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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 (diphenhydromine, benztropine, trihexyphenidril)
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
What are the adverse effects of Flexeril (drug for spasm)?
- 1. CNS depression
- 2. Anticholinergic activity
- 3. Arrhythmias
- 4. MIs
- 5. Seizures
What is one significant pharmokinetics of baclofen?
it crosses blood-brain barrier
What is one major side effect of Rheumatrex?
It can suppresses bone marrow
Besides managing RA, Enbrel (C: TNF) can treat what other conditions?
Psoriasis & spondylitis
What are some nursing interventions for pt. receiving lidocaine orally?
- 1. Assess for swallowing
- 2. Assess for sensitivity -- this drug might cause allergic rxn (hives to anaphylactic shock)
What are the N.I for pt. receiving propofol?
- 1. continuous monitoring of BP, CO, pulm cap wedge pressure, resp system
- 2. turn q2h & assess skin
- 3. check lipid levels q3-7 days.
- 4. Discard preparatio if discoloration or particculate matter or emulsion separated d/t risk of bacteria growth
T or F
Pt. is receiving tubocurarine & is now sedated d/t this drug's effect on the CNS.
False. Pt. is still awake. This drug does not effect the CNS
What pertinent family hx should you be aware of when preparing to admnister succinylcholine?
family hx malignant hyperthermia
This drug targets rapid proliferating cells & other types of inflammatory.
Has Black Box warning
A/E: rash, headache, n/v/diarrhea, stomatitis, alopecia, suppression of bone marrow
If pt. has hyperthyroidism & is prescribed with Flexeril, what do you have to be cautious about?
Risk for tachycardia. You don't want to induce tachycardia
Pt. has Parkinson's & history of stroke. Would you want to give baclofen to this pt.?
No. Because its contraindication is hypersensitivity & spasticity of cerebral origin
Thhis drug can cause emergence of hallucinations or psychotic episodes since it affects the GABA receptor in the brain.
What is the MOA of MTX (Rheumatrex)?
It has immunosuppressive effects by inhhibiting the replication & function of T lymphocytes that stimulate the productions of cytokines
What are some contraindications & precautions for pt. taking Enbrel
If they currently have infections or malignancy, this drug is not recommended
What is the first line of drug to treat gout?
Dilantin can be used to treat all types of seizures except for which one?
Besides seizures, what is Tegretol used for?
- 1. Bipolar
- 2. Trigeminal & glossopharyngeal neuralgias (Bell's palsy)
Since TCA's adverse effect is increased sympathetic, what the treatment for this ae?
Give Dilantin, lidocaine, or propranolol
Also give at bedtime to reduce daytime adverse effects
Pt. starts to sweat, develop a fever, muscle rigdity, tremor, incontinence, stupor. Labs show elevated WBCs, elevated creatinine, elevated phosphokinase levels, renal failure. What to do?
Administer large volumes of NS. Also administer antipyretic, stay w/ patient, apply restraints if needed
What are S&S of lithium toxicity?
- *Slurred speech
- *Unsteady gait
- *Irregular Hearbeat
Barbiturates were used to treat insomnia before benzos. However, they are used as an adjunct for seizures now. How is it that it could be lethal?
Barbiturates are highly habit forming. Patients can develop tolerance & dependence and more likely to OD. Withdrawal symptoms can be severe: OD results in severe respiratory depression & CNS effects.
Benzos are first drug of choice for status epilepticus & seizures associated with alcohol withdrawal. How safe is it?
It has large therapeutic index, so very safe
What are some side effects of drugs used to treat insomnia?
- * Anterograde amnesia
- * Depression sx may worsen
- * Bizarre behaviors (hallucinations, aggressiveness, loss of inhibtion)
- *Teratogenic when used during 1st semester
- *Increased risk of falls in older adults
- *headache, lightheadness
- *prolonged drowsiness, dizziness, difficulty with coordination
- *unpleasant taste
- *Should be taken immediately before bedtime, avoid high-fat, heavy meals (delays onset of action)
What is the half life of Elavil? What is the % of its protein bound?
- 1-50 hrs half life
- 95% protein bound
What is the antidote for lorazipam overdose?