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143 Cards in this Set
- Front
- Back
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Bulk Forming Laxative
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psyllium ( Metamucil)
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MOA of Metamucil
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Bulk Forming....acts similarly to dietary fiber, softens the fecal mass, stretches the intestinal wall stimulating
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Side Effects of Metamucil
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abd. discomfort, and impaction
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COntraindications of Metamucil
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bowel obstruction and undiagnosed
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Nursing Con. with Metamucil
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mix immediately before administration, client should drink a full glass of water, BM should occur in 12-36 hrs.
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Stool Softners
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docusate sodium (Colace)
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MOA of Colace
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Stool Softener
promotes incorporation of water into stool, and secretion of electrolyte and water into color |
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Side Effects of Colace
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abd. cramping, diarrhea and rash
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contraindications of Colace
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abd. pain and N/V
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nursing con. for Colace
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assess for abd. distention, presence of bowel sounds and bowel function patterns. Also assess color.
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Stimulant Laxative
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bisacodyl (Ducolax)
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MOA Ducolax
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Stimulant Lax.
stimulates peristalsis, alters fluid and electrolyte transport |
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Side Effects of Ducolax
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Abd. cramps, N/V/D
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Nursing Cons. for Dulcolax
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assess for abd. distention, presence of bowel sounds and bowel function patterns. Also assess color, consistency and amount of stool
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Saline or Osmotic Lax.
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magnesium HCL
(Milk of Mag) (Miralax) |
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MOA of MoM and Miralax
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mg HCL
increases fluid in the intestine to dilute stool, stretch the bowel and increase peristalsis |
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Nurs. Cons. with MoM and Miralax
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give with 8 oz. water, monitor bowel movement, hydration and electrolyte levels, generally acts in 6-12 hours
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Herbal Lax.
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senna (Senekot)
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MOA of Senekot
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alter water and electolyte transport in the large intestine increasing persistalsis
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Nurs. Cons. of Senekot
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assess for abd. distention, presence of bowel sounds and bowel function patterns, Also assess color, consistency and amount of stool/
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Antidiarrheals
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Lomotil
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MOA of Lomotil
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direct effect on intestinal wall muscles, slowing intestinal motility
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side effects of lomotil
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drowsiness, dizziness, nausea, constipation, Opioid effects
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contraindications of Lomotil
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hepatic ore renal disease, dehydration w/electrolyte depletion, use cautiously with young children
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Nursing considerations with Lomotil
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encourage adequate fluid intake \
monitor hydration status check bowel sounds for peristalsis D/C and report abd. pain and distention DO NOT GIVE in presence of blood in diarrhea or temp of 101 or higher |
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IBS drug
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Zelnorn
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MOA of Zelnorn
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increase peristalsis, intestinal secretion and decreased visceral secretions
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Side effects of Zelnorn
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HA, diarrhea
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Contraindications in Zelnorn
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hepatic impairment, renal impairment, bowel obstruction, gall bladder disease, concurrent or frequent diarrhea
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Nursing Cons. with Zelnorn
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assess pt. for symptoms of IBS: abd. pain or discomfort, bloating, constipation
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antiemetics
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Compazine
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MOA of compazine
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alters the effects of dopamine in the CNS
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Side effects of Compazine
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NEUROLEPTIC MALIGNANT SYNDROME (NMS)
blurred vision dry mouth |
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Contraindications in Compazine
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cross senstitivity with other phenothiazines
angle closure glaucoma bone marrow depression |
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nurs. cons. for compazine
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monitor for NMS
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H2 receptor antagonist
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Zantac (ranitidine HCL)
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MoA of Zantac
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H2receptor antagonist
blocks H2 which blocks gastric acid production |
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Side effects of Zantac
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sleepiness
sweating rash diarrhea impotence glaucoma |
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Drug interactions with Zantac
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antacids
coumadin |
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Nursing Cons. with Zantac
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Montor:
LFT BUN Creatine CBC |
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patient teaching with Zantac
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encourage NO smoking
taking one dose at bedtime has longer effects |
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Proton Pump Inhibitors
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(PPI) Prilosec
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MoA of PPI's (prilosec)
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inhibits hydrogen potassium pump, and prevents secretion
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Side effects of PPI (prilosec)
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HA
N/V/D |
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drug interactions with PPI (Prilosec)
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coumadin
valium diazepam |
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Nursing cons. with PPI (prilosec)
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Monitor:
PT INR BUN creatine levels Billirubin |
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Pt. teaching with PPI (prilosec)
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drink with 8 oz. of water to prevent constipation, best if before meals
report abd. pain |
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Antacids
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aluminum (Amphojel)
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MOA of Amphojel (antacid)
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neutralize stomach acid by increasing pH and decreasing gas
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Side effects of Amphojel (antacid)
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constipation
hypoohospatemia hypernatremia |
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Drug interactions with Amphojel (antacid)
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any medication
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nursing cons. with Amphojel (antacid)
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monitor
serum CA phosphate magnesium Na levels Mg toxicicty |
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Pt teaching with Amphojel (antacid)
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increase fluid, fiber and exercise
avoid if kidney disease |
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Anxiolytics
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drugs that have the ability to relieve anxiety
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Examples of Anxiolytics
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Benzodiazepines (BZD's)
BuSpar |
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MoA of BZD's
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a schedule IV drug
Increases neurotransmitter GABA Preference of the limbic system Depresses the CNS Produces skeletal muscle relaxation Anticonvulsant properties Rapidly absorbed from the GI tract |
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Indications for use for BZD's
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short term treatment of anxiety
treatment of seizure disorders may be useful in acute stage of panic alcohol withdrawal central muscle relaxants Insomnia (shortens the time ti takes to go to sleep) induction agent for general anesthesia |
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Examples of BZD's
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Klonopin
Valium ativan Serax Xanax Librium Restoril Halcion Versed |
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Side effects of BZD's
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Less physical dependance and results in less tolerance than barbituates
CND depression/tolerance/dependence Does not gererally produce life threatening resp. depression/coma unless taken in large quantites with other CNS depressants Weight gain neutropenia menstrual irregularites change in sleep patterns |
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Romazicon
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(flumazenil) BZD receptor antagonist
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Xanax and Valium should...
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only be used short-term as dependance and tolerance develop more quickly
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Withdrawal syndrome of BZD's
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anxiety, tremors, insomina
seizures, delirium resp. depression and death |
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Nonpharmacologic treatment of anxiety
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Cognitive Behavioral therapy
counseling meditation prayer massage exercise |
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Pt. teaching with BZD's
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Take as directed
Goals of therapy-pharmacological and non pharmacological Avoid alcohol or other CNS depressants Avoid caffiene Contraindicated during pregnancy and lactation Caution while operating a car caution in elderly clients and those with hepatic or renal disorders Do not discontinue abruptly Keep out of the reach of children |
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Non BZD, Non-Barbiturate Anxiolytic
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BuSpar
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BuSpar MoA
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beleived to exert its effect as a partial agonist at seritonin receptors which increases seritonin turnover
Has a slow onset Does not produce dependance |
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Side effects of BuSpar
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dizziness
sedation HA nausea |
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Tricyclic antidepressants (TCA's)
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Oldest
Used mainly for major depression, some minor depression, panic attacks and OCD. Produce fewer s/e and are less dangerous than MAO inhibitors Gradually increase to therapuetic dose--takes 2-6 weeks |
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MoA of TCA's
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inhibit the re-uptake of the nerotransmitters norepinephrine and sertonin by neurons, mostly sparing dopamine
Have sedative effects |
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Clinical Uses for TCA's
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Clinical depression
Neuropathic pain Nocturnal enuresis ADHD HA, including migraines Anxiety Insominia Smoking Cessation Bulimia IBS adjunct for schizophrenia tx. Persistent hiccups |
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Side effects of TCA's
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Orthostatic hypotension
cardiac dysrythmias Sedation Anticholinergic effects weight gain seizures sexual dysfunction |
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Contraindications with TCA's
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Acute recovery of MI, heart block, or hx od cardiac dysrythmias
Caution with seizure disorders and clients with urinary retention, glaucoma or prostatic hypertrophy Extreme caution with asthma ...CV disorders ...GI disorders ...alcoholism and other psyche disorders such as schizophrenia and bi polar disorder |
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Drug interactions with TCA's
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Oral contraceptives (> efficiancy)
Tagamet (interferes metabolism and secretion) Antidysrhythmics, antihistimines, antihypertensives and CNS depressants (enhance effects) Smoking (> effects) |
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Selective Seretonin Reuptake Inhibitors (SSRI's)
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drug of choice for treating depression because of its favorable side profile and safety
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MoA of SSRI's
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Specific serotonin uptake inhibitors increase 5-HT by inhibiting uptake
...Serotonin is normally released into the synapse between the nerve cells and is either destroyed or reabsorbed back into the cell that released it. SSRI's block this reabsorption causing more serotonin to accumualte in the synapse. |
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Clinical use for SSRI's
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Clinical depression
Anxiety disorders OCD Eating disorders Chronic pain PTSD |
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Side effects of SSRI's
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increased HR, HTN
anti-cholinergic effects sexual dysfunction(up to 70%) Seizures SES (serotonin syndrome) |
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SES (serotonin syndrome)
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occurs when another med effects metabolism, synthesis, or reuptake of serotonin, causing serotonin to accumulate in the body.
**important to wait up to 6 weeks before starting another med.** can occur as early as 2 hours after the 1st dose or weeks later |
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S/S of SES (seratonin syndrome)
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confusion
anxiety restelssness HTN tremors sweating hyperpyrexia ataxia hyperthermia muscle rigidity |
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Drug interactions with SSRI's
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MAOI's or TCA's
Lithium Antabuse **always check all concomitant drugs for potential interaction** |
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Monoamine Oxidase Inhibitors (MAOI's)
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have a low safety margin and are reserved for clients who have not responded to TCA's or SSRI's
Last line of defense d/t potentially lethal drug and food interactions |
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MoA of MAOI's
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Inhibit monoamine oxidase, the enzyme that terminates the actions of neurotransmitters such as dopamine, norepinephrine, epinephrine, and serotonin
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Clinical uses for MAOI's
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Social anxiety
Depression Parkinsons disease Migraine prophylaxis |
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Side effects of MAOI's
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orthostatic hypotension
HA Insomnia Diarrhea Large number of foods and drugs interact with MAOI's |
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Contraindications w/ MAOI's
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avoid foods with tyramine, which can cause acute HTN, occipital HA, stiff neck, flushing, palpitations, diaphoresis, n/v, CVA's, MI's
Avoid other antidepressants, antihypertensives MAOI's potentiate hypoglycemic effect |
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Antidote for MAOI overdose
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calcium channel blocker
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Mood stabilizer
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used primarily with bi polar disorder which is characterized by extreme opposite in moods (depression and mania)
Moderate extreme shifts in emotions between mania and depression |
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Examples of mood stabilizers
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Tegretol
Depakene Lamictal **most are usually anti seizure drugs |
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The mood stabilizer of choice for bi polar disorder...
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Lithium
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Lithium
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has a narrow therapuetic index monitor serum drug level Q 1-3 days at onset of therapy and then Q 2-3 months
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Lithium acts like...
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sodium in the body, so conditions in which sodium is lost, excessive sweating or dehydration, can cause lithium toxicity.
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Lithium Toxicity
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vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness and twitching
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Lithium MoA
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Altercation transport in nerve and muscle
May also influence the reuptake of neurotransmitters |
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Side effects for Lithium
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Dizziness,
fatigue short term memory increased urination n/v loss of appetite diarrhea dry mouth muscle weakness |
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Contraindications for Lithium
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Debilitated clients
Severe CV disease Dehydration Renal disease Severe Na depletion INCREASED Na intake will increase renal excretion |
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Client teaching with Lithium
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Do not avoid salt as doing so reduces lithium excretion
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Psychosis
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a mental condition characterized by delusions, hallucinations, illusions, disorganized behavior and difficulty relating to others
Behavior may range from total inactivity to extreme agitation and combativeness May exhibit paranoia |
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Paranoia
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an extreme suspicion and delusion that someone is following them or out to harm them
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Psychosis can result from...
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Brain damage
OD to certain meds Extreme depression chronic alcoholism drug addiction genetic factors Schizophrenia |
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Pharmacologic Mgmt. of Psychoses
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Difficult d/t non-compliance--60-80% dont take their meds
Adverse and unpleasant s/e are common with these drugs Relapse when dont take meds |
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Generally treat Psychoses with..
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Phenothiazines
Nonphenothiazones Atypical antipsychotics Dopamine system stabilizers |
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Phenothiazines
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Work by preventing dopamine and serotonin from occupying thier receptor sites in certain regions of the brain
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S/E for phenothiazines
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anticholinergic effects
sexual dysfunction menstrual disorders extrapyramidal side effects NMS |
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Nonphenothiazines
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Initially thought to produce less s/e but now know this is not true
Spectrum of s/e are identical to phenothizines, though the degree of the s/e varies from drug to drug |
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Atypical Antipsychotics
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Have become the drug of choice for treating schizophrenia
Have a broader spectrum of action than conventional antipsychotics and do not cause extrapyramidal s/e Cause greater weight gain, as well as decreased libido, menstural disorders, and osteoporosis in women. |
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Nusring considerations for Atypical Antipsychotics
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Monitor WBC carefully as leukopenia and agranulocytosis
can occur |
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Dopamine Mood stabalizers
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also thought to cause fever s/e while treating a broader range of schizophrenic sx.
Abilify the most commonly used drug inthis class |
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Most commonly used Dopamine mood stabilizer
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Abilify
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parkinsons disease is a...
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deficient in Dopamine
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prototype BZD
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Ativan
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Librium (BZD) is used for
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Detox
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Most used BZD on Geriatrics
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Ativan
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Antidote for BZD's
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Romazicon
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Side effects with BZD's
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Change in sleep pattern
Paradoxical excitement |
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Paradoxical Excitement
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agitated, delirious
combatative |
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Black box warning
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issued to clients and families and health professionals to closely monitor adults and children taking antidepressants for warning signs of suicide, especially at the beginning of treatment and with dose changes.
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Prototype TCA
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Tofranil
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Do not administer TCA's to....
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Geriatrics
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Do not give suicidal patients....
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TCA's (has a short half life...easily overdosed)
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CLient teaching with TCA"s
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Change positions slowly
Give in small doses (easy OD) |
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Prototype SSRI
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Lexapro
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Do not take St. Johns Wort with ...
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SSRI's
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SSRI's have a less intense.......
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anticholinergic effect
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Prototype MAOI
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Nardil
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Least seen antidepressant and last resort
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MAOI's
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What to avoid with MAOI's
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foods with Tyramine
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Tyramine causes...
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acute HTN
occipital HA stiff neck flushing palpitations diaphoresis n/v CVA's MI's |
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Foods that contain Tyramine
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cheese
chocolate yeast sour cream beer wine avacados salami sausage hot dogs bananas raisins |
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When taking MAOI's always wear ....
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a medic alert bracelet of necklace
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Client teaching with MAOI's
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Do not take with other meds
Do not ingest foods with tyramine Wear medic alert bracelet |
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Wellbutrin
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Has least sexual side effects
but with larger doses can cause seizures |
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Desyrel (trazodone)
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atypical anti psychotic used as sleep sedation
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Normal Lithium levels
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0.5-1.5
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1st drug of choice for mood stabilizer
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Lithium
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Client teaching with Lithium
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Keep salt intake the same
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Which med would you not give with Diuretics
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Lithium
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Prototype Phenothiazines
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Thorazine
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Extrapyramidal side effects
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side effect of Phenothiazines
acute dystonia akathisia parkinsonism tardive dyskinesia lip smacking spasms of face, tongue and back jerking motions stooped posture' shuffling gait |
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akathesia
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internal restlessness
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Neuroleptic malignant syndrome
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elevated temp
unstable BP profuse sweating dysnpnea muscle rigidity IC *If symptoms....send to ICU immediately |
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Prototype Nonphenothiazine
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Haldol
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Prototype Atypical Anti psychotic
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Clozaril
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Nursing considerations with Clozaril
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Affects WBC intensly
Monitor closely WBC |
