Phenylephrine

(Neo-Synephrine)

Actions are specific to different organ sub-receptors

Cardiovascular side effects: Tachycardia, hypertension, dysrhythmias limit therapy

Prazosin 

(minipress)

Both alpha and beta blockers 

used for treating hypertension

Used for effects on vascular smooth muscle-vasodilation, decrease BP

Problem: orthostatic hypotension and rebound tachycardia-give first dose at bedtime

avoid pts with asthma

Hold for bradycardia

Bethanechol

(urecholine)

Activate parasympathetic

adverse effects-toxic nerve gas, organophosphate insecticides

should be avoided in patients with suspected urinary obstruction

suppress pns impulses, sns response induced

used for GI disorders-decrease secretion of gastric acid, treat diarrhea

Used to accelerate heart rate, dilate bronchi for asthma (atrovent),reduce salvation before surgery.

Negative impact-urinary retention in men with prostate disorders

Benzodiazepines for Anxiety, Insomnia, seizures

Lorazepam 

(ativan)

MUST GIVE PO asses for side effects of drowsiness and dizziness

RESPIRATORY DEPRESSION when given parenterally or in combination with other CNS depressants (alcohol) or if the client has sleep apnea

Avoid in the elderly especially those with comorbidities

used to treat short term anxiety and insomnia

Barbiturates as Sedatives

Phenobarbital

(Luminal)

CNS depressant;rarely used for anxiety/insomnia because of SE and other more effective meds

overdose results in serious respiratory depression, hypotension, shock

Schedule II high risk of dependence

avoid stopping suddenly-withdrawl symptoms

always assess for respiratory depression

Misc. drugs for Anxiety/insomnia

Zolpidem 

(Ambien)

Schedule IV controlled substance

Pregnancy Category B-safe

Use with caution and high risk of suicide

rebounds of insomnia if d/c'd

amnesia or sleepwalking

daytime sedation 

given before bed

Anti seziure

(anticonvulant drugs)

Phenobarbitol & Diazepam

taken long term, should be gradually reduced if indicated

Barbiturates for halting seizures; Benzodiazepines & others for seizure control in epilepsy

Phenytoin 

(Dilantin)

Most commonly perscribed for seizures

Narrow range bewteen therapeutic dose &toxic dose

First line in treating status epilepticus

May need to change meds or d/c if pregnant

Ketogenic diet=High fat, low carbs, limits water intake

need blood levels checked

Drugs for Mood Disorders: Depression

ECT Electroconvulsive therapy

Use when unresponsive to Medications

Antidepressants help to increase levels of serontonin and Norepinephrine

Need to complete physical before can be diagnosed with depression

Most require treatment with psychotherapy and meds

Tricyclic Antidepressants

Imipramine

(Tofranil)

Side effects: orthostatic hypotension and sedation and anticholinergic effects

may take 2-6 wks to occur

suicide potential increase as blood levels increase before peak therapeutic level reached

has more energy to carry out suiced than @ begining when to tired to get out of bed

Contra-indicated-cardiac patients, urinary retention, narrow angle glaucoma

Selective serontonin Reuptake Inhibitors

(SSRIs)

Sertraline

(Zoloft)

Decreased libido & inability to reach orgasm in men and women (70%)

Need baseline liver tests as is metabolized in liver; need baseline weight as weight gain is typical

May take u to 5 weeks to obtain therapeutic level

Do not stop suddenly

Monoamine Oxidase Inhibitors

(MAOIs)

Phenelzine

(Nardil)

Due to drug-drug &drug to food interactions used only if other drugs are not effective

Antidepressants

SIDE EFFECTS:

Orthostatic hypotension, hypertensive crisis when taken with foods containing tyramine (beer, wine, banana's, sausage, aged cheese, yogurt, raisins, chocolate!!!!!!!

Bipolar Disorder: Mood stabilizers

Lithium

(Eskalith)

Narrow therapeutic index- need monitoring of blood levels

compliance is key, lithium toxicity=sodium sweating or dehydration

Low therapeutic window before toxic!

Drugs for ADHD

Methylphenidate

(Ritalin)

Schedule II drug

Monitor-med may cause paradoxical hyperactivity-really good till wears off

insomnia may be a side effect

NOT AT BEDTIME

Poor attention span, behavior control issues & hyperactivity

Treated with CNS stimulants-highten alertness and increase focus

Drugs for Psychoses

used for:

Feeling psychotic, abnormal thoughts and thought process, withdrawl from other people

high risk for suicide 

Compliane is problematic-many donts see themselves as being abnormal

Traditional antipsychotic meds have numberous side effects, including unstable BP, muscle spasms, sedation

Risperidone

(Risperadal)

Atypical antipsychotic agents treatment of choice for both positive and negative symptoms

Pregnancy Category B

Hard to put on regular meds, feel trapped, compliance is huge, usually put in institution

Drugs for Degenerative Diseases of Nervous System

Parkinsons is Levodopa

(L-dopa)

levodopa is a precursor of dopamine synthesis

combine with carbidopa as Sinemet, makes more levodopa availabe to enter CNS

Alzheimers Disease

donepezil hydrochloride

(aricept)

used to slowprogression of Alzheimers symptoms

does not change or reverse symptoms

efficacy is modest at best-slow symptoms

other symptoms treated with atypical antipsychotic agents

NO DRUG WILL CURE ALZHEIMERS

chronic inflammatory, auto immune disorder

immune modulating drugs are typically the drugs used to treat this disease

Clozapine

(Clozaril)

Atenolol

(Tenormin)

Propranolol

(Inderal)

Glycopyrrolate

(Robinul)

Diazepam

(Valium)

Epinephrine

(Adrenaline)