Studied by 1 person
Benzodiazepine drugs include:
Alpralozam (Xanax)
Clonazepam (Klonopin)
chlordiazepoxide (Librium)
Diazepam (Valium)
Lorazempam (Ativan)
Temazepam (Restolril)
MEMORY TRICK “PAM”
Which Benzodiazepine can treat alcohol withdrawal symptoms?
chlordiazepoxide (Librium)
What is the action of a Benzodiazpeine?
acts in the limbic system and the RAS
make GABA more effective
what do lower doses of benzodiazepines assist with?
anxiety
what do higher doses of benzodiazepines assist with?
sedation and hypnosis
what are the indications of Benzodiazepines?
anxiety disorders
alcohol withdrawal
hyper-excitability and agitation
preoperative relief of anxiety (aids in balanced anesthesia)
seizure control
Benzodiazepines pharmacokinetics
well absorbed from GI tract
peak in 30 minutes - 2 hours
lipid soluble and distributes well throughout the body
cross placenta
enter breast milk
METABOLIZED IN LIVER
EXCRETION PRIMARILY IN URINE
Benzodiazpeines contraindications/cautions
allergy
psychosis
acute narrow angle glaucoma
shock
coma
acute alcohol intoxication
pregnancy
Why are Benzodiazepines contraindicated in pregnancy?
cause cleft palette in the baby
what are the adverse effects of benzodiazepines?
sedation
drowsiness
depression
lethargy
blurred vision
confusion
dry mouth
constipation
n/v
hypotension
urinary retention
Benzodiazpines drug-drug interactions
increases CNS depression when taken with alcohol
increase in effects when take with cimetidine, oral contraceptives, or disulfiram
decrease in effects when given with theophylline/rantidine
A patient overdoes on Benzodiazepines what would you as the nurse administer?
Flumazenil (Romazicon)
A patient overdoses on narcotics what would you as the nurse administer?
narcan/naloxone
what is the action of barbiturates?
CNS DEPRESSANTS
inhibit neuronal impulse conduction in ascending RAS
depress cerebral cortex
depress motor output
what are the names of some Barbiturates?
Amobarbital
Butabarbital
Phenobarbital
Primidone
MEMORY TRICK “BARBITAL”
Barbiturates indication
relief of the signs and symptoms of anxiety
sedation
Insomnia
Preanesthesia
seizures
Barbiturates pharmacokinetics
well absorbed
PEAK 20-60 minutes
METABOLIZED IN LIVER
EXCRETED IN URINE
Barbiturates contraindications and cautions
Allergy: give IV benadryl
marked hepatic impairment or nephritis
Barbiturates adverse effects
CNS Depression
Physical Dependency
Drowsiness
Somnolence
Lethargy
Ataxia
Vertigo
Nausea
Vomiting
Constipation
Barbiturates drug-drug interactions
increase CNS DEPRESSION when given with alcohol, antihistamines, other tranquilizers
altered respone to phenytoin
MAOI cause increase serum levels and effect
which specific class of drugs can Barbiturates effect?
anticoagulants
digoxin
triycyclic antidepressants
cotricosteroids
oral contraceptives
What is the preferred anxiolytic drug ?
Buspirone (Buspar): reduces the s/s of anxiety WITHOUT severed CNS and adverse effects
NOT ADDICTING
what are 3 other anxiolytic and hypnotic drugs?
antihistamines: promethazine (promethegan), diphenhydramine
dexmedetomidine (precedex)
Eszopiclone (lunesta)
what are some s/s of depression?
low energy level
sleep disturbances
lack of appetite
limited libido
inability to perform ADLs
overwhelming feelings of sadness, despair, hopelessness, and disorganization
what respiratory disorder puts patients at high risk of depression?
copd
what are the actions of antidepressant therapy?
inhibit the effects of MAO
Monoamine oxidase (MAO)
may break them down to be recycled or restored in the neuron
what are the 4 classifications of antidepressants?
tricylic antidepressants (TCAs)
MAO inhibitors (MAOIs)
selective serotonin reuptake inhibitors (SSRIs)
serotonin norepinephrine inhibitors (SNRIs)
what are the 3 trycylic antidepressants?
Imipramine
Amitriptyline
Notriptyline
what is the action of trycyclic antidepressants?
reduce the reuptake of 5HT (serotonin) and NE into nerves
indications of tricyclic antidepressants
relief of symptoms of depression
used in pts. with sleep disorders
treatment of enuresis
chronic pain
pharmacokinetics of trycyclic antidepressants
peak 2-4 hours
T 1/2 8-46 hours
metabolized in the liver
excreted in the urine
contraindications of trycyclic antidepressants (TCA)
known allergy
recent MI
Myelography
PREGNANCY AND LACTATION
TCA cautions
Cv disease, angle closure glaucoma, urinary retention, manic-depression
MONITOR URINE OUTPUT
TCA drug-drug interactions
MAOIs, cimetidine, fluoxetine, ranitidine, oral anticoagulants
TCA adverse effects
sedation
sleep disturbances
fatigue
hallucinations
ataxia
dry mouth
constipation
N/V
Monoamine Oxidase Inhibitors examples:
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranycypromie (parnate)
MEMORY TRICK MAR, NAR, PAR!!!!!!
Isocarboxazide (Marplan) (MAOIs) used for ?
patients who did not respond to or could not take newer safer antidepressants
Phenelzine (Nardil) (MAOIs) used for?
patients who did not respond to newer safer antidepressants
Tranylcypromine (Partite) (MAOIs) used for?
adult outpatients with reactive depression
MAOIs action?
irreversibly inhibits MAO allowing epinephrine, serotonin, and dopamine to accumulate in the synaptic cleft
indications of MAOIs
treatment of patients with depression who are unresponsive or unable to take other antidepressants
MAOIs pharmacokinetics
absorbed from GI tract
peak 2-3 hours
metabolized in the liver, excreted in the urine
cross placenta and enter breast milk
MAOIs contraindications
known allergy
pheochromocytoma
CV disease
headaches
RENAL OR HEPATIC IMPAIRMENT
MAOIs adverse effects
dizziness
excitement
nervousness
mania
hyperreflexia
tremors
confusion
insomnia
agitation
liver toxicity
N/V
diarrhea or constipation
anorexia
weight gain
dry mouth
abdominal pain
MAOIs drug interactions
other antidepressants
methyldopa
insulin or oral anti diabetic agents
MAOIs food interactions
tyramine or pressor amine = increase BP
selective serotonin repute inhibitors (SSRIs)
specifically block the rep uptake of 5HT (serotonin) with little to no effect on NE
what is the benefit of SSRIs?
do not have many adverse effects associated with TCAs and MAOIs
indications of SSRIs
depression
OCDs
panic attacks
bulimia
premenstrual dysmorphic disorder
PTSD
social phobias
social anxiety
SSRIs pharmacokinetics
absorbed from GI tract
metabolized in liver
associated with congenital abnormalities
SSRIs contraindications
known allergy
pregnancy and lactation
impaired renal or hepatic function
SSRIs adverse effects
headache
drowsiness
dizziness
INSOMNIA
anxiety
tremor
agitation
SSRIs drug interactions
MAOIs
TCAs increase therapeutic and toxic effect
SSRI drugs include:
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
Serotonin Norepinephrine inhibitors (SNRIs) actions
decreases neuronal reuptake of both serotonin and norepinephrine and more weakly inhibit dopamine
SNRIs contraindications
allergies
MAOIs use
SNRIs adverse effects
nausea
constipation
higher HR
hyperhidrosis
erectile dysfunction
tachycardias
vomiting
palpations
serotonin syndrome
HTN
abnormal bleeding
angle closure glaucoma
urinary retention
SNRIs drug-drug interactions
MAOIs
SSRIs
TCAs
serotonergic drugs
aspirin
NSAIDs
antiplatelet drugs
SNRIs include:
Desvenlafazine (Pristiq)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)
Venlafaxine (Effexor, Effexor XR)
what drug helps with suicide and smoking cessation ?
Bupropion (Wellbutrin, Zyban)
psychotherapeutic agents
used to treat psychoses
DRUGS DO NOT CURE THE DISORDER
used in both children and adults
HELPS PT. FUNCTION
scihizophrenia
hallucination, paranoia, delusions, speech abnormalities, and effective problems
what are the causes of schizophrenia?
strong genetic association
may reflect a fundamental biochemical abnormality
antipsychotic/neuroleptic drugs actions
block dopamine receptors, preventing the stimulation of the postsynaptic neurons by dopamine
depress RAS, limit stimuli coming to brain
what are the indications for antipsychotic/neuroleptic drugs?
schizophrenia
hyperactivity
combative behavior
agitation in elderly
severe behavioral problems in children
antipsychotic/neuroleptic drugs contraindications
underlying diseases that could be exacerbated by dopamine-blocking effects of these drugs
CNS depression
Parkinson’s disease
prolonged QT interval
antipsychotic/neuroleptic drugs include:
haloperidol (Haldol)
chlorpromazine (Thorazine)
POOR COMPLIANCE WITH THESE MEDS
drugs for bipolar disorders include:
Lithium (Lithobid)
Apripiprazole (Abilify)
Lamotrigine (Lamictal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
actions of lithium
alters sodium transport in nerve and muscle cells
inhibits release of NE and dopamine but not serotonin
increases intraneuronal stores of NE and dopamine slightly
adverse effects of lithium
<1.5 = lethargy, slurred speech, weakness, N/V
1.5-2 = above plus ECG changes
2-2.5 = ataxia, hyperreflexia
2.5 = DEATH
lithium pharmacokinetics
peak in 30 minutes
excreted from kidneys 80% reabsorbed
CNS stimulants actions
act as cortical and RAS, increase release of catecholamines leading to increased stimulation of the postsynaptic neurons
CNS stimulants indications
attention deficit disorder/syndromes
narcolepsy
CNS stimulants pharmacokinetics
peak 2-4 hours
T 1/2 2-15 hours
what is an example of a CNS stimulant?
Methylphenidate (Ritalin)
nursing considerations = tolerance and dose, may be habit forming, insomnia, and heart defect
anti seizure agents include: HYDANTOINS
Hydantoins
Ethotoin (Peganone)
Fosphenytoin (Cerebryx)
Phenytoin (Dilantin)
therapeutic serum phenytoin levels
10-20 mcg/mL
therapeutic serum ethotoin levels
15-50 mcg/mL
Hydantoins contraindications and cautions include:
known allergies
pregnancy and lactation
GINGIVAL HYPERLPLASIA
Hydantoins adverse effects
relate mostly to CNS depression
sever liver toxicity and bone marrow suppression
hydantoins drug-drug interactions
alcohol
barbiturates and barbiturate-like drugs include:
phenobarbital (Solfoton, Luminal)
Primidone (Mysoline)
phosphenytoin
ASSOCIATED WITH SIGNIFICANT CNS DEPRESSION
some benzodiazepines are used as anti epileptic drugs such as:
Clobazam (Onfi)
Clonazepam (Klonopin)
Diazepam (Valium)
pharmacokinetics of Benzodiazepines
long half-life of 18-50 hours!!!!
Succinimides indications
most frequently used to treat absence or focal seizures
Succinimides include:
Ethosuximiden (Zarontin)
Methsuximide (Celontin)
MEMORY TRICK SUCC = SUX
contraindications of Succinimides
patients with intermittent porphyria (blood disease)
Succinimides adverse effects
CNS depressant effects
BONE MARROW SUPPRESSION
Succinimides drug-drug interactions
Primidone
what are the 2 other drugs for treating absent seizures?
Acetazolamide (Diamox)
Valproic acid (Depakene)
Parkinson’s disease
progressive neuro disorder
NO CURE
therapy aimed in management of signs and symptoms
progression of Parkison’s disease
rhythmic tremors
rigidity/weakness
MASK-LIKE FACIAL EXPRESSIONS
drooling and affected speech
Dopaminergic drugs are for what only?
Parkinson’s disease
contraindications of dopaminergic drugs
allergy
angle closure glaucoma
BPH (benign prostatic hypertrophy): may not be able to pee
dopaminergic adverse effects include:
anxiety
nervousness
headache
blurred vision
ARRYTHMIAS!!!!!
Dopaminergics drug-drug interactions
MAOIs
Vitamin B6
Tyramine containing foods
St. John’s wort
analgesics
what is the only Dopaminergic drug for parkinson’s ?
Levodopa
what is almost always given in combination with Levodopa?
Carbidopa (Sinemet) because it decreases the amount of levodopa needed to reach therapeutic levels which reduces adverse side effects
Dopaminergic: levodopa drug-drug interactions
MAOIs = enhances effects of Levodopa
Vitamin B6
