pharm exam 1 part1. Mechanism of Action / Disorders Prescribed For. part2. Side Effects / Adverse Reactions. part 3Nursing Implications part 4Contraindications / Drug Interactions. part 5 PATIENT EDUCATION

Thiazide Diuretics

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• Inhibit sodium and chloride reabsorption in the distal convoluted tubule of the nephron.

• Promotes diuresis and reduces plasma volume, lowering blood pressure.

Prescribed For:

• Hypertension (first-line therapy)

• Edema (e.g., heart failure, liver cirrhosis, nephrotic syndrome)

• Calcium kidney stones (helps reduce calcium in urine)

Verapamil (for Afib)

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• Calcium channel blocker (non-dihydropyridine)

• Blocks L-type calcium channels, slowing conduction through the AV node and reducing heart rate.

Prescribed For:

• Atrial fibrillation/flutter

• Supraventricular tachycardia (SVT)

• Hypertension

• Angina

Gamma-Aminobutyric Acid (GABA)

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• Primary inhibitory neurotransmitter in the CNS.

• Increases chloride influx into neurons → hyperpolarization → reduced neuronal excitability.

Dysfunction Involved In:

• Anxiety, epilepsy, insomnia, muscle spasticity

Drugs targeting GABA:

• Benzodiazepines, barbiturates, gabapentin, valproate

Dopamine Agonists

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• Stimulate dopamine receptors (D2) in the brain, mimicking dopamine’s effect.

Prescribed For:

• Parkinson’s disease (improves motor symptoms)

• Restless legs syndrome (RLS)

• Hyperprolactinemia (e.g., bromocriptine)

• Sometimes in acromegaly or pituitary adenomas

Tolcapone (Tasmar)

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• COMT (Catechol-O-methyltransferase) inhibitor

• Prevents breakdown of levodopa in the periphery → increases central dopamine availability.

Prescribed For:

• Parkinson’s disease (used with carbidopa/levodopa to enhance its effects)

Sedatives

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• Depress CNS activity, usually by enhancing GABAergic transmission.

Prescribed For:

• Anxiety

• Insomnia

• Preoperative sedation

• Seizure control (in some cases)

Examples: Benzodiazepines, barbiturates, Z-drugs (zolpidem)

Benzodiazepines (Benzos)

MECHANISM OF ACTION / what disorder prescribed for

• Mechanism: Enhance the effect of GABA at the GABA-A receptor, producing anxiolytic, sedative, and anticonvulsant effects.

• Disorders Treated: Anxiety disorders, insomnia, seizures, alcohol withdrawal.

Buspirone

MECHANISM OF ACTION / what disorder prescribed for

• Mechanism: Partial agonist at serotonin 5-HT₁A receptors.

• Disorders Treated: Generalized anxiety disorder (GAD)

Lithium

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• Modulates neurotransmitter activity (especially serotonin, norepinephrine)

• Affects second messengers like inositol monophosphatase.

Prescribed For:

• Bipolar disorder (especially mania and mood stabilization)

• May reduce suicidal risk

SSRIs (Selective Serotonin Reuptake Inhibitors)

MECHANISM OF ACTION / what disorder prescribed for

Mechanism of Action:

• Block reuptake of serotonin (5-HT) at presynaptic neuron → increased serotonin in synapse

Prescribed For:

• Major depressive disorder (MDD)

• Anxiety disorders (GAD, panic, phobias)

• OCD

• PTSD

• PMDD (premenstrual dysphoric disorder)

• Eating disorders (e.g., bulimia)

Symptoms Treated:

• Mood symptoms (sadness, hopelessness)

• Anxiety, obsessions, compulsions

• Sleep disturbances, appetite changes, irritability, low energy

Diuretics

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Dehydration

• Electrolyte imbalances (hypokalemia, hyponatremia)

• Hypotension

• Dizziness, fatigue

• Increased urination

Nitrates

SIDE EFFECTS / ADVERSE REACTIONS

• Headache (very common)

• Flushing

• Dizziness

• Orthostatic hypotension

• Reflex tachycardia

Phenazopyridine

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Red-orange urine discoloration (harmless but alarming)

• Headache

• GI upset

Serious Adverse Effects (rare):

• Hemolytic anemia (especially in G6PD deficiency)

• Hepatotoxicity or nephrotoxicity (with long-term use)

Thiazide Diuretics

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Hypokalemia

• Hypercalcemia

• Hyperuricemia (can worsen gout)

• Hyperglycemia

• Hypotension

• Erectile dysfunction

Sotalol

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Bradycardia

• Fatigue, dizziness

• Dyspnea

Adverse Reactions:

• QT prolongation → torsades de pointes (life-threatening arrhythmia)

• Worsening heart failure

SSRIs

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Nausea

• Sexual dysfunction

• Weight gain or loss

• Insomnia or somnolence

• Dry mouth

• Increased anxiety early in treatment

Adverse Reactions:

• Increased suicidal thoughts (especially in young adults)

• Serotonin syndrome (if combined with other serotonergic drugs)

Lithium Toxicity

SIDE EFFECTS / ADVERSE REACTIONS

Early Signs:

• Nausea, vomiting, diarrhea

• Tremors

• Muscle weakness

• Drowsiness, lack of coordination

Severe Toxicity:

• Ataxia

• Confusion, delirium

• Seizures

• Coma

• Renal failure

Chlorpromazine (Thorazine)

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Sedation

• Orthostatic hypotension

• Anticholinergic effects (dry mouth, constipation)

Neuroleptic Malignant Syndrome (NMS):

• Hyperthermia

• Muscle rigidity

• Altered mental status

• Autonomic instability (↑HR, BP, RR)

• Elevated CPK

Fluphenazine (Prolixin)

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Extrapyramidal symptoms (EPS): dystonia, akathisia, parkinsonism

• Sedation

• Dry mouth, constipation

Adverse Reactions:

• Tardive dyskinesia

• Neuroleptic malignant syndrome

• QT prolongation

Risperidone (Risperdal)

SIDE EFFECTS / ADVERSE REACTIONS

Common Side Effects:

• Weight gain

• Sedation

• Hyperprolactinemia → galactorrhea, gynecomastia

• Orthostatic hypotension

Adverse Reactions:

• Extrapyramidal symptoms (especially at higher doses)

• Tardive dyskinesia

• Neuroleptic malignant syndrome

Serotonin Syndrome

SIDE EFFECTS / ADVERSE REACTIONS

Mild to Severe Symptoms:

• Mental status changes (agitation, confusion)

• Autonomic instability (fever, sweating, tachycardia, hypertension)

• Neuromuscular changes (tremor, clonus, hyperreflexia)

• GI symptoms (nausea, diarrhea)

Medical Emergency – often caused by combining SSRIs, SNRIs, MAOIs, or serotonergic drugs.

Parkinson’s Disease Symptoms

SIDE EFFECTS / ADVERSE REACTIONS

• Resting tremor

• Bradykinesia (slow movement)

• Muscle rigidity

• Postural instability

• Masked facial expression

• Shuffling gait

• Depression, cognitive decline (late stages)

Monoamine Oxidase Type B (MOA-B) Inhibitors/Tyramine Diet

SIDE EFFECTS / ADVERSE REACTIONS

Examples: Selegiline, Rasagiline

Dietary Consideration:

• Avoid tyramine-rich foods (aged cheese, wine, cured meats)

Risk:

• Hypertensive crisis (headache, chest pain, stroke risk)

Drug Interactions:

• SSRIs/SNRIs, TCAs, other MAOIs → serotonin syndrome

• Sympathomimetics (decongestants, stimulants) → hypertension

Anginal Pain

NURSING IMPLICATIONS

• Assess character, onset, duration, and location of chest pain.

• Monitor vital signs before and after giving nitrates or beta-blockers.

• Ensure patient is at rest during acute episodes.

• Keep Nitroglycerin readily available (educate on sublingual use).

• Monitor for relief of pain and side effects (hypotension, headache).

• Instruct to seek emergency help if pain is not relieved by 3 doses of nitro.

Finasteride

NURSING IMPLICATIONS

• Used for BPH or male pattern baldness.

• Pregnant women should not handle crushed tablets (can harm male fetus).

• Monitor urinary output and PSA levels.

• Therapeutic effects may take 6 months or more.

• Educate on sexual side effects (↓ libido, ED, ejaculation disorders).

Nitroglycerin

NURSING IMPLICATIONS

• Monitor BP and HR before and after administration.

• Ensure sublingual tablets are kept in a dark, tightly sealed bottle.

• Rotate sites for transdermal patches to prevent skin irritation.

• Remove patch at night to prevent tolerance.

• Instruct patient to lie or sit down when taking due to dizziness.

Digoxin

NURSING IMPLICATIONS

• Check apical pulse for 1 full minute before administration (hold if <60 bpm).

• Monitor for digoxin toxicity: N/V, vision changes (yellow/green halos), bradycardia.

• Monitor serum potassium (low K⁺ increases risk of toxicity).

• Educate on regular blood levels and adherence.

• Avoid giving with high-fiber meals (interferes with absorption).

Lasix (Furosemide)

NURSING IMPLICATIONS

• Monitor I&O, daily weight, and electrolytes (especially K⁺).

• Assess for signs of dehydration and hypotension.

• Give in the morning to prevent nocturia.

• Watch for ototoxicity with high doses.

• Encourage potassium-rich foods if not on supplements.

Dopamine Agonists

NURSING IMPLICATIONS

• Monitor for orthostatic hypotension and drowsiness.

• Educate about risk of sudden sleep attacks—avoid driving.

• Watch for compulsive behaviors (gambling, shopping).

• Titrate dose slowly to minimize side effects.

Benzodiazepines

NURSING IMPLICATIONS

• Monitor for respiratory depression, especially with opioids.

• Use fall precautions due to sedation/dizziness.

• Assess for signs of dependence or abuse.

• Educate on short-term use only.

• Taper gradually to prevent withdrawal symptoms.

Antidepressants

NURSING IMPLICATIONS

• Monitor for suicidal ideation, especially in first few weeks.

• Educate that therapeutic effects may take 2–4 weeks.

• Watch for side effects like insomnia, weight changes, sexual dysfunction.

• Do not stop abruptly—risk of withdrawal syndrome.

• Monitor for serotonin syndrome with polypharmacy.

Imipramine

NURSING IMPLICATIONS

• Monitor for orthostatic hypotension and anticholinergic effects.

• Assess for suicidal thoughts, especially early in therapy.

• Overdose can be fatal—use cautiously in patients with suicidal risk.

• Educate on avoiding alcohol and CNS depressants.

• Taper dose slowly to avoid discontinuation syndrome.

Antiepileptic Drugs

NURSING IMPLICATIONS

• Monitor seizure frequency, side effects, and adherence.

• Ensure serum drug levels are within therapeutic range.

• Educate not to stop abruptly—can trigger status epilepticus.

• Warn about CNS effects (drowsiness, dizziness, blurred vision).

• Counsel women on contraceptive interactions (some AEDs reduce effectiveness).

Benzodiazepines

CONTRAINDICATIONS/DRUG INTERACTIONS

Examples: Diazepam, Lorazepam, Alprazolam

Contraindications:

• Severe respiratory depression or sleep apnea

• Acute narrow-angle glaucoma

• Severe hepatic impairment

• Myasthenia gravis (caution due to muscle weakness)

• Pregnancy (especially first trimester—teratogenic risk)

Drug Interactions:

• Alcohol → increased CNS/respiratory depression

• Opioids → increased risk of death from sedation and respiratory depression

• CNS depressants (e.g., antihistamines, antipsychotics) → additive effects

• CYP3A4 inhibitors (e.g., erythromycin, ketoconazole) → increased benzo levels

Tricyclic Antidepressants (TCAs)

CONTRAINDICATIONS/DRUG INTERACTIONS

Examples: Amitriptyline, Imipramine, Nortriptyline

Contraindications:

• Recent myocardial infarction (MI)

• Severe heart disease or arrhythmias

• Angle-closure glaucoma

• MAOI use within 14 days → risk of hypertensive crisis or serotonin syndrome

• Drug Interactions:

  • MAOIs → fatal interactions

  • Anticholinergics → increased side effects (dry mouth, constipation, urinary retention)

  • Alcohol → increased sedation and CNS depression

  • QT-prolonging drugs → additive cardiac risks

Dalfampridine

CONTRAINDICATIONS/DRUG INTERACTIONS

Used for: Improving walking in MS patients

Contraindications:

• History of seizures (lowers seizure threshold)

• Moderate to severe renal impairment (CrCl ≤ 50 mL/min) → increased toxicity risk

Drug Interactions:

• Other CNS stimulants or seizure-threshold-lowering drugs → increased seizure risk

• Cimetidine (rare use, but may decrease clearance)

Donepezil (Aricept)

CONTRAINDICATIONS / DRUG INTERACTIONS

Used for: Alzheimer’s disease (cholinesterase inhibitor)

Contraindications:

• Known hypersensitivity to donepezil or piperidine derivatives

Use with caution in:

• Bradycardia, sick sinus syndrome, or AV block

• Asthma or COPD (can increase cholinergic bronchoconstriction)

• Active GI bleeding or ulcers

Drug Interactions:

• Anticholinergic drugs → reduced donepezil effectiveness

• NSAIDs → increased risk of GI bleeding

• CYP450 inducers/inhibitors may affect metabolism (e.g., ketoconazole ↑ levels; phenytoin ↓ levels)

Dopamine Agonist / Antihypertensive Drug

CONTRAINDICATIONS / DRUG INTERACTIONS

Risk:

• Additive hypotensive effects → orthostatic hypotension, dizziness, falls

Contraindications/Precautions:

• Hypotension, volume depletion

• Elderly patients (increased sensitivity to hypotension)

• Avoid combining with other dopamine-affecting drugs unless closely monitored

Lasix (Furosemide )

PATIENT EDUCATION

• Take in the morning to avoid nocturia.

• Expect increased urination—stay hydrated.

• Monitor for signs of dehydration and electrolyte imbalance (e.g., muscle cramps, weakness).

• Report dizziness or hypotension.

• May require potassium supplementation.

Lamotrigine

PATIENT EDUCATION

• Used for epilepsy and bipolar disorder.

• Start low and go slow due to risk of Stevens-Johnson Syndrome (report rash immediately).

• Take at the same time daily.

• Do not stop abruptly—can trigger seizures.

• May cause dizziness or blurred vision.

Nitro (Nitroglycerin)

PATIENT EDUCATION

• Sit or lie down before taking it (to prevent fainting).

• Place sublingual tablets under the tongue; do not chew or swallow.

• Call 911 if chest pain persists after 1st dose and 5 minutes.

• Store in a dark, airtight container; replace after 6 months if unused.

• Can cause headache or flushing.

Loop Diuretic (e.g., Furosemide)

PATIENT EDUCATION

• Same education as Lasix (see a).

• Rise slowly to prevent orthostatic hypotension.

• Monitor weight daily for fluid changes.

• Notify provider of hearing changes (ototoxicity risk at high doses).

Antihypertensive Medications

PATIENT EDUCATION

• Take at the same time daily.

• Do not skip doses—may cause rebound hypertension.

• Monitor blood pressure regularly.

• Lifestyle changes (low-sodium diet, exercise) enhance effectiveness.

• Report persistent dizziness or swelling.

Flumazenil

PATIENT EDUCATION

• Antidote for benzodiazepine overdose—usually used in hospital setting.

• Patient may experience withdrawal symptoms (seizures, agitation) if dependent.

• Short half-life—monitor for re-sedation.

Dopamine Agonist

PATIENT EDUCATION

• May cause drowsiness or sudden sleep attacks—avoid driving until effects are known.

• Can lead to impulse control disorders (e.g., gambling).

• Take with food to reduce nausea.

• May cause orthostatic hypotension—rise slowly.

Benzodiazepines

PATIENT EDUCATION

• Short-term use only due to dependency risk.

• Avoid alcohol and other CNS depressants.

• May impair memory and coordination.

• Do not abruptly stop—can cause withdrawal seizures.

• Take exactly as prescribed.

SNRI (e.g., venlafaxine, duloxetine)

PATIENT EDUCATION

• Used for depression, anxiety, and some pain disorders.

• May take several weeks for full effect.

• Can cause nausea, insomnia, increased BP.

• Do not stop suddenly—risk of withdrawal symptoms.

• Report worsening mood or suicidal thoughts.

Isocarboxazid (MAOI)

PATIENT EDUCATION

• Strictly avoid tyramine-rich foods (aged cheese, wine, cured meats)—risk of hypertensive crisis.

• Avoid other serotonergic drugs (SSRIs, SNRIs, TCAs) due to serotonin syndrome risk.

• Wait 2 weeks after stopping before starting new antidepressant.

• Report severe headache or palpitations.

Lithium

PATIENT EDUCATION

• Maintain consistent salt and fluid intake.

• Requires regular blood tests to monitor levels.

• Take with food to minimize GI upset.

• Avoid dehydration and NSAIDs (can raise levels).

• Signs of toxicity: tremor, nausea, confusion, slurred speech

Lithium Toxicity

PATIENT EDUCATION

• Early signs: nausea, diarrhea, fine hand tremor, weakness.

• Advanced signs: confusion, ataxia, slurred speech, seizures.

• Encourage hydration and adherence to lab appointments.

• Educate on drug interactions that increase toxicity risk (e.g., diuretics, NSAIDs).

Antipsychotic Drugs

PATIENT EDUCATION

• May cause weight gain, sedation, or metabolic syndrome.

• Monitor blood sugar and cholesterol.

• Watch for extrapyramidal symptoms (tremor, rigidity).

• Do not stop abruptly.

• Importance of medication adherence even if symptoms improve.

Amitriptyline (TCA)

PATIENT EDUCATION

• Take at bedtime due to sedation.

• May cause dry mouth, constipation, urinary retention.

• Avoid alcohol—intensifies sedation.

• Takes weeks to see effect.

• Do not abruptly stop—risk of withdrawal.

Carbidopa/Levodopa

PATIENT EDUCATION

• Used for Parkinson’s disease.

• Take on an empty stomach or low-protein meal to increase absorption.

• May cause orthostatic hypotension and dyskinesia.

• Effectiveness may wear off over time ("on-off" effect).

• Do not stop suddenly—can cause neuroleptic malignant-like syndrome.

Monoclonal Antibody

PATIENT EDUCATION

• May be used in autoimmune, neurologic, or cancer treatment.

• Risk of infusion reactions—report rash, fever, breathing difficulty.

• Increases infection risk—avoid sick contacts.

• Long-term use may affect immune system function.

• Regular monitoring required (labs, infection signs).

Neurologic Drug

PATIENT EDUCATION

(General education depending on the class, e.g., AEDs, dopaminergics)

• Adherence is critical—do not miss doses.

• Report new or worsening neurologic symptoms.

• Avoid alcohol and monitor for sedation or cognitive changes.

• Discuss pregnancy safety (some are teratogenic).

• Regular monitoring for therapeutic levels or liver function may be needed.