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;
28 Cards in this Set
- Front
- Back
|
Epilepsy |
- Disorder of recurrent seizures - Anticonvulsants prevent and control most epileptic seizures - Goal of drug therapy is to reduce seizure activity with lowest level of drug - Start 1 at a time, slowly increase dose, may need multiple drugs |
|
|
Seizures |
Disorganized, rapid-firing, electrical activity Generalized seizures - produced by the entire brain 1. Grand Mal - unconsciousness, convulsions, muscle rigidity 2. Absence - Brief loss of consciousness 3. Myoclonic - Sporadic (isolated), jerking movements 4. Clonic - Repetitive, jerking movements 5. Tonic - Muscle stiffness, rigidity 6. Atonic - Loss of muscle tone |
|
|
Generalized Seizures: First Line Generations |
Mechanism of Action: Generally unknown Cause a decrease in voltage, frequency, and spread of electrical impulses Side Effects: ataxia, dizziness, drowsiness, loss of coordination Adverse Effects: Bleeding Examples: Dilantin (phenytoin), Tegretol (carbamepine), Depakote (valproic acid) Note: Can't stop abruptly, no alcohol consumption |
|
|
Anticonvulsants: First Line Specifics Phenytoin (Dilantin) |
- Narrow therapeutic index, teratogenic Side Effects: hyperplasia of gums, diplopia, hypotension Adverse Effect: Neutropenia, aplastic anemia (Low WBCs and RBCs) Interactions: Increase Effects of anticoagulants, decrease absorption with antacids |
|
|
Anticonvulsants: First Line Specifics Carbamazepine |
- Used for bipolar disorder and alcohol withdrawal Adverse Effects: Neutropenia, thrombocytopenia (low platelets) No grapefruit juice - causes increased levels of the drug |
|
|
Anticonvulsants: First Line Specifics Valproic Acid (Depakote) |
Mechanism of Action: attributed to increased GABA (calming effect) Adverse Effects: hepatotoxicity, pancreatitis |
|
|
Anticonvulsants: First Line for Absence Seizures |
Mechanism of Action: Depresses motor cortex and increases the CNS threshold to stimuli Side Effects: GI (anorexia, n/v), sensitivity to light, drowsiness Adverse Effects: Pancytopenia (Low blood cells) Example: Zarontin (ethosuximide) Note: Also use valproic acid (Depakote) for absence seizures |
|
|
Anticonvulsants: Second Line: Benzodiazepines |
Mechanism of Action: Potentiate GABA, generally useful for all seizures Side Effects: ataxia, GI distress, sedation Adverse Effects: Severe CNS depression Examples: clonazepam, diazepam, lorazepam (Ativan) Note: Do not stop abruptly, Antagonist: Romazicon (for when patient stops breathing - risk they will start seizing again) |
|
|
Anticonvulsants: Second Line: Barbiturates |
Mechanism of Action: Nonspecific CNS depressant. Potentiates GABA. Useful for all seizures. Side Effects: Sedation, GI distress, drowsiness Adverse Effects: Respiratory depression Examples: phenobarbitol Note: May cause physical dependence |
|
|
Antidepressants |
Tricyclic (TCA), SSRIs, Atypical, MAOIs Take 2-8 weeks to work |
|
|
Antidepressants: Tricyclic (TCAs) |
Mechanism of Action: Inhibit reuptake of NE, dopamine, and serotonin Side Effects: Sedation, blurry vision, dry mouth Adverse Effects: Arrythmias Example: Elavil (amitriptyline) Note: Effective but sedating - give at bedtime |
|
|
Antidepressants: SSRIs |
Mechanism of Action: Prevent serotonin reuptake, thus increasing the amount of serotonin Side Effects: Insomnia, GI, tremors, decreased sexual activity Adverse Effects: Serotonin Syndrome --> toxicity Examples: Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram) Note: Most commonly prescribed |
|
|
Antidepressants: Atypical |
Mechanism of Action: Unique, work differently by changing dopamine, NE, serotonin Side Effects: Dizziness, headaches Adverse Effects: Seizures Examples: Bupropion (Wellbutrin), trazadone (Desyrel), venlafaxine (Effexor) Note: Wellbutrin may be marketed as Zyban for smoking cessation |
|
|
Antidepressants: Monoamine Oxidase Inhibitors (MAOIs) |
Mechanism of Action: Inhibit monoamine oxidase (MAO) from removing NE, serotonin, and dopamine from the brain Side Effects: Multiple Adverse Effects: food and drug interactions Examples: Parnate, Nardil Note: diet restrictions, HTN results when mixed with certain foods, avoid food high in tyramine (processed meat, aged cheese, red wine, pickled foods) |
|
|
Nursing Process for Antidepressants |
Obtain med/drug history Monitor drug levels Monitor client's response Educate and monitor for side effects Pediatric: May increase risk for suicidal thoughts, may suppress growth (Effexor) Pregnancy considerations: Category C or D |
|
|
Antianxiety/Anxiolytics |
Benzodiazepines -zepam -alprazolam
SSRIs and venlafaxine (Effexor) -Milder side effects |
|
|
Antipsychotics: Generalized Therapy |
Mechanism of Action: Block Dopamine receptors. Impulse transmission decreases. CNS relaxes. Side effects: Many. Sedation, agitation, tremors, blurry vision Adverse effects: Multiple on CNS, ANS, and cardiac. Tardive dyskinesia, Neuroleptic Malignant Syndrome |
|
|
What to monitor for in antipsychotics |
Extrapyramidal symptoms (EPS) - Tardive dyskinesia (TD) - tongue rolling/protrusion, sucking/smacking of lips, abnormal facial or body movement - More common in long term use Neuroleptic Malignant Syndrome - Rare dysfunction of autonomic nervous system - Increase in HR and RR, high fever 105-106 |
|
|
Antipsychotics: Mood Stabilizers |
Mechanism of Action: Alters NE and serotonin synthesis, used for bipolar Side Effects: Dizzinesss, sedation, headache Adverse Effects: Toxicity, Increase in reflexes, HR, HTN, Decreased LOC Examples: Lithium, Abilify Note: Teratogenic, Narrow therapeutic window, Maintain hydration, avoid alcohol |
|
|
Parkinsonism |
Signs and symptoms, not disease itself Tremors, slow movement -Imbalance of dopamine and acetylcholine For therapy: -Acetylcholine needs to be blocked, more dopamine is needed Focus on parasympathetic nervous system |
|
|
Parkinsonism medications |
Anticholinergics Dopaminergics - levadopa - carbidopa-levadopa Dopamine Agonists - amantadine MAO-B inhibitor - selegiline COMT inhibitor - entacapone |
|
|
Parkinsonism: Dopaminergics: Levodopa |
- Most effective
- Can cross the blood-brain barrier - Short half-life - Need to take the drug 3-4 times a day Side effects: dyskinesia, orthostatic hypotension, cardiac dysrhythmias, and psychosis |
|
|
Parkinsonism: Domaminergics: Carbidopa - Levodopa |
2 medications in 1 Allows more conversion of dopamine 1:10 ratio 1 part carbidopa to 10 parts levodopa Side effects: dystonic movement (involuntary abnormal movement), and psychotic behavior |
|
|
Parkinsonism: Dopamine Agonists: Amantadine |
Given in early treatment, delays the need for levodopa Effective in drug-induced parkinsinism also, with fewer side effects than anticholinergics |
|
|
Parkinsonism: Dopamine Agonists: Bromocriptine |
Used in early treatment for Parkinsinism Can be given with levodopa therapy Side effect: amnesia |
|
|
Parkinsonism: MAO-B inhibitor: Selegiline |
Inhibits the catabolic enzymes of dopamine It Increases the action of dopamine Given in the early phase of Parkinson's disease When used less levodopa is needed Side effects: confusion, dry mouth |
|
|
Parkinsonism: COMT inhibitor: Entacapone |
Inhibits the COMT enzyme the concentration of levodopa is increased Used in combination with levodopa-carbidopa When used less levodopa is needed Side Effects: dyskinesia, dystonia, headache |
|
|
Alzheimer's Agents |
Thought to be the result of deficient Ach Medication therapy aimed at preventing breakdown of Ach in CNS Palliative, not curative Acetylcholinesterase (AChE) Inhibitors Prevent the breakdown of Ach Mild: Aricept, Exelon Mild/Moderate: Namenda Side Effects: Increased parasympathetic action |
