia
_______ should not be used by clients with seizure disorders, because it lowers the seizure threshold.
Full therapeutic effects of fluoxetine take ______.
up to 1 month
Persistent GI upset and confusion are signs of elevated ______ levels between 1.5 and 2.0, which signify EARLY toxicity.
______ may occur at serum lithium levels above 2.5 but not in early stages of toxicity.
_____ causes fluctuations in weight.
Lithium has been proven to decrease _______, while valproic acid has not
suicide (the only area in which lithium is superior to valproic acid)
__________ secondary to a reaction caused by the combination of an MAOI and a tyramine-containing food is the major problem with an MAOI.
Acute dystonia, or severe muscle spasms—especially of the back, neck, face, or tongue—may appear within hours or days of the first dose of a ________ and should be reported immediately.
Tardive dyskinesia occurs late in _________ therapy, and is more common in the older adult.
The _________ medications usually cause adverse effects even when taken as prescribed.
The nurse expects that the client experiencing extrapyramidal symptoms during therapy with phenothiazines will be prescribed what med?
- Benztropine (Cogentin)
- -(it's an anticholinergic & suppresses tremor and rigidity)
EPS occurs frequently, especially at the beginning of therapy with ________.
A person with _________ should not take haloperidol because they are all conditions that affect the CNS.
- Parkinson's disease,
- seizure disorders,
- alcoholism, or
- severe mental depression
There is an increased risk of hyperglycemia or diabetes in clients taking ________.
Hypotension is related to adverse reactions of _______ and must be monitored and reported if it occurs.
Fever, tachycardia, stupor, and incontinence are symptoms of ___________, a potentially fatal adverse effect of antipsychotics that must be diagnosed and treated immediately.
neuroleptic malignant syndrome (NMS)
Any blood dyscrasia is a contraindication to the use of _________.
The risk of developing diabetes mellitus is higher with _______ than with any of the other atypical antipsychotic agents.
_________ is either not prescribed or discontinued if there is history of bone marrow depression, or evidence of leukemia, leukopenia, neutropenia, or blood dyscrasias.
Clozapine may be associated with an increased risk of __________ especially during, but not limited to, the first month of therapy.
- fatal myocarditis
- (an inflammation of the heart muscle)
Clozapine is one of the drugs used to treat _________.
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