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35 Cards in this Set

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Mood stabilizers (new class)

hint
lithium
Tegretol
LT- lite feeling
Eskalith/lithium
treats mania in bipolar disorder
metallic salt
renal Na regulation affects lithium levels.
Kidneys cannot tell the difference btw lithium salts and regular salt.
- sweating affects
narrow therapeutic index-requires regular monitoring of blood serum levels. often req. informed consent due to high risk for toxicity
75% pts have 1 or more
s.e.:
TREMOR, wgt gain, fatigue, polydypsia, polyuria, edema, GI upset (most are Na regulation and fluid retention)
many drug interactions
Antipsychotics (new class)
major tranquilizers

see hint
schizophrenia
1.positive signs-,delusions, hallucinations,paranoia,agitation
2.negative signs-blunted affect, poor hygiene, poverty of speech, social withdrawal
regulate neurotransmitters- in the CNS
persons on this drug: schizos or elderly w/dementia
positive signs you see
negative signs are things missing
Typical Anti-psychotics
Thorazine/chlorpromazine



1st ever used-treats the postive symptoms- but left with the negative affects
major side effects of antipsychotics/Thorazines,Haldol,Dantrium and other drugs
d.e.: sedation, orthostatic hypotension,anticholernergic,hypothelactimia (too much hormone),dykinesia (movement disorders)
Extrapyramidal symptoms
Neuroleptic Malignant Syndrome (thorazine SE or any of the anti-psy)
picking air, picking sheets, pulling out IV, then give them Haldol or other antipsy
Extrapyramidal symptoms of antipsych.

see hint
early symptoms-
1.dystonia
2.akathisia
3.parkinsonism
late symtom:
Tardive dyskinesia
dapt-
dystonia-pulling over of neck,side, bump into things,always turned to one side, w/in 30 min.can be serious, painful
akathisia-restlessness,nervous,move from chair to chair
parkinsonism-tremors, shuffling gait
targive dyskinesia
ESP symptoms-early- dystonia
1.spasms, prolonged contractions of muscle groups, dangerous and painful and can be treated- Benedryl or Cogentin

give Haldol for dystonia but causes primary torsion dystonia (where head is painfully to one side)
ESP symptoms -early -akathisia
continuous restlessness, inability to sit still
ESP symptoms- early-parkinsonism

hint
muscle tremors, shuffling gait, drooling, rigidity
DOPA drugs, work on dopamine, stop parkinson symptoms, given to treat symptoms of anti-psycotic drugs-ex: levodopa
ESP late symptoms-

hint
Targive dyskinesia- usually irreversible-involuntary movements of the tongue and face (fly catching. smacking)
assess often, b4 giving meds must sign consent- take immediately taken off meds or lower dose
AIM- Abnormal involuntary movement form, assess any funny movement then do again when hospitalized
Neuroleptic Malignant Syndrome from antipsych.

hint
Thorazine SE- and all antipsychotics s.e
"lead-pipe" stilted walk,sudden high fever and changes in cognition
Dantrium/dantrolene is used for treatment
early detection has dropped mortality from 30% to 4%
Thorazine vs Dantrium(for malignant hyperthermia also used for this symptom)
Atypical Antipsychotic Drugs
Risperidone/Risperdal
treat negative symptoms better than positive -
works with elderly to stop agitation
Risperidone/Risperdal - atypical antipsy. drug
s.e.: orthostatic hypotension,
sedation,
anticholinergic effects.
Have fewer extrapyramidal symptoms
Nursing Implications of antipsych. drugs
1. stress importance of taking meds as prescribed-relaspe & non-compliance is a major problem
2.refer pt to local mental health clinic for follow-up and pt. educ.
3.closely monitor pt during 1st few wks of therapy so pt can take the lowest amt of meds possible
4.report anti-cholinergic effects-urinery retention, etc-need close med. followup
5. MOST IMP: READ LITERATURE B4 ADMINISTERING ANTI-PSYCHOTIC AGENTS-LOTS OF SIDE EFFECTS
new class: Neuromuscular System agents
1.skeletal muscle relaxants
2.anti-parkinson agents
3.anticonvulsants
Neuromuscular
Systems Agents: Skeletal Muscle Relaxants

hint
Central acting agents-most common
Flexeril/cyclobenzaprine
used to relieve acute muscle spasms/pain, does not treat spasticity
s.e.: drowsiness/sedation (most imp.), dizziness
caution: don't use with other CNS depressants such as alcohol, barbituates,benzodiazepines, 1st generation antihistamines and some anaesthetics
Muscle relaxant-flexible
Other muscle relaxant NSAs
Lioresal/baclofen
treats spasticity
acts by relieving spasms at the spinal cord level
adverse effect: drowsiness
Do not take with CNS depressants
Antiparkinson Agents- NSAs
Parkinson's disease is a progressive neurologic- the balance of dopamine and acetylcholine is altered, characterized by tremors at rest,
akinesia(loss of muscle movement)
rigidity
disturbances of posture and equilibrium
2 types of drugs
Antiparkinson Agents - 2 types
1.Anticholinergics to decrease/block acetylcholine-Artane
2.Dopaminergic agents (DOPA)to increase dopamine-L-dopa
Anticholinergic agents-antiparkinson

hint
Artane/trihexyphenidyl-
most common- usually given w/initial dx to prevent progression
suppresses cholinergic activity in the CNS-initial agents when the disease is mild
s.e.: dry mouth, constipation, urinary retention, hypotension
caution: may cause CNS depression, thick pulmonary secretions (dries up respiratory), GI upset, worsening glaucoma
Anticholeric
Antiparkinson
Artane

cholinergic -entire parasympethetic system, uses acetycholine as its neurotransmitter
Dopaminergic Agents-antiparkinson

nint
Larodopa/levodopa-
acts by replacing dopamine in the brain-for moderate to severe parkinsons
can turn off as a switch
many contraindications: s.e.: NV, orthostatic hypotension, cardiac arrythmias, dyskinesia (involuntary movements)
Dopa/minergic
Laro/dopa
levo/dopa
can be used w/other NM drugs
Dopaminergic Agents- Dopamine
antiparkinson


hint
additional complications:
1.gradual loss of effectiveness during the day as drug levels decrease, requires pt to calculate timing of med.good morning or good evening
2. abrupt loss of effectiveness even when serum level is adequate. this may last for min. or hrs
3.lose their effectiveness after approx. 2 yrs, probably due to increasing disease process
Levo/dopamine
Laro/dopamine
etc
Combination drug therapy-antiparkinson

hint
Levadopa is often combined with caridopa which increases the effectiveness of levadopa by preventing its metabolism b4 it reaches the CNS- supplied as Sinemet 25/100 (carbidopa 25mg/levadopa 100mg)
remember to double both drugs in a combo, not just double the first
New class- Anticonvulsants

hint
Hydantoins-Dilantin/phenytoin
Barbituates-Luminal/phenobarbital
Mood Stabilizer: Tegretol/carbamazepine
decrease seizure activity
Anticonvulsant-Hydantoins-Dilantin/phenytoin

hint
anti-seizures
acts: stabilizes excitable nerve cells and has some antiarrythmic properties
s.e.: nystagmus (shaky eyeballs), gingival hyperplasia(overgrowing of gums), hypotension, GI distress
caution: many drug-drug interactions including decreasing the effectivness of contraceptives
highly individualized dosage
treats epilepsy/seizure disorders
Cardiac arrythmia effects
Anticonvulsant-Barbituate-Luminal/phenobarbital

hint
acts by raising the seizure threshold
many drug interactions by causing increase drug metabolism of many drugs, including contraceptives
s.e: drowsiness, dizziness, and overdose may cause respiratory depression
illuminates! the seizure threshold-also used to treat anxiety
Anticonvulsants/mood stabilizer - others- Tegretol/carbamazepine
regulates seizure better but must monitor labs, CBC's drawn with these meds
similar to phentoin/Dilantin
causes hematologic problems
New class: Anesthesia
3 types of agents are usually given to produce a "balanced anesthesia"
smooth and rapid induction, with adequate muscle relaxation and anesthesia
Anesthesia: cocktail:
1.short-acting barbituate-Penothal/thiopental
2.Neuromuscular blocking agent
3, Opioid- to relieve pain
4. Anesthesia- individual drug called that-puts you out
General Anesthesia drugs


hint
Forane/isoflurane-gas
admin by inhalation
offers precise and rapid control of depth of anesthesia and decreases laryngeal reflexes
excreted in lungs as active agents
s.e.: hypotension, respiratory suppression, confusion
let the anesthesialogist worry about side effects
causes: malignant hyperthermia- sudden and severe increase in body temp.rectal prope or skin prope to follow temp
Dantrium/dantrolene is used to treat
Forane vs Dantrium to treat
Anesthesia- Nitrous Oxide
laughing gas
has low anesthesia property and high analgesia property (pain relief)
begins effectiveness in seconds and last about 10 min
often used for dental procedures and minor surgical procedures
Injectable Anesthesia

hint
ketamine/Ketalar-
used in short term surgery
causes analgesia, sedation, immobility and amnesia (good hallucinations)
pt may have dreams or hallucinations when recovering from ketamine
special K
Conscious Sedation


hint
Versed/midazolam (benzodiazepine) used alot, cannot give instructions to a pt on this drug- very High amnesia rate
benzodiazepine as is Valium

worsted is verstad-must monitor
Versed - conscious sedation

hint
for minor surgeries and endoscopy procedures lasting 1 hr or less
sedation, amnesia and lack of anxiety
pt is passive and restful but able to respond to commands
often combined with analgesic
s.e: respiratory depression
respiratory and cardiac arrest
PT MUST BE MONITORED AT ALL TIMES-LICENSED PERSON WITH THEM UNTIL WEARS OFF
when given w/ opioids decreased doses of opioids are required, decrease in half! versed synergizes the opioid
ex: if doc orders 100 mg of Demoral then mention to him that maybe it needs half of that
Adjunts of Anesthesia
often analgesic, anticholinergic and anti-anxiety agents are given as preoperative meds
often cholinergic agents are given post-operatively to counteract effects of pre-op agents -