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Pharmacology
Unit 6
| Question | Answer |
|---|---|
| Diazepam | Benzodiazepine |
| Benzodiazepine:Action | -Stimulate GABA receptors in ascending RAS -Make GABA more effective -Causes interference with neurons firing -Lower doses cause antiolytic effects -Higher doses cause sedation and hypnosis |
| Benzodiazepine:Route | -Oral -IM -IV -Rectal |
| Benzodiazepine:Indications | -Anxiety disorders -Alcohol withdrawal -Hyperexcitability and agitation -Preop relief of anxiety and tension |
| Benzodiazepine:Contraindications and Cautions | -Psychosis -Acute Narrow Angle Glaucoma -Shock -Coma -Acute Alcohol Intoxication |
| Benzodiazepine:Adverse Reactions | -Amnesia -Fatigue,Muscle Weakness -Dry mouth, NVC -Dizziness and ataxia -Sedation,drowsiness, lethargy -Depression, confusion -Blurred Vision -Urinary retention |
| Benzodiazepine: Drug to Drug | -Alcohol- Increase CNS depression -Increase effect with cimetidine, oral contraceptives, disulfram -Decrease effect with theophyline or rantidine |
| Benzodiazepine: Nursing Considerations | -Check to be certain pill is swallowed -Taper withdrawal after long-term use -Do not mix with IV meds; give slowly -Reduce narcotic dose to decrease sedation -Flumazenil for overdose |
| Phenobarbital | Barbiturates |
| Barbiturates: Action | -General CNS depressant -Inhibits neuronal impulse conduction in ascending RAS -Depresses cerebral cortex -Alters cerebellar function -Depresses motor output |
| Barbiturates: Route | -Oral -IV -IM -SQ |
| Barbiturates: Indications | -Relief of signs and symptoms of anxiety -Sedation -Insomnia -Preanesthesia -Seizures |
| Barbiturates:Contraindications and Cautions | -Previous Hx addiction sedative-hypnotic drugs -Latent or manifest porphyria -Marked hepatic impairment or nephritis -Respiratory distress or dysfunction |
| Barbiturates: Adverse Reactions | -Drowsiness, somolence, lethargy -CNS depression, physical dependency -Vertigo, ataxia -NVC |
| Barbiturates: Drug to Drug | - >CNS depression-alcohol, antihistamines, tranquilizers -Phenytoin reduces metabolism -<serum and effect-MAOIs -Decrease effectiveness-Anticoagulants, Digoxin (BB) Tricyclic antidepressants, Corticosteroids, Oral contraceptives, estrogen, theophyline |
| Barbiturates: Nursing Considerations | -IM-inject deep into muscle -IV - Never arterial; avoid extravasation; do not mix with other drugs; very slow push -Monitor blood levels (15-40 mcg) -Taper dose gradually after long use |
| Zolpidem | -Other anxiolytic/ hypnotic -Short term treatment of insomnia |
| Diphenhydramine | -Other anxiolytic/ hypnotic -Benadryl -Preop and post to decrease need for narcotics |
| Buspirone | -Other anxiolytic/ hypnotic -Reduce S&S of anxiety without sever CNS and adverse effects |
| Paraldehyde | -Other anxiolytic/ hypnotic -Sedation: Delirium tremens, psych conditions with extreme excitement |
| Meprobamate | -Other anxiolytic/ hypnotic -Manage acute anxiety up to four minutes |
| Chloral hydrate | -Other anxiolytic/ hypnotic -Nocturnal sedation or preop sedation |
| Buspirone | Anxiolytic Drug |
| Buspirone:Indications | -Generalized anxiety states - works best with patients who haven't taken benzodiazepines |
| Buspirone:Actions | -Unclear -Seems to work in midbrain as a modulator -Has a high affinity for serotonin receptors but doesn't affect GABA receptors |
| Buspirone:Pharmcokinetics | -Slow onset -Not for quick relief |
| Buspirone: Adverse Effects | -Dizziness -Light headedness -Insomnia -Tachycardia -Palpitations -HA -Dry mouth |
| Buspirone:Drug to Drug | -MAOIs - Hypertensive reaction |
| Buspirone:Nursing Considerations | -May have to start while still taking benzodiazepines -Give with food or drink -Avoid hazardous activities -Improvement usually in 7 -10 days -Optimal results in 3-4 weeks |
| Imipramine | Tricyclic Antidepressants |
| Tricyclic Antidepressants: Actions | -Reduce reuptake of 5HT and NE into presynaptic nerves -Increases 5HT and NE in synapses -Relieves depression -Also block acetylcholine and histamine receptors |
| Tricyclic Antidepressants: Route | - Oral |
| Tricyclic Antidepressants: Indications | -Relief of symptoms of depression -OCD -Sleep disorders -Enuresis, urinary incontinence -Chronic pain |
| Tricyclic Antidepressants: Contraindications and Cautions | -Recent MI -Myelography -CV disease -Angle closure glaucoma -Urinary retention -Manic-depression |
| Tricyclic Antidepressants: Drug to Drug | -Increase catecholamine effects (>BP) -Amhetamines; Sympathomimetics -Decrease clonidine and guanethidine effects on BP: -MAOIs; Cimetidine; Fluoxetine; Rantidine; Oral anticoagulants |
| Tricyclic Antidepressants: Nursing Considerations | -Avoid alcohol -Stay out of sunlight, tanning beds -May alter glucose, so monitor diabetes -Benefits may take 2-4 weeks -Withdraw drug slowly |
| Isocarboxazid | Monamine Oxidase Inhibitors -For patients who didn't respond to or couldn't take newer antidepressants |
| Phenelzine | Monamine Oxidase Inhibitors -For patients who didn't respond to or couldn't take newer antidepressants -Prototype |
| Tranlycypromine | Monamine Oxidase Inhibitors -Adult outpatients with reactive depression |
| MAOIs: Actions | -Irreversibly inhibits MAO allowing NE, 5HT, and dopamine to accumulate in synaptic cleft |
| MAOIs:Route | -Oral |
| MAOIs:Indications | -Depression when patients are unresponsive to other antidepressive therapy |
| MAOIs:Contraindications | -Pheochromocytoma -CV disease -HA -Renal or Hepatic impairement |
| MAOIs:Adverse Reactions | -Dizziness -Excitement, nervousness, insomnia -Hyperreflexia, tremors -Mania, confusion, agitation -NVC or D -Anorexia, weight gain -Dry mouth, Abdominal pain -Liver Toxicity |
| MAOIs: Drug to Drug | -Other antidepressants - hypertension, coma -Methyldopa-effects increase -Insulin or oral antidiabetic agents -hypoglycemia |
| MAOIs: Foods | -Food with tyramine or pressor amines - increase BP -Aged cheese -Aged or fermented meats, fish, poultry -Brewer's Yeast -Fava Bans -Red Wines -Smoked or pickled meats, fish, poultry |
| MAOIs: Nursing Considerations | -Discontinue 14 days before surgery -Taper withdrawal -Withhold dose and notify MD if symptoms of overdose - palpitations, severe hypertension, frequent HA -Consult MD before taking cold, hay fever or diet aids |
| Fluoxetine | Selective Serotonin Reuptake Inhibitors |
| SSRIs: Actions | -Block reuptake of 5HT |
| SSRIs:Indications | -Depression -OCD -Panic Attacks -Bulimia -Pre-menstrual dysmorphic disorder -Posttraumatic stress disorders -Social phobias - public speaking -Social anxiety disorders |
| SSRIs:Contraindications | -Impaired renal and hepatic function |
| SSRIs:Adverse reactions | -HA -Drowsiness, dizziness -Insomnia -Anxiety, tremor, agitation |
| SSRIs:Drug to Drug | -MAOIs - can be fatal -TCAs - increase effect -Inhibits liver enzymes that oxidize a number of drugs |
| SSRIs: Nursing Considerations | -Give in morning to prevent insomnia -May take 2-4 weeks to be effective -Avoid activities that require alertness -Use antihistamine or topical steroids to treat rashes and pruitus -Take as provided, don't alter dose -Take with or without food |
| Trazodone | Antidepressant |
| Trazodone: Indications | -Depression -Aggressive behavior -Panic disorder -Can use in children under 6 yr old |
| Trazodone: Actions | -Unknown -Thought to inhibit neural uptake of serotonin and norepinephrine |
| Trazodone: Half Life | -5-10 Hours |
| Trazodone: Adverse Effects | -Drowsiness -Dizziness -Insomnia |
| Trazodone:Nursing Considerations | -Give in the morning |
| Chorpromazine | Typical Antipsychotic / First Generation |
| Halperidol | Typical Antipsychotic / First Generation |
| Typical Antipsychotic: Indications | -Psychosis -Suppress narcotic withdrawal -Children with sever behavioral problems who are combative |
| Typical Antipsychotic: Actions | -Blocks dopamine receptors |
| Typical Antipsychotic: Pharmacokinetics | -Erratic -Onset Peak 2-6 hr |
| Typical Antipsychotic: Adverse Effects | -Sedations -EPS -Orthostatic hypotension -Dry mouth and eyes -Photosensitivity -Tachycardia -Seizures -Urinary Retention -Resp. Depression |
| Typical Antipsychotic: Contraindications | -Narrow angle glaucoma -Bone marrow depression -Parkinson's -CNS depression -Renal and hepatic depression |
| Typical Antipsychotic: Nursing Considerations | -Monitor for tardive dyskinesia -Change dosage if form of drug changed -Use Diphenehydramine for acute dystonic reactions -Phenothiazines may cause pink or brown urine color -Watch for EPS side effects |
| Risperidone: Indications | -Psychosis -Schizophrenia |
| Risperidone:Actions | -Interferes with binding of dopamine to dopamine D2 and serotonin |
| Risperidone:Pharmacokinetics | -Peak 1-2 hrs -T 1/2 - 24 hrs |
| Risperidone:Drug to Drug | -Increase effect antihypertensives -Not as effective if combined with other antipsychotics |
| Risperidone: Adverse Effects | -Sedation -Weight gain -Dry mouth -Sexual Dysfunction -Phtosensitivity -Hyperglycemia -Orthostatic hypotension -Tachycardia -EPS symptoms -Neuroleptic malignant syndrome |
| Clozapine | -Atypical Antipsychotics / Second Generation |
| Atypical Antipsychotics: Actions | -Block dopamine receptors and serotonin receptor activity -Fewer EPS symptoms |
| Atypical Antipsychotics: Indications | -Schizophrenia -Psychotic symptoms in dementia |
| Atypical Antipsychotics: Route | -Oral |
| Atypical Antipsychotics: Adverse Effects | -Drowsiness -Sedation -Seizures -Dizziness -Syncope -HA,N,V -Tachycardia -Fever -Neuroleptic malignant syndrome |
| Atypical Antipsychotics: Drug to Drug | -Antihypertensives - Hypotension -Increased CNS depression with benzodiazepines or CNS depressants -Increase levels of digozin or warfarin -Decrease levels of clozapine with phenytoin |
| Atypical Antipsychotics: Nursing Considerations | - Watch for: tachycardia or decrease BP, urine retention, constipation, increase bilirubin levels -Don't stop suddenly -Discard if discolored |
| Atypical Antipsychotics: Teaching | -Don't alter dosing -Take dose at bedtime if sedation occurs -May take several weeks to be effective -Avoid: alcohol, herbal products, OTC drugs -Avoid hazardous tasks -Avoid exposure to extreme heat or cold -Protect drugs from light |
| Risperidone Zipasidone | Neuroleptic Drug |
| Neuroleptic Drugs: Indications | -Schizophrenia -Hyperactivity -Combative Behavior -Agitation in elderly -Severe behavioral problems in children |
| Neuroleptic Drugs:Contraindications | -Underlying disease that can be exacerbated by doapmine blocking -CNS depression -Circulatory disease -Parkinson's -Coronary disease -Severe hypotension -Prolonged OT interval |
| Neuroleptic Drugs: Adverse Reaction | -Drowsiness, Sedation, Weakness -Tremors, EPS effects -Dry mouth -Nasal congestion -Constipation |
| Neuroleptic Drugs: Drug to Drug | -Beta-Blockers -Alcohol -Mesoridazine -Thioridazine |
| Lithium | Antimaniac |
| Lamotrigine | Antimaniac |
| Olanzapine | Antimaniac |
| Quetiapine | Antimaniac |
| Lithium: Actions | -Alters sodium transport in nerve and muscle cells -Inhibits release of NE and dopamine -Increases intraneuronal stores of NE and dopamine -Decreases intraneuronal content of second messengers |
| Lithium: Route | -Oral -Oral extended release |
| Lithium: Indications | -Treatment of manic episodes of bipolar manic depressive illness |
| Lithium:Contraindications | -Renal disease -Cardiac disease -Leukemia -Metabolic disorders -Pregnancy and lactation |
| Lithium:Adverse Reactions | < 1.5 -Lethargy, Slurred Speech, Muscle Weakness, NVD 1.5-2 - Above ECG changes 2-2.5 - Ataxia, Clonic movements, hyperreflexia, seizures >2.5 - complex multiorgan toxicity, risk of death |
| Lithium: Assessment | -Dehydration -Use of diuretics -Prolonged sweating -Diarrhea |
| Lithium: Teaching | -Do not restrict salt and water intake -Take with plenty of water after meals -Use contraception to avoid pregnancy |
| Lithium: Nursing Considerations | -Monitor blood levels: 8-12 after first dose; 2-3 times first week; weekly first month; monthly once stable -Expect N,polyuria, thirst first few days -May decrease dose after acute attack -Don't switch brands -Wear medical identification |
| Dextroamphetamine | -Central nervous system stimulants |
| Methylphenidate | -Central nervous system stimulants |
| Central nervous system stimulants: Action | -Act on cortical and RAS -Increase levels of dopamine and norepinephrine -Increase in stimulation of postsynaptic neurons |
| Central nervous system stimulants:Indications | -Attention deficit syndrome -Narcolepsy |
| Central nervous system stimulants: Contraindications | -Marked anxiety -Agitation or tension -Severe fatigue -Glaucoma |
| Central nervous system stimulants: Adverse effects | -Nervousness -Insomnia -Dizziness -HA -Blurred vision -Anorexia -N -Weight loss |
| Central nervous system stimulants:Drug to drug | -MAOIs - wait 14 days -Guanethidine -increase effect -TCAs - increase effect -Phenytoin - Increase effect |
| Central nervous system stimulants: Nursing Considerations | -Watch for abuse -Avoid caffeine- Coffee, chocolate, other meds |
| Phenytoin | -Hydantoins |
| Hydantoins: Actions | - Stabilizes neuronal membranes |
| Hydantoins: Indications | -Seizures during neurosurgery |
| Hydantoins: Route | -Oral -IV |
| Hydantoins: Adverse Effects | -Ataxia, confusion, dizziness, fatigue, tremor, HA, Stevens-Johnson syndrome |
| Hydantoins; Nursing Considerations | -10-20mcg/ml = therapeutic level -Stop enteral tube feeding 2h before and after dose -Don't IV push into veins on hands -Mix with normal saline, not D5W |
| Hydantoins: Teaching | -Don't stop drug w/out MD direction -Can take with food for GI distress -Wear medical ID -See dentist regularly -May discolor urine pink, red, or red-brown -Alcohol decreases drug benefit |
| Ethosuximiden | -Succinimides |
| Methsuximide | -Succinimides |
| Succinimides: Actions | -Raise seizure threshold |
| Succinimides: Indications | -Control of absence seizures |
| Succinimides: Route | - Oral |
| Succinimides: Adverse Effects | -Drowsiness -Ataxia -Dizziness -Nervousness -Stevens-Johnson syndrome -Anorexia |
| Succinimides: Drug to drug | -Elevate phenytoin levels -Valproic acid may increase or decrease E level -Decrease levels of primidone |
| Succinimides:Nursing Considerations | -Check for sulfonamide allergies -Monitor body temp - sweating may decrease -Don't break or cite capsule -Take with or without food; Increase fluid intake |
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prettyinpink7
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