Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
81 Cards in this Set
- Front
- Back
|
pearls...labor and delivery
|
Labor/delivery- don't give Motrin (it effects the closing of the PDA). Can give regualr tylenol, sudaphed, and plain claritin. Can give 5mg Ambien, can give morephine 15mg/ phenergan 25mg IM. Spinal Headache: treat with blood patch (take 10cc of blood from arm) and inject into the hole so no fluid leaks out.
|
|
|
pearls...IV in foot
|
25mg/hr Demerol,Ativan 1g (would make you DRT) Phenergan 25mg IV. She had been on a lot of drugs when admitted she was in drug withdrawal. Foot IV in an adult can cause fleabitis and clots. A clot in the leg goes to the lungs.
|
|
|
Psychosis
|
severe emotional disorder that often impairs mental function to the point of significant disability regarding ADLs. A hallmark of psychosis is a loss of contact with reality.
|
|
|
Affective disorders (mood disorders)
|
characterized by changes in mood and range from mania to depression. Bipolar disorder.
|
|
|
Anxiety
|
unpleasant state of mind chiefly characterized by a sense of dread and fear
|
|
|
DSM-IV 6 major disorders of anxiety
|
Obsessive-Compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD) Generalized anxiety disorder (GAD) Panic disorder Social phobia Simple phobia |
|
|
Biochemical Imbalance Concept of Mental Illness
|
Abnormal levels of endogenous chemicals in the brain known as neurotransmitters
Catecholamines – dopamine, norepinephrine Indolamines – serotonin and histamine GABA – gamma-aminobutyric acid ACh |
|
|
Antianxiety Agents
|
Benzodiazepines – anxiolytic effect by depressing activity in the brainstem and limbic system. Increase the GABA Action and have specific receptor binding sites.
Antihistamines – sedating effects (Atarax and Vistaril). Miscellaneous – BuSpar (non-sedating and non-habiting forming). |
|
|
Benzodiazepines
|
Valium
Ativan Xanax Klonopin Librium Versed – only IV for moderate sedation |
|
|
Physostigmine (cholinergic)
|
Used for overdose of antihistamines
Used for overdose of tricyclic antidepressants IV – 0.5 – 3mgs (do not give faster than 1mg/min) Romazicon used for benzodiazepine overdose 0.2 mg over 15 seconds and may repeat 0.2 mg every 60 seconds for 4 additional doses or a cumulative dose of 1 mg. |
|
|
Antimanic Drugs
|
Lithium –narrow range of therapeutic index
Very Toxic – must have lab work Maintenance ranges are 0.6 – 1.2 mEq/L Mania – levels can be 1.0 to 1.5 mEq/L Half-life is 18-24 hours Many medications used in conjunction to lithium (valporic acid, ACE inhibitors). Recommend po dose of lithium is 600-1200 mg/day. Difficult for compliance because do not like the “down” feeling. |
|
|
Explaining Depression
|
Biogenic amine hypothesis
Permissive hypothesis Dysregulation hypothesis |
|
|
New Generation Antidepressants
|
Prozac, Paxil, Zoloft, Luvox, Celexa, Lexapro, & Cymbalta – SSRIs (4-6 weeks to work)
Less side effects than tricyclic drugs and MAOIs. SSRIs have little or no effect on the Cardiovascular system. Inhibit serotonin reuptake and have weak effects on norepinephrine and dopamine reuptake |
|
|
2 generation
|
Desyrel and Wellbutrin
|
|
|
3 generation
|
Effexor, Remeron
|
|
|
Black Box Warning
|
In 2005 – Regular monitoring for worsening depressive symptoms
Monitoring of suicide ideations SSRI – first line therapy now Replacing TCAs and MAOIs |
|
|
Side Effects of New Generation Antidepressants
|
Insomina
Weight gain Sexual dysfunction Serotonin Syndrome – delirium, agitation, tachycardia, sweating, muscle spasms, hyperreflexia, shivering, coarse tremors, and extensor plantar muscle spasms. |
|
|
Tricyclic Antidepressants
|
Sedation
Orthostatic Hypotension Impotence Geriatric – dizziness, postural hypotension, constipation, delayed micturition, edema, and muscle tremors. TCA – notoriously lethal. (Elavil). Effect the heart and causes lethal dysrhythmias and seizures. |
|
|
TCAs
|
Elavil, Endep (amitriptyline) Adult – 15-300 mg/day
Aventyl, Pamelor (nortriptyline) Adult- 25-100mg/day |
|
|
MAOIs
|
1st generation of antidepressants but have move to the last of the line
Very toxic and many side effects Nardil and Parnate Interact with food containing tyramine and cause hypertensive crisis Can not use Demerol with MAOIs – hypertensive crisis |
|
|
Antipsychotic Agents
|
Phenothiazines are the largest group of antipsychotic drugs.
Block dopamine receptors in the brain, thus decreasing the dopamine concentration in the CNS. Side Effects – agranlocytosis and hemolytic anemia, exfoliative dermatitis, drowsiness, neuroleptic malignant syndrome, extrapyramidal symptoms, tardive dyskinsea. |
|
|
Side Effects of Antipsychotics
|
Neuroleptic malignant syndrome – life-threatening adverse effect that may include high fever, unstable blood pressure, and myoglobienmia.
Extrapyramidal symptoms – involuntary motor symptoms similar to pseudoparkinsonsism Tardive dyskinesia – late onset of contractions of oral and facial muscles, involuntary tongue thrusting and wave like movement of the extremities. Usually after long term therapy. |
|
|
Antipsychotic Drugs
|
Thorazine
Prolixin Haldol Loxitane Moban Navane |
|
|
Atypical Antipsychotic Drugs
|
Clozaril
Risperdal Zyprexa Seroquel Geodon Abilify |
|
|
Antipsychotic Interactions
|
Antacids decrease absorption
Antihypertensive have an added effect CNS depressants have an added effect Tannic acids (tea, grapes, wine) decrease absorption |
|
|
First Generation Antipsychotic Agents
|
Thorazine
Prolixin Haldol Loxitane Moban Navane |
|
|
Atypical Antianxity Agents
|
Clozaril
Risperdal Zyprexa Seroquel Geodon |
|
|
Antipsychotic Nursing Assessment
|
Check for suicidal tendencies
B/P readings Level of consciousness (Mini-Mental Status Examination for level of orientation, attention and calculation ability, recall testing, and language skills.) Lab: CBC, Erythrocyte sedimentation rate, serum electrolytes, glucose levels, blood urea nitrogen (BUN), liver function studies, serum Vitamin B12, and thyroid studies. Dementia – CT and MRI Eye problems may occur with benzodiazepines Lithium contraindicated in patients with renal disease, liver disease, organic brain syndrome brain trauma, schizophrenia, severe dehydration, cardiac disease, pregnant and lactating women, and in children younger than 12 years of age. It takes approximately 3 weeks for therapeutic blood levels Don’t use TCAs if you have narrow angle glaucoma, pregnancy, or myocardial infarction. Many drug interactions with TCAs, i.e. cimetidine, kava, any other CNS depressants. |
|
|
Phenothiazine/Antipsychotic Drugs Teaching
|
Postural hypotension
Protect from sun. Solar erythema due to photosensitivity Dental Care Avoid extreme temperature because of risk of hyperthermia leading to heat prostration and also drop in B/P. Report any signs of infection, i.e. sore throat, malaise, fever, bleeding Follow up visits and labs |
|
|
neurotransmitter
|
endogenous chemicals in the brain
|
|
|
GABA
|
gamma aminobutyric acid- the cholinergic neurotransmitter acetylcholine
|
|
|
Alprazolam
(Xanax) |
most commonly used as an anxiolytic and as an adjunct for the treatment of depression.
Half life:1hr Onset: 1-2hr Peak:6-12hr |
|
|
Chloradiazepoxide
(Librium) |
most commonly used for the treatment of alcohol withdrawal, the relief of anxiety, and a preoperative drug. When giving IM use provided dilutent. DON'T use dilutent when giving IV.
Half Life: 9-34 hrs Onset: 30-60min Peak: .5-4 hrs Duration: 12-24hr |
|
|
Diazepam
(Valium) |
one of the most commonly prescribed benzodiazepines. It is indicated for the relief of anxiety, alcohol withdrawal,and seizure disorders, for sedation, nad as an adjunct of skeletal muscle spasms. Can cause hepatic problems b/c active metabolites collect in the liver and may cause prolonged sedation, respiratory depression, or coma.
|
|
|
lorazepam
(Ativan) |
a widely used benzodiazepine. It is currently approved for use in the management of anxiety disorders for the short term relief of acute anxiety, and as a preoperatve medication to provide sedation and light anestheia and to diminish patient recall (amnesia). It has also shown efficaccy in the prevention and treatment of chemotherapy-related nausea and vomiting and the symptoms of acute alcohol withdrawal.
Half-life: IV 12-16 hrs PO 12-16hrs Onset: IV rapid PO 15-45 mins Peak: IV 15-20 mins PO 2hr Duration: IV 4hr PO 12-24hrs |
|
|
lithium
|
The antimanic effect of lithium effects are not fully understood. The therapeutic level is close to the toxic level but there is increased tolerance in manic phases. There are no absolute contraindications to lithium treatment and the adverse effects depend on serum levels. Levels that exceed 1.5 mEq/L to 2.5 mEq/L begin to produse toxicity
|
|
|
Signs of Lithium toxicity and adverse effects
|
gastrointestinal discomfort, tremor, confusion, somnolence, seizures and possibly death. The most adverse effects is cardiac dysrthymias. Other effects include drowsiness, slurred speach, epileptic-type seizures, choreoatheataxia, ataxia, and hypotension, may cause hypothyroidism.
|
|
|
valporic acid
(depakot, depakene) |
anticonvulsant, used for seizure disorders for many years, but more recently it has been used for mania. Normally reserved for preventive drug therapy maintenance against manic episodes.
|
|
|
biogenic amine hypothesis (BAH)
|
widely held hypothesis about the cause of depression.
|
|
|
permissive hypothesis
|
hypothesis advanced to explain the etiology of affective disorders.
|
|
|
Dysregulation hypothesis
|
a new leading theory attempting to explain the etiology of affective disorders.
|
|
|
carbamezepine drug interactions
|
increased carbamezepine levels, toxicity, ocular changes, vertigo, tremor
|
|
|
MAOIs Drug interactions
|
hyperthermia, diaphoresis, shivering, tremor, seizures, ataxis, autonomic instability
|
|
|
TCAs Drug interactions
|
sedation, decreased energy, lightheadedness, dry mouth, constipation, elevated TCA levels
|
|
|
warfarin
|
increased warfarin levels
|
|
|
bupropion (wellbutrin, zyban, wellbutrin SR)
|
second generation
PO: 200-400mg/day, divided Indications: Depression (Wellbutrin) smoking cessation (Zyban) |
|
|
fluoxetine (Prozac, Sarafem)
|
SSRI
PO, SR: 150-450 mg/day, divided bid-tid Depression, OCD, bulimia nervosa, premenstrual dysphoric disorder |
|
|
sertaline (zoloft)
|
SSRI
PO: 25-200mg/day taken qd depression, OCD, panic disorder, PTSD |
|
|
paroxetine (Paxil)
|
SSRI
PO: 10-50 mg/day, taken qd depression, OCD, pnic disorder, social anxiety disorder, GAD |
|
|
venlafaxine (effexor)
|
Third Generation
PO: 75-375 mg/day divided bid depression, GAD (XR form) |
|
|
fluvoxamine (Luvox)
|
SSRI
50-300 mg/day, with larger does divided bid OCD |
|
|
mirtazepine(Remeron)
|
third generation
15-14mg/day qhs depression |
|
|
citalopram (celexa)
|
SSRI
20-40 mg/day taken qd-qAM or qPM depression |
|
|
escitalopram (lexapro)
|
SSRI
10-20 mg/day depression, generalized anxiety disorder |
|
|
duloxetine (cymbalta)
|
SNRI
30-60 mg/day depression, pain from diabetic neuropathy |
|
|
fluvoxamine (Luvox)
|
SSRI
50-300 mg/day, with larger doses divided bid used to treat OCD |
|
|
mirtazapine (Remeron)
|
Third Generation
15-45 mg/day qhs used to treat depression |
|
|
citalopram (celexa)
|
SSRI
20-40 mg/day taken qd-qam or qpm used to treat deoression |
|
|
escitalopram (Lexapro)
|
SSRI
10-20 mg/day used to treat depression, generalized anxiety disorder |
|
|
duloxetine (cymbalta)
|
SNRI
30-60 mg/day used to treat depression, pain from diabetic neuropathy |
|
|
Tricyclic Antidepressants: Adverse Effects: cardiovascular
|
tremors, tachycardia, orthostatic hypotension, dysrhythmias
|
|
|
Tricyclic Antidepressants: Adverse Effects: Central nervous
|
anxiety, confusion, extrapyramdal effects, sedation
|
|
|
Tricyclic Antidepressants: Adverse Effects: gastorintestinal
|
nausea, constipation, dry mouth
|
|
|
Tricyclic Antidepressants: Adverse Effects: Hematologic
|
pancytopenia
|
|
|
Tricyclic Antidepressants: Adverse Effects: other
|
blurred vision, urinary retention, weight gain, impotence
|
|
|
TCA overdoses are notoriously _____.
|
lethal
It is estimated that 70% to 80% of patients who die from TCA overdose do so before reaching the hospital. |
|
|
amitriptyline (elavil, endep)
|
Adult: PO: 15-300 mg/day divided
Elderly: PO: 100-150 mg/day divided used to treat depression |
|
|
MAOI's adverse effects: cardiovascualr
|
orthstatic hypotension, tachycardia, palpitations, other arrythmias, edems
|
|
|
MAOI's adverse effects: central nervous
|
dizziness, drowsiness, restlessness, insomnia, headache, ataxia, hallucinations, seizures, tremors, confusion
|
|
|
MAOI's adverse effects: gastrointestinal
|
anorexia, abdominal cramps, nausea, dry mouth
|
|
|
MAOI's adverse effects: other
|
blurred vision, impotence, skin rashes, respiratory depression
|
|
|
Food and Drink to Avoid when taking MAOIs NOT PERMITTED
|
aged cheese (cheddar, swiss...), smoke/pickled meats (herring, sausage,corned beef...), aged/fermented meats (chicken or beef live pate, game fish, or poultry), yeast extract, red wines, italian broad beans (fava beans ha ha silence of the lambs!),
|
|
|
Food and Drink to Avoid when taking MAOIs LIMITED AMOUNTS
|
meat extracts, pasteurized light and pale beer, ripe avocado
|
|
|
Food and Drink to Avoid when taking MAOIs PERMISSIBLE
|
distilled spirits (vodka, gin, rye...), american and mozzarella (cottage and cream cheese), chocolate and caffeinated beverages, fruit (figs, bananas...), soy sauce, yogurt, sour cream
|
|
|
phenelzine (nardil)
|
PO: initial dose 45-90 mg/day divided tid followed by dose reduction to minimal effective dose after therapeutic effect achieved
used to treat depression and panic disorders |
|
|
tranylcypromine (parnate)
|
20-60 mg/day divided bid
used to treat depression |
|
|
clozapine (clozaril)
|
25-900 mg/ day with larger doses divided tid
used to treat psychotic disorders |
|
|
risperdone (risperdol)
|
PO:1-8 mg/day qd-bid
IM depot form (Risperdol Consta): 25-50 mg IM every two weeks used to treat schizophrenia, bipolar mania |
|
|
olanzapine (zyprexa)
|
5-20 mg/day qd
used to treat schizophrenia, bipolar mania |
|
|
quetiapine (seroquel)
|
25-800 mg/day with larger doses divided bid-tid
schizophrenia |
|
|
aripiprazole (Abilify)
|
10-30 mg/day once daily
used to treat schizophrenia, bipolar mania |
