FVI Pharm Exam 5

Benzodiazepines

Examples: Alprazolam, Lorazepam, Diazepam, Clonazepam

• Use: Anxiety, panic attacks, seizures (lorazepam (ativan)), insomnia ( also in anesthesia)

• MOA: Enhance GABA (relaxes)→ CNS depression

• Side Effects: Drowsiness, dizziness, respiratory depression, amnesia, withdrawal effects, paradoxical effect

• Nursing: Fall precautions, avoid alcohol, do not stop abruptly

• Antidote: Flumazenil (Romasico)

SSRIs (selective serotonin reuptake inhibitors)

Examples: Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram

• Use: Depression, anxiety

• MOA: Increase serotonin

• Side Effects: suicidal ideation, GI upset, insomnia, sexual dysfunction, hyponatrimia(low sodium), weight changes, serotonin syndrome

• Nursing: Takes 4-8 weeks to work

• Important: Watch for serotonin syndrome and suicidal thoughts

• Given in the morning at the same time every day

SNRI (serotonin norepinephrine reuptake inhibitors)

Examples: Venlafaxine, duloxetine

Stronger than SSRI

Increase serotonin and epinephrine

Given in the morning at the same time every day

TCAs

Examples: Amitriptyline, Nortriptyline, Imipramine

• MOA: block the reuptake of serotonin and norepinephrine

• Use: Depression, nerve pain

• Side Effects: seizures, sedation, dry mouth, constipation, orthostatic hypotension, excessive sweating

• Nursing: Avoid alcohol, rise slowly

• Toxicity: Can cause fatal arrhythmias in overdose

Buspirone

• Use: Generalized anxiety and panic disorder

• MOA: Serotonin receptor agonist

• Side Effects: Dizziness, headache

• Nursing: Takes 2–4 weeks to work

• Important: No dependence or withdrawal

Bupropion (Wellbutrin)

• Use: Depression, smoking cessation

• MOA: Increases norepinephrine & dopamine

• Side Effects: Insomnia, dry mouth

• Important: Can cause seizures

• Avoid: Patients with seizure or eating disorders

Lithium Carbonate

• Use: Bipolar disorder

• Therapeutic Level: 0.6–1.2 mEq/L

• Side Effects: Tremor, nausea, increased urination, hypothyroidism (DSH level test), hyponatremia increases the risk of toxicity

• Nursing: Maintain sodium and fluid intake

• Toxicity: Confusion, severe tremor, seizures

Antipsychotics 1st Generation

Example: Chlopromazine, Haloperidol, Fluphenazine

• Block dopamine (D2) receptors → decrease hallucinations and delusions.

• Adverse effects:dystonia (muscle stiffness), akatisha(restlessness), dyskinesia, orthostatic hypotension, dry mouth, neuroleptic malignant syndrome

• Patient Teaching:Rise slowly, Avoid alcohol, report fever, muscle stiffness, or uncontrolled movements immediately.

Antipsychotics 2nd Generation

Examples; Risperidone, Olanzapine, Quetiapine, Aripiprazole, Brexpiprazole

MOA: Block dopamine (D2) and serotonin (5-HT2A) receptors → improve positive and negative symptoms of schizophrenia.

Major Side Effects:Weight gain, Hyperglycemia/diabetes, High cholesterol, Sedation, Lower risk of EPS than first-generation antipsychotics

Patient Teaching:Eat a healthy diet and exercise, Report excessive thirst, frequent urination, or unusual weight gain.

Zolpidem

• Use: Insomnia

• Side Effects: Drowsiness, sleepwalking

• Nursing: Take immediately before bed

• Avoid: Alcohol

Valproic Acid

• Use: Seizures, bipolar disorder

• Side Effects: Liver toxicity, pancreatitis

• Nursing: Monitor liver function

• Important: Report abdominal pain immediately

MAOIs

Examples: Phenelzine, Isocarboxazid, Selegiline, Tranylcypromine

• MOA: All monoamines (serotonin, norepinephrine, dopamine) increase

• Use: strongest antidepressant

• Side Effects:

• Important: Avoid tyramine foods (aged food, red wine, ham, pepporoni, salami)

• Risk: Hypertensive crisis if have eaten tyramine foods

Heparin

• Use: Prevent/treat blood clots

• Monitor: aPTT

• Side Effects: Bleeding

• Antidote: Protamine sulfate

Warfarin

• Use: Long-term anticoagulant

• Monitor: INR (Goal usually 2–3)

• Side Effects: Bleeding

• Antidote: Vitamin K

• Teaching: Keep vitamin K intake consistent

Abciximab

• Use: Prevent platelet clumping during PCI

• Side Effects: Bleeding

• Nursing: Monitor platelets and bleeding

Aspirin

• Use: Pain, fever, antiplatelet

• Side Effects: GI bleeding, tinnitus

• Avoid: Children with viral illness (Reye syndrome)

• Teaching: Take with food

Epoetin Alfa

• Use: Treat anemia

• MOA: Stimulates RBC production

• Nursing: Monitor hemoglobin and blood pressure

• Important: Ensure adequate iron stores

Filgrastim

• Use: Increase neutrophils

• MOA: Stimulates WBC production

• Side Effects: Bone pain

• Nursing: Monitor ANC (absolute neutrophil count)

• Important: Helps prevent infection during chemotherapy