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What class of drug should not be used on patients with cardiac problems? Even a small # of these pills can make a person OD, and lead to death (even in a pt. w/o cardiac problems.
Tricyclic antidepressants (eg. Elavil)
This class of antidepressants, when given in LOW doses (10-50 mg) at bedtime for sleep, for diabetic foot pain, for fibromyalgia & other pain syndromes (don't have antidepressants effect). Antidepressant doses are 150-200 mg.
Tricyclic antidepressants (eg. Elavil)
This is a typical antipsychotic. Its MOA is blocking dopamine, alpha, serotonin, histamine receptors, minimally cholinergic receptors.
Its major contraindication is PARKINSON'S DZ b/c it blocks dopamine
What is a rx for dystonia? for akathesia? for tardive dyskinesia?
- 1. Dystonia. Rx: antihistamines: benadryl, cogenten
- 2. Akathisia: Rx: beta blockers, benzodiazepenes
- 3. Tardive dyskinesia: Rx: No real rx. remove antipsychotics. Cautious when receiving antipsychotics in the future. Start at low dose.
What are the side effects of antipsychotics? (11)
- 1. EPS
- 2. NMS (rare. in OD)
- 3. anticholinergic
- 4. orthostatic hypotension
- 5. sedation
- 6. neuroendocrine effects
- 7. seizures
- 8. sexual dysfunction
- 9. dermatologic effects
- 10. agranulocytosis
- 11. severe dysrhythmias
Benzodiazepenes are for....
Can antipsychotic drugs cause addiction?
What atypical antidepressants that don't have sexual dysfunction side effect?
What are some drugs to avoid when taking lithium?
- 1. Diuretics - alter serum concentration of lithium
- 2. NSAIDs
- 3. Anticholinergics
What is the treatment for benzodiazepines overdose? What is one thing we must be cautious about when giving that antidote?
flumazenil (Romazicon) - but also antagonist of Narcan (the antidote for morphine)
A patient has overdose on barbiturates. What are you going to do?
No antidote = call for ventilators & supportive care
What are the sx of acute barbiturates toxicity?
- 1. respiratory depression
- 2. coma
- 3. pinpoint pupil
What are some type of drugs to avoid when taking antipsychotics?
- 1. anticholinergic drugs
- 2. CNS depressants: alcohol, antihistamines, benzodiazepines, barbiturates
- 3. Any drugs that increases dopamine: for Parkinson's (levadopa, dopamine -agonists)
When giving Dilantin via IV, what should we be cautious about?
GO SLOW SLOW SLOW b/c too fast can cause cardiovascular collapse
Mix ONLY W/ NS & FLUSH WELL!!!!
What antipsychotic is used for chronic hiccups?
What is a common antipsychotic drug used for DT's? It is also a preferred drug for Tourette's syndrome
Give a common brand name for Tricyclic Antidepressants
What is SSRI's used for?
A lot of things:
- 1. Depression
- 2. OCD
- 3. PMDD (severe PMS)
- 4. Bulimia nervosa
- 5. Anxiety
If your elderly pt. is on diuretics thiazide & the Dr. prescribes her w/ an SSRI, what should you watch out for?
What's going to happen if you're thirsty & decide to drink a lot of water while you're taking lithium?
Watch for hyponatremia because that can increases lithium toxicity
Why should we avoid high protein diet & B6 in a pt. taking Sinemet?
What are some examples of B6?
Because they compete w/ levodopa for absorption in intestines --> less levadopa getting to the brain
B6 = Oatmeal, meats
What are the side effects of Sinemet?
- 1. Psychosis: hallcucinations, vivid dreams, paranoia
- 2. Orthostatic hypotension: change position slowly
- 3. EPS: especially dyskinesia
- 4. Dysrhythmias: notify MD if tachycardia, palpitations
- 5. N/V
What are the side effects of Aricept?
- 1. GI (n/v, decreased appetite)
- 2. Cholinergic side effects
- 3. dizziness
- 4. headache
- 5. bronchoconstriction
Because one of the side effects of Aricept is decreased appetite, n/v, what should you do as a nurse?
Monitor for nutrition: give protein, calories count. If they're not eating well, give them shakes
This is a new drug.
It is better tolerated than cholinesterase inhibitors.
It is an adjunct to Aricept
It is indicated for moderate to severe AD