exam 4 PHARM

What is an anxiolytic?

A medication used for anxiety.

What is a hypnotic?

A medication used for insomnia.

What is the prototype benzodiazepine?

Diazepam,

How do diazepam work?

They increase or potentiate the effects of GABA, an inhibitory neurotransmitter.

What are diazepam used to treat?

• Anxiety

• Insomnia

• Muscle spasms

• Seizures

• Alcohol or ETOH withdrawal

  • Anesthesia induction

How can diazepams be given?

• By mouth, or PO

• Intramuscularly, or IM

  • Intravenously, or IV

Can diazepam cross the blood-brain barrier?

Yes. They are highly lipid-soluble and can cross the blood-brain barrier.

Where are diazepam metabolized?

in the liver

What medications interact with dizapam

Other CNS depressants.

Can a patient develop tolerance to dizapam

yes

What diapam effect can develop significant tolerance?

The antiseizure effect.

Who may have cross-tolerance to dizapam?

People who already have tolerance to:

• Barbiturates

• Alcohol

  • Opioids

scdeule for dizapam

schedule IV

What expected CNS effects occur with dizapam

• Reduced anxiety

• Promoted sleep

  • Muscle relaxation

What cardiac effect usually occurs when dizapam are taken by mouth?

Usually no cardiac effect.

What serious cardiac effect can occur with IV dizapam

Hypotension that can progress to cardiac arrest.

How do dizapam normally affect breathing?

Respiratory depression is usually mild.

Which patients may have significant respiratory effects from dizapam?

Patients with:

• COPD

  • Obstructive sleep apnea, or OSA

dizapam acute toxicity

rare in oral overdose

What symptoms may occur after an oral dizapam overdose?

• Drowsiness

• Lethargy

  • Confusion

Are cardiovascular and respiratory problems common after an oral dizapam overdose?

No, unless the medication was taken with other sedative drugs.

What supportive care is needed after an oral dizapam overdose?

• Keep the airway open

• Monitor respiratory rate

  • Give IV fluids to maintain blood pressure

What can happen during an IV dizapam overdose?

• Profound hypotension

• Cardiac arrest

  • Respiratory arrest

What is the antidote for dizapam toxicity?

flumazenil

How does flumazenil work?

competitive benzodiazepine-receptor antagonist.

How is flumazenil administered?

Rapidly by IV over 15 seconds.

Why might flumazenil need to be given more than once?

a short half-life and may require frequent dosing.

What does flumazenil reverse?

sedation

Does flumazenil reverse respiratory depression

No.

What serious adverse effect can flumazenil cause?

Seizures, especially in patients with:

• Epilepsy

  • Benzodiazepine dependence

What major safety risk occurs with dizapam

falls

What should the nurse monitor for a patient taking dizapam

vital signs

What mental effects should the nurse assess? with dizapam

memory changes

paradoxical reaction

prototype for benzodiazepine-LIKE drug

zolpidem

How does zolpidem work?

It increases the effects of GABA, an inhibitory neurotransmitter.

What is zolpidem used to treat?

Insomnia

What are common adverse effects of zolpidem?

• Daytime drowsiness

• Dizziness

  • Sleep-related behaviors`

What sleep-related behaviors can occur with zolpidem?

• Sleepwalking

  • Sleep driving

Does zolpidem normally cause respiratory depression when taken alone?

No, but it should not be combined with CNS depressants.

What can happen with long-term zolpidem use?

Tolerance and dependence can develop.

What controlled-substance schedule is zolpidem?

Schedule IV.

How is zolpidem normally used?

Short-term to help a patient begin and maintain sleep.

How is zolpidem different from dizapam

It acts on GABA receptors like benzodiazepines but has a different chemical structure.

What should the nurse observe for in a patient taking zolpidem?
A:

• Daytime drowsiness

• Dizziness

• Sleepwalking

  • Sleep driving

What symptoms should the nurse analyze as possible zolpidem effects?

• Confusion

• Unsteady gait

  • Amnesia

How should zolpidem be prescribed and used?

Use the lowest effective dose for a short period.

When should a patient take zolpidem?

Immediately before bed.

How much sleep time should a patient allow after taking zolpidem?

A full seven to eight hours.

protype for barbiturates

phenobarbital

How does phenobarbital work?

It enhances and mimics the action of GABA.

What is phenobarbital used for?

• Seizure control

  • Anesthesia

What CNS effect occurs with phenobarbital?

CNS depression.

What cardiac effects can phenobarbital cause?

• Hypotension

  • Bradycardia

How does phenobarbital affect CYP450 enzymes?

It is a CYP450 enzyme inducer.

What does being a CYP450 inducer mean for other medications?

Phenobarbital can reduce the effectiveness of other medications.

Can tolerance develop with phenobarbital?

Yes, but tolerance does not develop to respiratory depression.

Can phenobarbital cause dependence and cross-tolerance?

Yes. Cross-tolerance can occur with other CNS depressants.

What are signs of phenobarbital toxicity?

• Respiratory depression

• Coma

• Pinpoint pupils

• Hypotension

  • Hypothermia

Is there a specific antidote for phenobarbital toxicity?

nope

`What brain change is associated with bipolar disorder

Altered brain physiology with neuronal atrophy of the prefrontal cortex, which is involved in emotions.

How long is treatment normally needed for bipolar disorder?

lifelong treatment

What mood episodes can occur with bipolar disorder?

• Depression

• Dysphoria

• Normal mood

• Hypomania

  • Mania

prototype for mood stabilizer

lithium carbonate

How does lithium work?

Its exact action is unclear. It likely alters ions, neurotransmitters, and other processes.

What is lithium used to treat?

• Acute mania

  • Long-term prevention of mania in bipolar disorder

How is lithium given and absorbed?

taken by mouth and is well absorbed.

What type of half-life does lithium have?

short half-life.

How often might lithium need to be taken?

2-4 times each day

How is lithium removed from the body?

excreted by the kidneys.

What electrolyte affects lithium excretion and levels?

sodium

What therapeutic lithium range is listed on the medication slide?

0.4–1.0 mEq/L.

At what lithium level does the medication slide say toxicity occurs?

Greater than 1.5 mEq/L.

How do thiazide and loop diuretics affect lithium?

cause hyponatremia, which increases the risk of lithium toxicity.

How do NSAIDs affect lithium levels?

NSAIDs suppress prostaglandins and increase the kidneys’ reabsorption of lithium.

Why can anticholinergic medications be uncomfortable for a patient taking lithium?

Anticholinergics can cause urinary hesitancy while lithium can cause polyuria.

What thyroid concern is listed with lithium?

Lithium can affect thyroid hormone secretion.

What findings are listed at a lithium level below 1.5 mEq/L?

• Nausea, vomiting, and diarrhea

• Weakness

• Fine hand tremor

• Polydipsia and polyuria

  • Slurred speech

What findings are listed at a lithium level of 1.5–2 mEq/L?

• Worsening gastrointestinal upset

• Coarse hand tremors

• Sedation

• Confusion

• Incoordination

  • ECG changes

What findings are listed at a lithium level of 2–2.5 mEq/L?

• Ataxia

• Polyuria with dilute urine

• Severe ECG changes

• Clonic movements

• Seizures

• Stupor or coma

  • Hypotension

What findings are listed at a lithium level greater than 2.5 mEq/L?

• Seizures

• Oliguria

  • Death

How should lithium be given to reduce gastrointestinal effects?

give it with food

What laboratory values should be monitored for a patient taking lithium?

• Sodium

• BUN

• Creatinine

• GFR

• Thyroid levels

  • HCG or pregnancy testing

What endocrine problem should the nurse monitor for?

signs of hypothyroidism

What is levodopa used for?

Treats Parkinson disease by increasing dopamine in the brain to improve tremor, rigidity, and slow movement.

How does levodopa work?

Crosses the blood-brain barrier and is changed into dopamine.

What are the major side effects of levodopa?

• Nausea/vomiting

• Dyskinesia (involuntary movements)

• Orthostatic hypotension

• Hallucinations

  • Dark sweat or urine (harmless)

What should the nurse teach a patient taking levodopa?

• Avoid high-protein meals near the dose.

• Rise slowly.

  • Report hallucinations, palpitations, twitching, or if the medicine stops working.

What NCLEX clue helps identify levodopa?

Parkinson patient moves better but develops involuntary movements or dark urine.