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Module 1 Pharm Fall
Module 1 Pharm Fall 2022
| Mood Stabilizers Prototype: Lithium | Used mainly to treat and prevent manic episodes |
| Atypical antipsychotics | Aripiprazole, olanzapine, fluoxentine, quetiapine, risperidone, ziprasidone |
| Lithium | Drug of choice for use in the treatment of manic episodes of bipolar disorder and as a maintenance treatment to decrease the number and intensity of manic episodes. |
| Lithium toxicity risks | Renal impairment, hyponatremia, diuretics |
| Lithium adverse effects | Metallic taste, hand tremors, nausea, polyuria, polydipsia, diarrhea, muscular weakness, fatigue, edema and weight gain |
| Lithium contraindications | Sensitivity to the drug as well as pregnancy. Category D Medication. Cardiac malformations, |
| Lithium administration | Baseline studies of renal, cardiac, and thyroid status because adverse drug effects involve these organ systems. Measure the serum drug concentration two or three times weekly until therapeutic levels reached, then every 3 months |
| Lithium toxicity | metallic taste, hand tremors, nausea, polyuria, polydipsia, diarrhea, muscular weakness, fatigue, edema, weight gain |
| Nurse observes for decreases in manic behavior and stability in mood swings. Therapeutic effects don't occur until approx 7-10 days after therapeutic serum drug levels are attained. In mania a benzo or antipsychotic drug to reduce agitation and control be | Assessing therapeutic effects for Lithium |
| Gabapentin | Treats seizures, and alcohol withdrawals, neuropathy |
| Gabapentin adverse effects | "Croatian Don't Never Put Dough aSide" -CNS Depression -Dry mouth -Nausea/vomiting -Pruritus-itching -Dyspepsia (indigestion) -Suicide Idealation |
| Hydantoins Phenytoin (prototype) | Treats seizures. Oldest and most widely used antiepileptic |
| Hydantoin Phenytoin adverse effects | "Cows Graze Grass" -CNS depression -GI effect -Gingival hyperplasia -Increased risk of osteoporosis -Ataxia, drowsiness, lethargy -N/V |
| Hydantoins Pheytoin Uses | Used to control tonic-clonic seizures, psychomotor seizures and nonepileptic seizures |
| Benzodiazepines Diazepam (Prototype) | CNS depression (resp depression), Used as Antidepressants, antiepileptics, or skeletal muscle relaxants. |
| Benzodiazepines Diazepam (Prototype) used for: | Used for treatment of severe recurrent convulsive seizures and status epilepticus |
| Benzodiazepines Diazepam (Prototype) Contraindications | -Acute narrow-angle glaucoma -shock -coma -acute alcohol intoxication, and pregnancy |
| Benzodiazepines Diazepam (Prototype) Adverse Effects | "Really heavy lifting"(RHL) -Resp low -Hypotension -Lethargy |
| Benzodiazepines Diazepam (Prototype) Interventions | -No grapefruit 2 types of contraceptive -watch RR down |
| Barbiturates Phenobarbital (Prototype) | Depresses the CNS by inhibiting the conduction of impulses in the ascending reticular activating system, thus depressing the cerebral cortex and cerebellar function. |
| Barbiturates Phenobarbital (Prototype) Used As | Used as a sedative and antiepileptic agent in the treatment of generalized tonic-clonic and parial seizures. Parenteral form used to control acute seizures |
| Barbiturates Phenobarbital (Prototype) Adverse Effects | -CNS depression -Cognitive impairment with sedation -Somnolence, agitation, confusion, vertigo, and nightmares -Stevens-Johnson Syndrome-hypersensitivity reaction -Suicidal ideation Black box warning |
| Barbiturates Phenobarbital (Prototype) Contraindication | Liver failure, nephritis, resp. depression, pregnancy |
| Tricyclic antidepressant derivatives Cyclobenzaprine hydrochloride (Prototype) | Skeletal Muscle relaxants. Used in children, older adults, impaired renal function, impaired hepatic function, home care |
| Tricyclic antidepressant derivatives Cyclobenzaprine hydrochloride (Prototype) Avoid: | Avoid ETOH, don't drive, or operate machinery |
| Chlorpromazine (Thorazine) | 1st generation, Typical, Phenothiazine Antipsychotic/Schizophrenia |
| Chlorpromazine (Thorazine) Signs and symptoms | -Sedation -Hypotension -Photosensitivity -Prolong QT |
| Chlorpromazine (Thorazine) Interventions | -Monitor for EPS -Monitor renal, hepatic, WBC depression -Don't mix with alcohol, Lithium, barbituates, parkinsonism -anticholergenics, bone marrow supression |
| Chlorpromazine (Thorazine) Adverse effect | NMS |
| Lithium Indication | Used to treat and prevent manic episodes in patients with bipolar disorder |
| Lithium Contraindication | Pregnancy Category D Will cause cardiac malformations if consumed during 1st trimester |
| Lithium Drug Interactions | Diuretics & Alcohol Increases the risk of Dehydration and Lithium Toxicity SSRIs May cause SE such as confusion, drowsiness, and unstable coordination Angiotensin Increases the risk of Lithium Toxicity |
| Nursing Implications / Interventions for Lithium | Therapeutic dose is narrow. The drug is not metabolized, it is excreted entirely from the kidneys. Can cause renal impairment Therapeutic Effects take 7 to 10 days after the therapeutic serum drug levels are attained. Lithium Blood Level Range: 0.6 |
| Adverse Effects for Lithium | Metallic Taste Hand Tremors Nausea Polyuria Polydipsia Diarrhea Muscle Weakness Fatigue Edema Weight Gain |
| Lithium Concept and pharmaceutical classification | Concept: Drugs to Treat Mood Disorders Pharmaceutical Classification: Mood-Stabilizer |
| Prototypes: Chlorpromazine Hydrochloride Trade Name: Thorazine | Medication (Phenothiazines) 1st gen. “typical” or “conventional” |
| Prototypes: Chlorpromazine Hydrochloride Trade Name: Thorazine INDICATIONS | Mainly used to treat schizophrenia Other indications: Psychotic s/sx related to head trauma Tumor, stroke Alcohol withdrawal CNS stimulant overdose |
| Prototypes: Chlorpromazine Hydrochloride Trade Name: Thorazine Contraindications | Liver Damage Coronary Artery Disease Cerebrovascular Disease Parkinsonism Bone Marrow Depression Severe Hypotension or Hypertension Caution Use In: Older Adults PUD Diabetes Chronic Respiratory Disorders Glaucoma Pregnancy Prostatic |
| Prototypes: Chlorpromazine Hydrochloride Trade Name: Thorazine Drug Interactions | Barbitutues Lithium CNS depressants Narcotics Anticholinergics Beta-blockers Epinephrine and norepinephrine |
| Prototypes: Chlorpromazine Hydrochloride Trade Name: Thorazine Nursing Interventions / Implications | Admin. rectally in children for the control of nausea and vomiting Monitor for prolonged QT wave Monitor hepatic, renal, and WBC depression Patient Education Do not drive while taking this medication Be sure to drink enough fluids Wear protect |
| Prototypes: Chlorpromazine Hydrochloride Trade Name: Thorazine Adverse Effects | CNS Effects: Excessive Sedation Monitor for EPS Dystonia Akathisia Parkinsonism Tardive dyskinesia Neuroleptic malignant syndrome Hypotension Bone Marrow Suppression |
| Prototype: Haloperidol Trade name: Haldol | Medication (NonPhenothiazine) |
| Prototype: Haloperidol Trade name: Haldol Indications | Used to treat schizophrenia and other psychotic disorders Also can be used as a form of sedation for combative patients |
| Prototype: Haloperidol Trade name: Haldol Contraindications | Parkinson’s Disease Seizure Disorders Severe Mental Depression |
| Prototype: Haloperidol Trade name: Haldol Drug Interactions | Increase Effects Alcohol Anticholinergics CNS Depressants Antidepressants Antihistamines Buspirone Non-Steroidal AntiInflammatory Propranolol Angiotensin-Converting Enzyme Inhibitors Lithium Decrease Effects Antacids Carbamaze |
| Prototype: Haloperidol Trade name: Haldol Nursing Interventions / Implications | Monitor renal function (BUN) 10-20 Monitor for EPS and neuroleptic malignant syndrome Patient Education May cause dark colored urine (pink or red-brown), which is completely normal during med therapy. Maintain Hydration Report sore throat or fe |
| Prototype: Haloperidol Trade name: Haldol Adverse Effects | Hypotension Cardiac dysrhythmias (QT, torades) Photosensitivity Anticholinergic Laryngospasm |
| Protype: Clozapine Trade name: Clozaril | Medication 2nd gen. ‘atypical” |
| Protype: Clozapine Trade name: Clozaril Indications | First-Line Therapy for Schizophrenia and psychosis |
| Protype: Clozapine Trade name: Clozaril Contraindications | Known Allergy CNS Depression Hx of Seizure Disorders Hx of Clozapine-Induced Agranulocytosis or Severe Granulocytopenia Caution Use: Glaucoma Cardiovascular Diseases Diabetes Mellitus Pulmonary Disease Pregnancy |
| Protype: Clozapine Trade name: Clozaril Nursing Implications/Interventions | Monitor WBC and ANC Lowers seizure threshold Herbs & Dietary Interactions St. John's Wort American & Asian Ginseng |
| Protype: Clozapine Trade name: Clozaril Adverse Effects | Hyperglycemia (medication induced DM) Anticholinergic effects QT prolongation |
| Protype: Clozapine Trade name: Clozaril Drug Interactions | Increase Effects Alcohol Caffeine SSRIs Anticholinergics Decrease Effects Phenytoin Ethotoin Other Cytochrome P-450 Inducer |
| Prototypes: Phenobarbital Classification: Barbiturates | Concept: Drugs to Treat Seizure Disorders Pharmaceutical Classification: Antiepileptics |
| Prototypes: Phenobarbital Classification: Barbiturates Indications | Can be used as a sedative, but mainly used as an epileptic agent to treat generalized tonic-clonic and partial seizures. |
| Prototypes: Phenobarbital Classification: Barbiturates Contraindications | Hypersensitivity to Barbiturates Liver Failure Nephritis Porphyria Resp. Depression Pregnancy Addiction to Barbiturates |
| Prototypes: Phenobarbital Classification: Barbiturates Drug Interactions | Alcohol Diazepam MAOIs Gabapentin Primidone Valproate |
| Prototypes: Phenobarbital Classification: Barbiturates Nursing Interventions / Implications | Black box warning Suicidal ideation Liver failure Nephritis Pregnancy Respiratory depression Patient Education Women of childbearing age should use two forms of contraception. Wear a medical alert bracelet or necklace stating that you ha |
| Prototypes: Phenobarbital Classification: Barbiturates Adverse Effects | CNS depression Cognitive impairment with sedation Somnolence, agitation, confusion, vertigo, and nightmares Stevens-Johnson syndrome |
| Protype: Diazepam Classification: Benzodiazepine Indications | CNS Depressant Used as antidepressants, antiepileptics, and skeletal muscle relaxants Used for severe recurrent convulsive seizures and status epilepticus Give quickly to a patient with status epilepticus – 1st Med |
| Protype: Diazepam Classification: Benzodiazepine Contraindications | Acute Narrow-Angle Glaucoma Pregnancy Shock Coma Acute Alcohol Intoxication |
| Protype: Diazepam Classification: Benzodiazepine Drug Interactions | Increase Effects Alcohol Disulfiram Omeprazole Hormonal Contraceptives Cimetidine Decrease Effects Theophylline Ranitidine |
| Protype: Diazepam Classification: Benzodiazepine Nursing Interventions/Implications | Herbs & Dietary Interactions Avoid Grapefruit Patient Education Use two types of contraceptives if you are a woman of childbearing age and are sexually active Interventions Count RR after giving medication |
| Protype: Diazepam Classification: Benzodiazepine Adverse Effects | Respiratory depression Lethargy, hangover Hypotension |
| Prototype: Gabapentin Indication | Used to treat partial seizures, as well as postherpetic neuralgia pain. Unlabeled Use: Alcohol Withdrawal |
| Prototype: Gabapentin Adverse Effects | CNS Depression Dizziness Somnolence Insomnia Ataxia Pruritus Dry Mouth Dyspepsia N/V Suicidal Ideations |
| Protype: Phenytoin Indications | Used to control tonic - clonic seizures, psychomotor seizures, and nonepileptic seizures. |
| Protype: Phenytoin Contraindications | Caution Use: Pregnancy – risk for birth defects |
| Protype: Phenytoin Drug Interactions | Increase Effects Alcohol Amiodarone Chloramphenicol Omeprazole Ticlopidine Decrease Effects Enteral Feedings (due to decrease phenytoin absorption) |
| Protype: Phenytoin Nursing Interventions/Implications | Patient Education Long Term Use = Increased Risk For Osteoporosis Have Regular Dentist Visits Maintain Good Oral Hygiene Take w/ Food to Avoid GI Upset Use contraception if sexually active |
| Protype: Phenytoin Adverse Effects | CNS Effects Drowsiness Lethargy Ataxia GI Effects Nausea Vomiting Gingival Hyperplasia An overgrowth of gum tissue |
| Prototype: Cyclobenzaprine (Tricyclic antidepressant derivatives) Trade : Flexeril | Medication Flexeril Skeletal muscle relaxant |
| Prototype: Cyclobenzaprine Trade : Flexeril Indications | Management of acute painful musculoskeletal conditions associated with muscle spasm |
| Prototype: Cyclobenzaprine Trade : Flexeril Contraindications | Use cautiously with children, older adults, those with liver or kidney problems, and those receiving home care |
| Prototype: Cyclobenzaprine Trade : Flexeril Adverse Effects | Causes CNS depression |
| Prototype: Cyclobenzaprine Trade : Flexeril Nursing Interventions / Implications | Avoid alcohol Do not operate heavy machinery or drug |
| Status Epilepticus (>5 minutes) is characterized by prolonged seizures without return of consciousness. Caused by: | Med-Noncompliance Change in Medication Withdrawal Symptoms / Drug Overdose Brain Trauma or Tumors Systemic or CNS Infections |
| Diazepam | Count Respirations after giving this med Given as an emergency med for Status Epilepticus |
| Phenytoin can cause___________ And common adverse effect_____________ | cause a Vitamin D deficiency ; Gingival Hyperplasia |
| Other CNS Depressants | Alcohol Benzos (Anxiolytic) Opioids (used in pain management, illegally as well (heroin)) |
| Tolerance is _________________________ | when drug use is increased, and now they require more of the drug to achieve the same effect. |
| Chlordiazepoxide (Benzo) | Given for Alcohol Withdrawal CNS Depression , Constipation, Increased Sex Drive PO, IM, IV – Metabolized in the Liver Sedative Therapeutic Use: helps prevent delirium tremens Should be gradually reduced over 5 to 7 days (start at higher dose) |
| Disulfiram | Deters them from alcohol Reduces Cravings Makes you sick if you drink the alcohol Headache, Blurred Vision, N/V, Dysrhythmias, HF, Death, Hypotension DO NOT give to a patient who has consumed alcohol in the past 12 hrs. (page 1157) Avoid consump |
| Antidote for Benzo | Flumazenil (Romazicon) |
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