PHARM: cns part 1 + part 2

What are migraines caused by?

decreased serotonin levels = leads to vasodilation = pain and inflammation

Serotonin agonist

MOA:

• increased serotonin levels = vasoconstriction = prevents inflammation and pai

Used for

• first line drug for

Drugs

• ?

Normal SE

• ?

Adverse SE

• ?

Contraindications

• ?

• (-tripta or -triptan)

• nausea + CNS (dizzy, drowsy, weak) + burning mouth/nasty taste if using nasal spray

• adverse SE

  • if overused = headache

  • CV (hypertension, chest pain, thrombolytic events)

  • serotonin syndrome (altered mental status, fever, clonus, sweating)

• liver disease, CV issues, dyslipidemia (atherosclerosis vibes), smoking

Ergot alkaloids

MOA: vasoconstriction = prevents inflammation and pain

Used for

• Migraines

Drugs

• ?

Normal SE

• ?

Adverse SE

• ?

• ergotamine, dihydroergotamine

• nausea + CNS (dizzy, drowsy, weak)

• adverse SE

  • if overused =

  • CV (hypertension, chest pain, thrombolytic events)

  • ergotamine poisoning (SX: cold and numb hands/feet, muscle pain, cyanosis)

  • long term use —> risks addiction

  • *** think of ego the food critic from ratetoulle. he has migraine, he has cold limbs/muscle pain/blue pale skin**

Onabotulinum toxin A

• used for?

• black box warning?

• botox

• if it spreads beyond injection site —> dysphagia, SOB, wheezing

• What is parkinsons disease caused by?

• goal of parkinsons therapy?

• 3 main drug categories used?

• number one nursing rule for parkinson drugs?

• low dopamine and high AcH —> results in bradykinesia SX (tremors,

• SX relief + maintain independence and mobility

• dopamine agents + anti-COMT drugs (bc COMT breaksdown dopamine) + anticholinergic agents

• DONT STOP ABRUBTLY —> worsens parkinson SX

Levadopa

MOA:

• ?

Notes regarding Levadopa

• ?

Used for

• ?

Normal SE

• ?

Adverse SE

• ?

Administration

• ?

Nursing

• what can u do if on/off syndrome occurs?

• dopamine pro-drug that converts into dopamine once inside the body

• delayed full effect (takes months), on/off phenomenon, high dose is required to cross BBB ( which also results in adverse SE…), decarboxylase breaksdown Levadopa before it can cross the BBB thus reduced bioavailability

• parkinsons disease (but not drug of choice bc too many adverse SE)

• nausea

• adverse SE

  • altered mental status (confusion, psychosis)

  • on-off syndrome (bc Levadopa’s effect wears off after 2-5 years, resulting in abrupt loss of effect)

  • dyskinesia (involuntary movement)

• take on empty stomach (food delays absorption)

• HCP can adjust dose as needed

Levadopa-carbidopa combo

• note: using carbidopa alone has no effect; its only used to help Levadopa

MOA:

• Carbidopa prevents Levadopa being broken down = increased Levadopa bioavailability to cross BBB

Drugs:

• ?

• which one is the drug of choice for treating bradykinesia of parkinsons?

Normal SE

• ?

Adverse SE

• ?

Contraindicated

• ?

Drug interactions

Administration

• ?

Nursing

• when to hold dose?

• patient education?

• how to accomodate for on/off syndrome?

• if patient switching from levadopa to levadopa-carbidopa —> discontinue levadopa 8 hrs beforehand

• sinemet, parcopa *****think: LEAVEadopa carbidopa = the meme of The Simpsons school principal dude walking in slo-mo = bradykinesia ***

• sinemet

• nausea + discolored body fluid (red-brown) + orthostatic hypotension

  • ***think of an old man with parkinsons w/cogwheel rigidity leaking brown rusty liquid and tips-over bc orthostatic hypotension.

• adverse SE

  • arrythmia

  • altered mental status (confusion, psychosis)

  • on-off syndrome

  • dyskinesia (involuntary movement)

• Glaucoma + pre-cancerous skin lesions —> risks Melanoma

  • ***think: the old man also skin lesions and glaucoma**

• administration

  • take on empty stomach + ONLY take w/food if GI distress occurs

  • AVOID high protein meal OR take drug 30 min before or 1 hr after high protein meal

  • AVOPID vitamin B6 (beef liver, fish)

• HOLD dose and NOTIFY HCP if dyskinesea, altered mental status, or arrythmia occurs

• Patient education: delayed full effect (weeks-months) + on-off syndrome can occur

• HCP can adjust dose OR combine this drug with: dopamine agonist, COMT-inhibitor, or MAO-B inhibitor

Dopamine agonist

• less effective than Levadopa-carbidopa

• BUT what are this drug’s pros?

Used for:

• ?

Drugs

• Non-ergot dopamine agonist (Pramixepole, Ropinipole)

• Ergot dopamine agonist (Bromocriptine)

• doesnt need to be converted, decreased risk of dyskinesia, SAFE for high protein meals

• parkinsons motor SX
  

Non-ergot dopamine agonists

Used for

• ?

Drugs

• ?

Normal SE

• ?

Adverse SE

• ?

• drug of choice for early parkinsons

• Pramipexole, Ropinirole

• nausea

• dyskinesia (involuntary movement), orthostatic hypotension, compulsive behavior (gambling, alcoholism), daytime somnolence (“sleep attacks”), insomnia

  • *** Roll-pin-roll (ropinirole) + pay me (pramixepole) = grandpa compulsive gambling addict who jumps up and screams uncontrollably like daddy does (dyskinesia) = who stays up all night (insomnia/daytime sleep attacks)***

Ergot dopamine agonists

Drugs

• ?

Used for

• ?

Normal SE

• ?

Adverse SE

• ?

Drug interactions

• AVOID which drug?

• Bromocriptine

• tremors in parkinsons ***think of cryptoo-obsessed finance bro who is literally shaking while he raves about crypto**

• Adverse SE

  • N/v

  • Dyskinesia (uncontrolled involuntary movement)

  • Fibrosis of internal organs (especially @ heart valves)

  • Hypertension

  Drug interactions 

  • AVOID Erythromycin

MAO-B inhibitors

MOA

• ?

Used for

• ?

Drugs

• ?

Normal SE

Adverse SE

• ?

Drug interactions

• ?

Administration

• ?

• inhibits MAO-B —> prevents dopamine breakdown = more dopamine supply

• treating on-off syndrome in parkinsons

• (-giline); Selegiline, Rasagiline

• nausea + CNS (confusion, dizzy, headache) + dryness

• orthostatic hypotension + insomnia

• AVOID tyramine-foods —> Hypertensive crisis + AVOID SSRI antidepressant and OTC cough meds —> Serotonin syndrome

• give in morning

COMT inhibitors

• Needs to be used in combo w/Levadopa

MOA

• inhibits COMT (←naturally breaksdown Levadopa) = more Levadopa available

Used for

• ?

Drugs

• ?

Normal SE

Adverse SE

• treating on-off syndrome in parkinsons

• (-capone); Entacapone, Tolcapone

• Urine discoloration (orange-brown) + GI distress (diarrhea)

  • think: El capone saying “im gonna make u sh*t ur pants, and your uh… your pee orange! (awkward cricket sound effect….)

• Worsened dyskinesia + Hepatotoxicity (if using Talcapone)

Amantadine

Used for

• ?

Normal SE

• ?

Adverse SE

• ?

Contraindications

• dyskinesia caused by levadopa-carbidopa

• nausea + dry + confusion @ elderly (confusion, hallucinations)

• orthostatic hypotension + livdeo reticularis (skin mottling) + nephroxicity (bc Amantadine is excreted via kidneys)

  • ***think: amantadine sounds like a romantic girl name → this girl makes u dizzy (orthostatic hypotension), pee my pants, skin turns purple for her (skin mottling)***

Central Anticholinergic

MOA: reduces AcH

Used for

• tremors in parkinsons

• cogwheel rigidity

• excess drooling

Drugs

• ?

Normal SE

Adverse SE

• ?

Administration

• ?

Nursing

• ?

• Benztropine, Trihexyphenidyl, Biperiden, Procyclidine

• nausea + dryness + sedation + CNS (restless, insomnia)

• severe tachycardia + hyperthermia or heat stroke = so be careful exercising or being in hot weather

• administration

  • take with food if GI distress occurs

  • if taking one dose —> give daytime

  • if taking multiple dose —> give bedtime

• NOTIFY the nurse if severe urinary retention of confusion occurs + provide hydration (ice chips, candy, drinks) + increased fluid/fiber

• seizures are caused by severe surge in brain’s electrical activity = results in electrical imbalance

• goal of seizure treatment:

  • reduce seizure ocurrence to allow normal normal ADL

  • balanced seizure control w/ some inevitable side effects

General nursing for anti-seizure drugs

• Take drug EXACTLY as prescribed + DONT miss doses

• DONT stop abruptly → withdrawal from meds SLOWLY

• Monitor plasma drug levels

• Promote drug adherence (very important patient education)

• Most seizure drugs cause CNS depression → so AVOID alcohol, opioids, antidepressants, allergy meds

• Take w/food to reduce GI upset 

• DONT change brand names or dosage forms

• AVOID activities that require mental alerntess (ex: driving, carrying heavy machines)

• Space out activities throughout the day to allow for restnig periods to avoid fatigue/weakness/drowsy SE

• Often doctor appointment 

• Phenytoin may discolor urine (pink, red, brown)

• Proper orgal hygeine and regular densist visits espeiocally if taken phenytoin or fosphenytoin

• Most seizure drugs are contraindicated in pregnancy (categories C or D) so they disrupt oral contraceptives → accidental pregnancy 

• IN TEXAS, drivers license will be suspended until youve been seizure-free for 3 months + consistent drug adherence 

Phenytoin (Dilantin)

MOA: stabilizes nerve cells to prevent over-excitation

Used for

• partial seizures (SX: weird behavior + not fully aware)

• tonic clonic seizures (SX: collapse with full body shaking)

Normal SE

Adverse SE

Contraindications

Therapeudic index

• whats the normal TI?

• what happens if it becomes 20-30?

• what happens if it becomes 30-40?

• what happens if it becomes 40+?

Drug interactions

• Phenytoin is a p450 inducer!!! = decreases TE of most other drugs

  • Disrupts oral contraceptives

  • Disrupts Levadopa —> parkinsonism risk

  • Disrupts anticoagulants —> bleeding risk

Administration

• take at same time everyday without missing dose (bc narrow TI)

• DONT stop abruptly → rebound seizure risk 

• STOP enteral feeding ____ before or ____after taking phenytoin 

• what type of injection CANT be used for phenytoin + why?

• Best route is ______

  • is only compatible with what IV fluid type?

  • what complication occurs if you do IV push instead?

Nursing

• Phenytoin and Dilantin are the same drug, but different formulations are NOT interchangeable due to differences in absorption + dosing 

• hypotension + gingival hyperplasia

• CNS depression + Steven Johnson Syndrome + Hepatotoxicity + Leukopenia + Suicide/depression

• Liver disease + pregnancy

• 10-20

• nystagmus, diplopia

• ataxia, slurred speech, hand tremors

• stupor, coma

• 2 hrs before or 2 hrs after

• DONT give IM injection → tissue damage 

• Slow IV infusion

• normal saline

• purple hand syndrome

Fosphenytoin

• what makes this diff than phenytoin?

MOA

• ?

Used for

• when Phenytoin cant be used

• tonic clonic seizures

• status epilepticus (basically continuous seizures)

Route

• hint: its the 2 routes that cant be used for Phenytoin

Nursing

• ALWAYS prescribe Fosphenytoin in what units?

• safer bc less adverse SE + can be given fast = preferred for high acuity settings

• pro-drug of phenytoin that converts into phenytoin

• IM injection + IV push

• PE units (aka Phenytoin Sodium Equivalents)

Barbituates

MOA: enhanced GABA activity —> increased CNS depression

Drug

• Phenobarbital

Adverse SE

• ?

Contraindications

• ?

Drug interactions

• barbituate is a strong p450 inducer = thus reduced TE of other drugs

• disrupts oral contraceptives

• Severe resp depression + CNS depression + hypotension + Neuro toxicity (nystagmus, ataxia)

• Liver issues (bc drug metabolism of Barbituate wont be good)

Carbamazepine

Used for

• seizures

• trigeminal neuroglia

• BPD

Normal SE

• nausea

Adverse SE

• a p450 inducer!

• ?

Contraindications

• ?

Drug interactions

• ?

Therapeudic index

• ?

Administration

• ?

Nursing

• adverse SE

  • steven johnson syndrome

  • agranulocytosis (=increased infxn risk)

  • hepatotoxicity

  • SIADH (sx: confusion, slurred speech, weakness)

  • Toxicity (SX: ataxia, diplopia, slurred speech)

• liver disease + kidney disease + glaucoma + CV issues + pregnancy

• disrupts oral contraceptives + AVOID MAOI antidepressants+ AVOID grapefruit

• 8-12

• if using NG tube route: flush NG tube before administration → mix the drug dose w/equal amount of water → then flush NG tube after administration

Benzodiazepines

MOA: increase GABA activity

Drugs

• ?

• which drug is drug of choice for status epilepticus?

Adverse SE

• ?

Toxicity

• antidote + how to administer antidote?

Nursing

• Taper off slowly

• Long term use —> Anti-seizure tolerance develops (but doesnt affect anxiolytic or sedation tolerance)

• Clonazepam, Lorazepam

• Lorazepam

• adverse SE

  • CNS depression 

  • Amnesia 

  • IV route → resp depression + hypotension + cardiac arrest 

  • Paradoxical effects (anxiety, insomnia, excitation, euphoria)

• Flumazenil → IV push 30 seconds → lasts 1 hr so may need to repeat doses (since benzos have long half life)

Carboxylic Acid derivative

MOA: increased GABA

Used for:

• seizures

• migraine

• BPD

Drugs

• ?

Expected SE

• ?

Adverse SE

Therapeudic index 

• ?

Drug interactions 

• ?

• valproic acid

• weight gain + GI distress

• adverse SE

  • Hepatoxicity

  • Pancreatitis (SX: left upper abdomen pain + elevated amylase/lipase)

  • Thrombocytopenia → increased bleeding risk

  • CNS (confusion, sedation, ataxia, nystagmus) 

  • ***think: Vlad the vampoire gained weight from drinking and likes to suck blood and eat pancreases from the Pheny twins (Phenorbitual + Phenytoin)**

• 50-100

• Valproic acid increases toxicity of phenytoin and phenobarbital

Gabapentin

Used for

• ?

Adverse SE

• ?

• drug of choice for neuropathy + partial seizures

• adverse SE

  • Severe resp depression **think: gabby hannah says she feels suffocated = cant breathe*

  • Leukopenia (low WBC) → increased infxn risk

  • Depression/suicide 

  • CNS depression (confusion, dizzy, ataxia)

  • Decreased levels of B9 + B12

Lamotrigine (Lamictol)

MOA: blocks Na channel = blocked glutamate release +  increased GABA release

*****think: blocked glutamate for Lamotrigine = bc Lam le was ripped asf and had amazing glutes**

Used for

• ?

Normal SE

• Nausea

Adverse SE

• ?

• seizures + BPD

• BLACK BOX WARNING: Steven johnson syndrome can develop 1 month later + suicide/depression

Topiramate

MOA: prevents spread of seizure via blocked glutamate = increased GABA

Used for

• ?

Expected SE

• ?

Adverse SE

• ?

Nursing

• ?

• seizures + migraines

• weight loss

• adverse SE

  • ***think: the ship’s Top Pirate is old, skinny (weight loss), has memory loss and slow cognition, glaucoma, has tingly limbs, holds the side of his stomach (bc kidney stone pain)**

  • Memory loss

  • Glaucoma 

  • Metabolic acidosis → kidney stones and parasthesia (SX: tingling, numb)

  • Slow cognition (confusion, drowsy, dizzy + ataxia, diplopia)

  • Decreased sweating

• hydrate to prevent kidney stones

Succinimides

MOA: opens Ca channels to inhibit neuron firing

Used for

• ?

Drugs

• ? 

Normal SE

• GI distress 

Adverse SE

• ?

Therapeutic index

• ?

Contraindicated

• ?

Nursing

• Monitor CBC + kidneys function + liver function test

• drug of choice for abcense seizures

• ethosuximide

• Malignant hyperthermia + Anorexia + Leukopenia + Anemia 

• 30-100

• liver disease + kidney disease

Levetiracetam (Keppra)

• Favorite seizure drug safe + less adverse SE 

Used for

• ?

Adverse SE

• ?

• drug of choice for long term seizure maintainence

• mood changes (irritability, suicide/depression) + steven johnson syndrome

  • ***think: Leve is an chronically (thus long term use drug) moody/angry little boy who is so mad that his skin is red (STJ rash)***

2 groups of muscle relaxant drugs

• which drugs used for localized muscle spasms (aka anti-spasmodics)?

• which drugs used for chronic full body muscle rigidity (aka anti-spasmodics)

Nursing for anti-spasmodics and anti-spastics

• drugs are NOT interchangable (except for diazepem which is used for both groups)

• diazepem, tizanidine

• diazepem, dantrolene, baclofen

Centrally acting muscle relaxants

Used for

• ?

Drugs

• **Diazepam

• C C C → Carisoprodol, Chlorzoxazone, Cyclobenzaprine

• M M → Metaxalone, Methocarbamol

• O → Orphenadrine

• T → **Tizanidine

Expected SE

• ?

Adverse SE

• GI distress

• Allergic rxn

• Arrhythmia 

• Bradycardia 

• Hepatoxicity

• Tizanidine → ____

• Long term use → ____

Administration

• Take w/food (to reduce GI distress)

• Oral route: 

  • Onset is ___

  • Duration ____

    • Cyclobenzaprine duration is ____

Drug interactions

• AVOID other CNS depressants (opioids, drugs, alcohol, barbituates, etc)

• Cyclobenzaprine interacts with MAO inhibitors → hyperthermia + seizure 

• Decreases effects of BP meds (ex: Clonidine)

• local muscle spasms (NOT spasticity)

• CNS depression

• hepatitis + liver necrosis

• 30-60 min

• 4-6 hr

• 12 hrs - up to 5 days

Centrally acting spasticity drugs

Used for

• Spasticity

Drugs

• ?

• which one is drug of choice for long term spasticity maintainence?

Normal SE

• CNS depression

• diazepam, baclofen, dantrolene

• baclofen

Baclofen

Adverse SE

• ?

• antidote for baclofen withdrawal?

Administration

• Give with food (to reduce GI distress)

Nursing

• ?

• adverse SE

  • resp depression, CNS depression, confusion @ elderly

  • DONT STOP ABRUBTLY → Baclofen Withdrawal SX (rebound spasticity, sweating, itching, fever, fluctuating BP, tachycardia, hyperventilation, hallucination, seizures)

• Antidote: Diazepam to offset withdrawal SX

• DONT stop abrut

Malignant hyperthermia

• who is at risk?

Manifeatations:

• high fever, flushed skin, sweating,

• severe hypotension (--> shock)

• spasticity

• dysrythmia

• hyperventilation

• brown-colored urine

• people a mutated RYR1 gene

Dantrolene (Dantrium)

MOA: acts directly on _____ to suppress release of Ca

Used for:

• ?

Adverse SE

• ?

• skeletal smooth muscle

• spasticity + antidote for Maliginant Hyperthermia (either Succinylcholine-induced or general anesthesia-induced)

  • MOA: by promoting relaxed muscles, Dantrolene prevents rigidity that contributes to the life-threatening body temp of malignant hyperthermia 

• adverse SE

  • Hepatotoxicity 

  • Muscle weakness

  • Sedation

  • GI distress (diarrhea)

  • Acne-like rash 

Amphetamines 

MOA: increases levels of dopamine + norepinephrine 

Used for

• ADHD

• Cancer-induced fatigue 

• Narcolepsy (“sleep attacks”)

Drug

• what is the drug of choice for ADHD?

Adverse SE

***basically corticosteroid vibes***

• ?

Contraindicated 

• Hypertension

• CV disease

• MAOI drugs (antidepressant) → risk hypertensive crisis

Administration

• Administer in ____

Nursing 

• If long term use = ____ to prevent rebound depression

• AVOID caffeine/stimulants 

• methylphenidate

• adverse SE

  • CV (hypertension, palpitations, tachycardia, chest pain)

  • CNS (insomnia, restless, anxiety)

  • Hyperglycemia 

  • Thrombocytopenia → bleeding risk

  • Growth suppression @ children 

  • HIGH addiction risk

  • Seizure 

  • Anorexia

• gradually reduce dose

Miscellaenous stimulants

MOA: weakly inhibits dopamine uptake 

Used for

• improving wakefulness

• sleep apnea-induced fatigue

• chemotherapy-induced fatigue 

Drugs

• ?

Expected SE

• ?

Adverse SE

• CNS (restless, anxiety)

• Nausea/vomit 

• Rhinitis 

• Diarrhea

Drug interactions

• P450 inducer → disrupts oral contraceptives

• (-finil); modafinil, armonfafinil

Lithium

Used for:

• ?

Expected SE

• ?

Adverse SE

• ?

Contraindictions

• ?

Excretion and absorption

• Onset is ____

• Full effect takes ___

• Excreted via kidneys

Therapeudic range

• normal therapeudic range for acute mania ____

• normal therapeudic range for chronic maintenece of mania ____

• If overdose = need to do hemodialysis 

Drug interactions

• Lithium toxicity primarily caused by _____

  • thus AVOID NSAID, diuretics, low sodium diets, dehydration, hot weather

• If used with other BPD drugs (Carbamazepine, Haloperidol) → neurotoxicity 

• Lithium increases hypothyroidism SE of iodine drugs

• SSRI’s may worsen mania 

Nursing

• Maintain STABLE sodium intake (dont increase/decrease) → discuss with HCP before adjusting 

• Monitor lithium levels:

  • 8-12 hrs first dose

  • 3x weekly for first month

  • then every week after that

• Monitor kidney function, electrolytes, thyroid function 

• Monitor patients with diabetes insipidus   

• Hydrate + take w/food to minimize GI distress

• discomfort first few days (fatigue, confusion, impaired memory + metallic taste, polyuria, thirst)

• Neprotoxicity, hypothyroidism w/goiter, LIthium toxicity (n/v/d, fine** tremors, drowsy, neuro SX)

• kidney disease, severe dehydration, preggo

• 1 week

• months

• 1-1.5

• 0.6-1.2

• low Na levels

1st gen (typical) VS 2nd gen (atypical) anti-psychotics

1st gen

• manifestations: higher EPS risk + neuroepileptic malignant syndrome

2nd gen

• manifestations: less EPS risk + metabolic syndrome + neuroepileptic malignant syndrome

1st gen antipsychotics (“typical”)

Class:

• ?

Drugs:

• Low potency: Chlorpromazine 

• Medium potency: Loxapine

• High potency: Haloperidol

Administration

• given in divides doses throughout the day 

Adverse SE:

**Early onset of EPS

• ____ ; onset within hours-days

  • manifests as?

  • reversible or irreversible?

• ____ ; onset is days-weeks

  • manifests as?

  • reversible or irreversible?

• ____ ; onset is weeks-months

  • manifests as?

  • reversible or irreversible?

**Late onset

• ____; onset is months later

  • manifests as?

  • reversible or irreversible?

***Neuroepileptic malignant syndrome 

• SX: sudden fever, sweating + rigidity, seizure

• treatment?

• phenothiazines

• acute dystonia

• facial muscle/neck spasms

• reversible

• akathasia

• pacing around, cant stand still, restless

• reversible

• parkinonism

• bradykinsea

• reversible

• irreversible tardive dyskinesia

• irreversible

• Dantrolene and Bromocriptine

2nd gen antipsychotics (atypical antipsychotics)

• hella preferred over 1st gen bc less risk for EPS!!!!

Drugs

• ***Clozapine 

• Olanzapine

• Quetiapine

• Aripiprazole

• Risperidone

• Ziprasadone

Adverse SE:

***mainly metabolic symptoms + neuroepileptic ***

• Metabolic syndrome 

  • SX?

• Neuroepileptic malignant syndrome

Clozapine

Used for

• antipsychotic

Adverse SE

• ?

Nursing 

• monitor CBC

• weight gain, diabetes, hyperlipidemia 

• adverse SE

  • Fatal agranulocytosis → risks life threatening infection 

  • Myocarditis

  • Extrapyramidal SX 

  • Deadly if used on dementia @ older adults 

MAOI antidepressants

MOA: inhibits MAOI neurotransmitters

Used for

• Drug of choice for Atypical depression

• OCD

• Bulimia

• Panick attacks

Drugs

• ?

• which of these is the only transderm option?

Adverse SE

• ?

Drug interactions

• AVOID OTC cold meds (ex: decongestants like Ephedrine)

• AVOID other antidepressants (SSRI, SNRI, TCA) → risks Serotonin syndrome (SX: “worst headache of my life”, sweating, fever, rigidity, tremor, hyper-reflexia)

• if taken w/ Meperidine → Fever

• AVOID anti-hypertension drugs (ex: BB, dihydropyridines, etc…) 

Nursing 

• When changing to a different antidepressant, washout period is ____ minimum

  • washout period is longer for Fluoxetine at _____ minimum

• Check OTC cold meds (make sure they dont contain sympathomimetics)

• Tranylcypromine, isocarboxazid, Phenelzine, Selegiline

• selegiline

• CNS stimulation (anxiety, insomnia, restless)

• orthostatic hypotension

• if eaten w/tyramine rich food —> hypertensive crisis

• 2 weeks

• 5 weeks

ENDED ATY TRICYCLIC ANTIDEPRESSANTS