pharm exam 4-jaime set

uses of benzodiazepine drugs

acute alcohol withdrawal, status epilepticus meds, anxiety med, hypotonic, mood stabilizers, preop sedative

benzodiazepine prototype

diazepam (lam & pam)

diazepam MOA

CNS depressant

diazepam SE/AE

decreases respiratory rate

diazepam antidote

flumazenil

nonbenzodiazepine agents (BuSpar) prototype

- eszopicolone (Lunaesta), ramelteon (Rozerem), zolpidem (Ambien), zaleplon (Sonata)

nonbenzodiazepine agents (BuSpar) MOA

CNS depressant

nonbenzodiazepine agents (BuSpar) SE/AE

night walking, night driving, night eating (risk for falls)

nonbenzodiazepine agents (BuSpar) nursing implication

have an environment that promotes sleep

schizophrenia medication divisions

first generation antipsychotics (FGAs) / conventional antipsychotics, second generation antipsychotics (SGAs) / atypical antipsychotics

first generation antipsychotics (FGAs)

block receptors for dopamine in CNS

second generation antipsychotic (SGAs)

only produce moderate blockade of dopamine receptors; stronger blockade for serotonin

FGAs can cause ___ EPS

serious

SGAs can cause ___ EPS

fewer

prototypes of high-sedative SGAs

haloperidol (Haldol), fluphenzaine

first generation antipsychotic MOA

block dopamine 2 (D2) receptors in the limbic area of the brain (within and outside the CNS)

high sedatives

high potency from small dose

drugs that can be given intramuscularly

haloperidol (Haldol), fluphenzaine

prototypes of medium-sedative SGAs

loxapine (Loxitane), perphenazine (Trilafon)

prototype of low-sedative SGAs

chloropromazine (Thorzaine)

low sedatives

small potency from high dose

ALL first-generation antipsychotics (FGAs) or conventional antipsychotics

haloperidol (haldol), fluphenzaine, loxapine (loxitane), perphenazine (trilafon), chloropromazine (thorzaine)

second generation antipsychotic prototype

clozapine (Clozaril)

clozapine (Clozaril) MOA

blocks dopamine and serotonin

clozapine (Clozaril) SE/AE

SE: EPS, diabetes, wt loss; AE: agranulocytosis

what symptoms do you mainly show from clozapine d/t the adverse effect?

flu-like symptoms, mucous membrane ulcerations because of agranulocytosis

labs needed when taking clozapine (Clozaril)

CBC (WBC specific d/t infection risk)

antidepressant medications

tricyclic, selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (S/NRIs), norepinephrine/dopamine reuptake inhibitors (N/DRIs) or atypical, monoamine oxidase inhibitors (MAOIs)

what are the prototypes of tricyclic?

amitriptyline, nortriptyline, desipramine, imipramine

MOA of tricyclic antidepressants

block neural reuptake of two monoamine transmitters -- norepinephrine (NE) and serotonin

SE/AE tricyclic antidepressants

cardiac issues (tachy, dysrhythmias, v. fib), sedation/drowsiness

what are the prototypes of selective serotonin reuptake inhibitors (SSRIs)?

fluoxentine, sertaline, escitalopram, citalopram, paroxetine

MOA of selective serotonin reuptake inhibitors (SSRIs)

produces selective inhibition of serotonin reuptake, producing CNS excitation

SE/AE of selective serotonin reuptake inhibitors (SSRIs)

serotonin syndrome (2-72 hours after tx), sexual dysfunction

nursing implication of selective serotonin reuptake inhibitors (SSRIs)

can wear off @ night, take in the morning, be cautious with caffeine and nicotine intake

serotonin/norepinephrine reuptake inhibitors (S/NRIs) prototypes

vanlafaxine (Effexor), duloxentine (Cymbalta)

venlafaxine (Effector) MOA

block NE and serotonin uptake

duloxetine (Cymbalta) MOA

inhibits serotonin and NE reuptake, weakly inhibits dopamine reuptake

N/DRI or atypical prototype

bupropion (Wellbutrin)

bupropion (Wellbutrin) MOA

acts as stimulant and suppresses appetite

bupropion (Wellbutrin) SE/AE

increases sexual desire and pleasure

bupropion (Wellbutrin) is an ___ drug

add-on

monoamine oxidase inhibitors (MAOIs) prototypes

isocarboxazid (Marplan), tranylcypromine sulfate (Parnate), phenelzine sulfate (Nardil)

monoamine oxidase inhibitors (MAOIs) MOA

converts monoamine neurotransmitters (NE, serotonin, and dopamine) into inactive products

monoamine oxidase inhibitors (MAOIs) SE/AE

CNS stimulant, orthostatic hypotension, hypertensive crisis

you should avoid consuming ___ when taking monoamine oxidase inhibitors (MAOIs).

tyramine

nursing implications for monoamine oxidase inhibitors (MAOIs)

monitor vital signs, avoid tyramine foods, avoid caffeine, avoid antihistamines, avoid light anesthesia, avoid amphetamine

bipolar medications

antidepressants, antipsychotics, lithium, anti epileptic drugs

antidepressants & antipsychotics are __ drugs for those who are diagnosed with bipolar

add-on

mood-stabilizing prototype

lithium

lithium MOA

altered synthesis and release of NE, serotonin, and dopamine. mediates intraceullar responses to neurotransmitters

lithium SE/AE

SE --> AE: tremors; hypernatremia = thirsty, increase BP

nursing implications for lithium

monitor levels q 2-3 days at initiation of therapy and then q 2-3 months

labs for lithium

Na levels

lithium and sodium are ___ related

directly

lithium has a __-half life

short

serum drug level for lithium drugs

0.5 - 1.5 mEq/L

antieplieptic drugs

carbamazepine, valproic acid

antieplieptic MOA

works on Na

carbamazepine serum drug levels

5 - 12 mcg/mL

carbamazepine SE/AE:

neuro: nystagmus (eye wiggle), ataxia (poor muscle control); hemato: affect WBC, plt count; derm/skin: rash, photosensitivity rxn

valproic acid serum drug levels

50 - 125 mcg/mL

ADD/ADHD drugs are CNS ___

stimulants

CNS stimulants

amphetamines, methyphenidate (concerta/ritalin), dexmethylphenidate (Focalin)

amphetamines MOA

releases norepinephrine and dopamine

amphetamines SE/AE

increase HR (BP), wt loss, psychosis (negative swings)

what do we ask patients who are on ADD/ADHD medications?

weight, height, sleep, school/focusing in school

what do we want to monitor for when giving ADD/ADHD?

HR/BP

methyphenidate (concerta/ritalin) MOA

reversible blockade of adenosine receptors (help w/ fatigue)

what do we not want to do with methyphenidates?

do not crush because medication is enteric coated

dexmethylphenidate (focalin) MOA

reversible blockade of adenosine receptors (help w/ fatigue)

dexmethylphenidate is similar in structure to ___

methyphenidate

overweight & obese drugs

adrenergic anorexiants (phentermine), lipase inhibitors (orlistat)

adrenergic anorexiants prototype

phentermine

adrenergic anorexiants (phentermine) MOA

stimulates the release of norepinephrine & dopamine

adrenergic anorexiants (phentermine) SE/AE

nervousness, hyperactivity, dry mouth, constipation

in simple terms, what does adrenergic anorexiants (phentermine) do?

decrease appetite and hopefully increase exercise

lipase inhibitors prototype

orlistat

lipase inhibitors (orlistat) MOA

bind to gastric and pancreatic lipases in the GI tract; can prevent absorption ingested fat

lipase inhibitors (orlistat) SE/AE

flatulence w/ discharge, fatty stools, increased defecation

Peptic Ulcer Disease/H. pylori antibiotics

amoxicillin, tetracycline, metronidazole

Peptic Ulcer Disease/H. pylori antibiotics -- amoxicillin MOA

inhibits synthesis of bacterial wall by binding w/ proteins to produce a defective wall

Peptic Ulcer Disease/H. pylori antibiotics -- amoxicillin SE/AE

N/V, yeast, diarrhea

Peptic Ulcer Disease/H. pylori antibiotics -- amoxicillin nursing implications

hypersensitive because of beta-lactam ring, broad spectrum ATB

Peptic Ulcer Disease/H. pylori antibiotics -- tetracycline MOA

penetrate microbial cells, inhibit protein synthesis

Peptic Ulcer Disease/H. pylori antibiotics -- tetracycline SE/AE

N/V, yeast, diarrhea

Peptic Ulcer Disease/H. pylori antibiotics -- tetracycline causes ___

discolor tooth enamel & depresses bone growth

Peptic Ulcer Disease/H. pylori antibiotics -- metronidazole MOA

inhibits protein synthesis by interacting with DNA and causes a helical DNA structure & strand breakage

Peptic Ulcer Disease/H. pylori antibiotics -- metronidazole SE/AE

N/V, yeast, diarrhea, increases BP

when taking metronidazole you want to avoid ___

alcoholic beverages, propylene glycol (can increase your sodium)

Histamine2-Receptor Antagonist ends with ___

-tidine

Histamine2-Receptor Antagonist prototypes

Cimetidine, Ranitidine, Famotidine, Nizatidine

Histamine2-Receptor Antagonist MOA

blocks H2 receptors in stomach, inhibits acid production

when taking Histamine2-Receptor Antagonist, you want to also take ___

antibiotics

Proton-pump inhibitors (PPIs) end in __

-prazole

examples of Proton-pump inhibitors (PPIs)

rabeprazole, pantoprazole, lasoprazole, esomeprazole

Proton-pump inhibitors (PPIs) specific prototype

omeprazole

Proton-pump inhibitors (omeprazole) MOA

stronger than H2 blockers, inhibits gastric secretion, slows down peristalsis

Proton-pump inhibitors (omeprazole) adverse effect

Alzheimers, Dementia (when using for too long)

Proton-pump inhibitors (omeprazole) has a __ half-life

short