Term
| Effect is overall calming of the person |
|
Definition
|
|
Term
| Effect is to facilitate or cause sleep |
|
Definition
|
|
Term
| What 3 SE cause health care to limit the use of sedatives and hypnotics in the elderly? |
|
Definition
- CNS Depression
- Falls Risk
- Confusion
|
|
|
Term
| 4 Types of Sedatives/Hypnotics |
|
Definition
- Benzodiazepines
- Barbiturates
- Insomnia Drugs
- OTC/Herbal-based Sedatives
|
|
|
Term
3 Uses for Benzodiazepines |
|
Definition
- Anxiety
- Insomnia
- Seizures
|
|
|
Term
| Reasons Benzos are Prescribed over Barbs |
|
Definition
- Lower potential for abuse
- More favorable SE profile
- Fewer drug-drug interactions
|
|
|
Term
What schedules are barbs? |
|
Definition
|
|
Term
| Name the benzo receptors, where they are, and what they do |
|
Definition
- BZ1 - Located in the cerebellum (which controls coordination and balance). Mediate anxiety.
- BZ2 - Located in the basal ganglia and hippocampus (which control smoothness of muscle control and emotions). Mediate muscle relaxation and cognition.
|
|
|
Term
How do you go off benzos? |
|
Definition
|
|
Term
| Group of drugs where oral has fewer CV SE than IV |
|
Definition
|
|
Term
| What respiratory issues do benzos have? |
|
Definition
- Exacerbate apnea
- Obstruct airways
|
|
|
Term
| What groups of drugs would you use for a colonoscopy and why? |
|
Definition
- Benzos
- Can produce amnesia of events (so if you need pt input, you have it, but pt doesn't remember event)
|
|
|
Term
Prototype benzo sedative/hypnotic |
|
Definition
|
|
Term
| Diazepam (Valium) indications |
|
Definition
- Anxiety
- Sedation
- Relief of muscle spasm
- Management of acute ETOH withdrawal
- Prep for surgical/diagnostic procedure
|
|
|
Term
|
Definition
- Wide range of selectivity for CNS effects
- Bind to specific benzo receptors and incr GABA
|
|
|
Term
|
Definition
| Well absorbed and widely distributed |
|
|
Term
| Location of high density of BZ receptors |
|
Definition
|
|
Term
| What is the limbic system? |
|
Definition
| Part of our brain that controls our emotions |
|
|
Term
|
Definition
- Drowsiness
- Hiccups
- Loss of dexterity
- GI Sx
- Blurred vision
|
|
|
Term
| What is the paradoxical effect of Diazepam (Valium)? |
|
Definition
|
|
Term
| Diazepam (Valium) adverse reactions |
|
Definition
- Behavorial problems (mostly in children)
- Insomnia
- Hallucinations
- Apprehension
|
|
|
Term
Diazepam (Valium) drug-drug |
|
Definition
| Other CNS depressants, esp ETOH |
|
|
Term
Problem with IV Diazepam (Valium) |
|
Definition
- Very irritating to vein (burning sensation)
- Can cause phlebitis
|
|
|
Term
Diazepam (Valium) toxicity |
|
Definition
- Very high margin of safety
- Combined OD is a problem
- Many of the metabolites are CNS depressants, which can become excessive with prolonged use
|
|
|
Term
| Diazepam (Valium) cautions |
|
Definition
- Can worsen depression
- Significant incidence of suicidal tendancies
- May cause respiratory depression in COPD
- Careful with glaucoma, renal failure, elderly
|
|
|
Term
|
Definition
- Alprazolam (Xanax)
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
- Midazolam (Versed)
- Temazepam (Restoril)
- Triazolam (Halcion)
|
|
|
Term
Reversal agent for benzos |
|
Definition
|
|
Term
| How does flumazenil affect the body when there is no benzo? |
|
Definition
|
|
Term
Does flumazenil work on narcs? |
|
Definition
|
|
Term
| Why do you need to redose flumazenil? |
|
Definition
|
|
Term
|
Definition
| Can cause seizures, esp if on seizure meds |
|
|
Term
| When an unconscious pt arrives in the ED, why do we give narcan with flumazenil? |
|
Definition
| Uknown if this is mixed drug OD |
|
|
Term
|
Definition
|
|
Term
| How are barbs classified? |
|
Definition
|
|
Term
| Name the length of action for each category of barb |
|
Definition
- Ultra-short, short (onset 15 min, peak 3-4 hours)
- Intermediate (onset 30-45 min, peak 6-8 hours)
- Long-acting (onset > 60 min, peak 10-12 hours)
|
|
|
Term
| Short, intermediate, or long-acting barb? Sedative |
|
Definition
|
|
Term
| Short, intermediate, or long-acting barb? Insomnia |
|
Definition
|
|
Term
| Short, intermediate, or long-acting barb? Epilepsy |
|
Definition
|
|
Term
| Short, intermediate, or long-acting barb? Preanesthetic |
|
Definition
|
|
Term
| Short, intermediate, or long-acting barb? Hypnotic |
|
Definition
|
|
Term
| Short, intermediate, or long-acting barb? Neurologic disorders |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How does lipid-solubility affect duration of action? |
|
Definition
| The more lipid-soluble, the longer the duration of action |
|
|
Term
| What is the generic for barbs and why is this a problem? |
|
Definition
- Phenobarb
- Regardless of duration, there is 1 generic name
- Rare instance where namebrands are used to refer to the meds
|
|
|
Term
| Prototype short-acting barb sedative/hypnotic |
|
Definition
|
|
Term
|
Definition
- Nonselective CNS depression
- Decr wakefulness and alertness
- Enhance systems that use GABA
|
|
|
Term
| Does Nembutal help with all types of insomnia? |
|
Definition
| No. It's not an analgesic, so no restful sleep when insomnia is due to pain |
|
|
Term
|
Definition
- Adjuncts to anesthesia
- Treatment of insomnia
|
|
|
Term
| Difference between low and high dose Nembutal |
|
Definition
- Low does allows sleep
- High dose produces sleep
|
|
|
Term
|
Definition
- Oral and IV well absorbed
- Continued use stimulates liver, so that the t 1/2 is decr and tolerance develops
|
|
|
Term
|
Definition
- CNS depression
- Daytime hangover, but no HA, n/v, ataxia
- Loss of REM sleep, irritability, restlessness, anxiety
- Resp depression at very high doses
- Decr in levels of Vit K and D
|
|
|
Term
|
Definition
- Additive with other CNS depressants
- Because stimulates liver, can cut the t 1/2 of other drugs metabolized by liver
|
|
|
Term
|
Definition
- Confusion
- Persistent irritability
- Ataxia
- Weakness
- Respiratory depression
- Bradycardia
- CV collapse
- Tolerance to therapeutic effect, but not toxic effect
|
|
|
Term
|
Definition
- Tolerance develops at unpredictable rates
- Abrupt withdrawal can cause seizures in epileptics and abstinence syndrome
|
|
|
Term
|
Definition
- Physical/emotional/social deterioration
- Anorexia
- Weakness, chills, restless sleep
- Abd cramping, lower back pain, extermity cramping
- N/v/d
- Sneezing, rhinorrhea
- Elevated BP and HR
- Develops in 2-48 hours, but can last 7-10 days
|
|
|
Term
|
Definition
- Not analgesic, so no restful sleep when insomnia is due to pain
- Continued use stimulated liver so that the t 1/2 is decr and tolerance develops, but toxic effect is not decr
- Decr in levels of Vit K and D
- Abstinence Syndrome
|
|
|
Term
| Benadryl and Unisom are _____ that can also be used as _____ |
|
Definition
- Antihistamines
- Hypnotics/Sedatives
|
|
|
Term
| 3 Insomnia drugs and uses |
|
Definition
- Zolpidem (Ambien) - Helps stay asleep
- Zalelplon (Sonata) - Helps get to sleep
- Eszopicline (Lunesta)
|
|
|
Term
| What is the benefit to eszopicline (Lunesta)? |
|
Definition
|
|
Term
With most insomnia drugs, what can long-term use (more than 2-3 days) cause? |
|
Definition
- Dependance
- Rebound insomnia (made worse by ETOH)
|
|
|
Term
|
Definition
- Motor paralysis of short duration
- Associated with sleep walking and sleep driving
|
|
|
Term
| Prototype melatonin agonist |
|
Definition
|
|
Term
| Remelton (Rozerem) and long-term use |
|
Definition
- No dependance
- No rebound insomnia when stopped
|
|
|
Term
Why is remelton (Rozerem) superior to herbal melatonin? |
|
Definition
| Selective to receptors that induce sleep |
|
|
Term
| Remelton (Rozerem) drug-drug |
|
Definition
- Fluvoxamine
- ETOH
- B/c of P450 issues, fluvoxamine levels incr 50x
|
|
|
Term
Hallmarks of insomnia drugs |
|
Definition
- Motor paralysis of short duration
- Sleep walking/driving
|
|
|
Term
| 5 types of anticonvulsants |
|
Definition
- Barbs
- Hydantoins
- Benzos
- Succinimides
- Magnesium Sulfate
|
|
|
Term
| How do anticonvulsants generally work? |
|
Definition
| Suppress abnormal electrical activity in the brain and/or reduce spread of seizures to other areas of the brain |
|
|
Term
| What is the goal of anticonvulsants? |
|
Definition
| Full function and seizure-free |
|
|
Term
| Most common cause of recurrent seizures |
|
Definition
| Noncompliance with med regimen |
|
|
Term
| Most seizures require lifetime meds. What 2 considerations relate? |
|
Definition
- Maintain steady state
- Must give meds on time (3x/day not the same as once every 8 hours)
|
|
|
Term
| Hydantoin seizure prototype |
|
Definition
|
|
Term
| Phenytoin (Dilantin) action |
|
Definition
| Site and mode not well understood |
|
|
Term
| Phenytoin (Dilantin) therapeutic window |
|
Definition
|
|
Term
Phenytoin (Dilantin) indications |
|
Definition
- More effective for tonic-clonic seizures
- Used for trigeminal neuralgia
|
|
|
Term
| Hallmarks of Phenytoin (Dilantin) |
|
Definition
- More effective for tonic-clonic seizures
- Used for trigeminal neuralgia
- SE rash can be stevens-johnson syndrome
- SE gingival overgrowth
- Birth defects
- Cimetidine and ETOH incr metabolism of med and could cause more seizures
- No antidote
|
|
|
Term
| Phenytoin (Dilantin) ADME |
|
Definition
- Highl protein-bound
- Stimulates liver's drug metabolizing enzyme systems
|
|
|
Term
| Do pregnant women stay on their seizure meds? |
|
Definition
| Only if the benefits of seizure control outweigh the risks to the fetus |
|
|
Term
|
Definition
- Rash (can be steven-johnson syndrome, which is fatal)
- Gingival growth
- Deficiencies in folic acid, Vit D and K
- Decr cardiac eletrcial conduction
|
|
|
Term
|
Definition
|
|
Term
| Phenytoin (Dilantin) drug-drug |
|
Definition
- Incr P450 systems
- Incr metabolism of anticoags, OCP, corticosteroids, theophylline, to name a few
- Cimetidine and ETOH incr metabolism of phenytoin (seizures more likely)
|
|
|
Term
|
Definition
- Used as a sedative in seizure-free individuals
- The only long-acting barb medically accepted as an anticonvulsant
- Clinical indications the same as for phenytoin (Dilantin)
- May worsen absence seizures
|
|
|
Term
| Phenytoin (Dilantin) toxicity |
|
Definition
- CNS depression
- Cardiac depression = coma
- No antidote, supportive care only
|
|
|
Term
|
Definition
- Only long-acting barb medically accepted as an anticonvulsant
- May worsen absence seizures
- Frquently the drug of choice in children
|
|
|
Term
| Phenytoin (Dilantin) and pregnancy |
|
Definition
- Associated with cranio-facial birth defects
- Can cause neuro birth defects (folic acid issue)
- Associated with heart defects
- Newborns bleed (impairs Vit K metabolism)
|
|
|
Term
| Why would you choose carbamazine over phenytoin (Dilantin)? |
|
Definition
|
|
Term
| What is the major problem with carbamazine? |
|
Definition
- Can induce bone marrow suppression
- Immune compromise
- Anemia
- Bleeding tendencies
|
|
|
Term
| Info about ethosuximide (Zarontin) |
|
Definition
- many fewer SE in this class than previous drugs
- Initial drowsiness wears off over time
- Works in partial seizures
|
|
|
Term
| Anti-seizure med used for fibromyalgia |
|
Definition
|
|
Term
| Anti-seizure med used as migraine prophylaxis |
|
Definition
|
|
Term
| Why do women like troprimate (Topomax)? |
|
Definition
| Might suppress appetite a little |
|
|
Term
| Prototype anticonvulsant benzo |
|
Definition
|
|
Term
| Diazepam (Valium) indications |
|
Definition
- Drug of choice for status epilepticus
- A single IV dose usually stops seizures within 5 minutes, but dose may have to be repeated and pt will be placed on IV henytoin or barbs
|
|
|
Term
| What benzo is long-acting and generall used as adjunct to other anticonvulsants for absence seizures? |
|
Definition
|
|
Term
| Anticonvulsant in eclampsia patient |
|
Definition
|
|
Term
|
Definition
| Inhibit seizures without respiratory depression |
|
|
Term
| How would you not administer Magnesium Sulfate? |
|
Definition
|
|
Term
| Antidote for Magnesium Sulfate |
|
Definition
|
|
Term
| Do you need a loading dose for Magnesium Sulfate? |
|
Definition
|
|
Term
| What do you check with Magnesium Sulfate? |
|
Definition
- Deep Tendon Reflexes
- Monitor EKG (prolongs QRS and PQ intervals)
- Monitor newborns for Mg OD
|
|
|
Term
| Purpose of psychotherapeutic meds |
|
Definition
- Help you handle a situation so you can get therapy
- Do not fix underlying problems
|
|
|
Term
| How do psychotherapeutic meds work? |
|
Definition
| Release of neurohormones stimulates transmission of appropriate reactions |
|
|
Term
|
Definition
- Acetylocholine
- Norepinephrine
- Dopamine (D1 and D2 receptors involved with antipsychotics)
- Serotonin (Hypothalamus, midbrain, spinal chord)
- GABA (major inhibitor transmitter)
|
|
|
Term
| What is known about early use of psychotherapeutic drugs? |
|
Definition
| Earlier use in a disease process now understood to delay progression of some diseases (schizophrenia) |
|
|
Term
|
Definition
| Normal state, but excessiveness intereferes with daily activities |
|
|
Term
|
Definition
| Lorazepam (Ativan) (benzo) |
|
|
Term
| Lorazepam (Ativan) drug-drug |
|
Definition
| Smoking may decr effectiveness |
|
|
Term
| Critical assessment with Lorazepam (Ativan) |
|
Definition
| Whether pt is restless because of sever pain or anxiety/confusion |
|
|
Term
| What happens with rapid infusion of Lorazepam (Ativan)? |
|
Definition
- Rapid infusion greater than 2mg/min can lead to cardiac arrest, bradycardia, and apnea
- The reversal agent doesn't work in this situation
|
|
|
Term
| Hallmarks of Lorazepam (Ativan) |
|
Definition
- Intended for short-term use
- Smoking may decr effectiveness
- Rapid infusion greater than 2mg/min can lead to cardiac arrest, bradycardia, apnea, and the reversal agent won't work in this situation
|
|
|
Term
| Antipsychotics primary use |
|
Definition
|
|
Term
Positive symptoms of schizophrenia |
|
Definition
- Sees or hears things that are not there
- Hallucinations
- Delusions
- Disordered thinking
- Disorganized speech
- Combativeness
- Agitation
- Paranoia
|
|
|
Term
| Negative symptoms of schizophrenia |
|
Definition
- Flat affect, poor interaction, withdrawal
- Social/emotional withdrawal
- Lack of motivation
- Poverty of speech
- Blunted affect
- Poor insight/judgement/self-care
|
|
|
Term
| Cognitive symptoms of schizophrenia |
|
Definition
- Disordered thinking
- Reduced ability to focus attention
- Prominent learning/memory difficulties
|
|
|
Term
| Prototype antipsychotic benzo |
|
Definition
| Chlorpromaine (Thorazine) |
|
|
Term
| Chlorpromaine (Thorazine) action |
|
Definition
- Dopamine blockade in specific CNS area
- Inhibit the vagus nerve in the GI tract
- Antianxiety effect by depressing reticular system
|
|
|
Term
| Chlorpromaine (Thorazine) indications |
|
Definition
- Psychosis
- N/V
- Pain
- Sedation
- Intractable hiccups
|
|
|
Term
| Chlorpromaine (Thorazine) ADME |
|
Definition
| Antipsychotic effect requires several weeks |
|
|
Term
| Chlorpromaine (Thorazine) potency |
|
Definition
| Relatively low potency compared to newer drugs |
|
|
Term
| Chlorpromaine (Thorazine) SE |
|
Definition
- Antimuscarinic effects (anticholinergic) - Dry mouth, blurred vision, photophobia
- Alpha adrenergic blocking - Hypotension, orthostatic hypotension
- Thorazine shuffle
|
|
|
Term
| Chlorpromaine (Thorazine) drug-drug |
|
Definition
| Additive with CNS depressants |
|
|
Term
| Chlorpromaine (Thorazine) OD/toxicity |
|
Definition
- OD common, but rarely fatal
- CNS depression, hypotension, extrapyramidal effects
- Care is supportive, no antidote
|
|
|
Term
| Nasty group of SE of some antipsychotics |
|
Definition
|
|
Term
| 4 types of extrapyramidal effects and definitions |
|
Definition
- Akathisia - Jitteriness, nervous energy, restlessness, irritability
- Dystonia - Severe muscle rigidity and spasm, protruding tongue, fixed upward gaze, excessive salivation
- Parkisonism - Shiffling gait, drooling, tremors, bradykinesia, akinesia
- Tardive Dyskinesia - Involuntary muscle movement (tongue makes worm-like movements)
|
|
|
Term
| Haloperidol (Haldol) action |
|
Definition
| Blocks D2 receptors, incr brain dopamine |
|
|
Term
| Haloperidol (Haldol) indications |
|
Definition
- Psychotic disorders
- Antiemetic
- Tourette's syndrome
- Severe agitation, combativeness
|
|
|
Term
Risperidone (Risperdal) action |
|
Definition
| Blocks both serotonin and dopamine receptors |
|
|
Term
| Risperidone (Risperdal) indications |
|
Definition
- Psychotic disorders
- Improve both + and - Sx of schizo
|
|
|
Term
Which schizo drug is less likely to cause extrapyramidal effects and why? |
|
Definition
- Clozapine (Clozaril)
- Less affinity for D2
|
|
|
Term
| Clozapine (Clozaril) indications |
|
Definition
| Treatment-resistant schizophrenia |
|
|
Term
|
Definition
- Agranulocytosis (bone marrow suppression leads to lack of WBCs)
- Significant weight gain
|
|
|
Term
| When does neuroleptic malignant syndrome usually occur? |
|
Definition
| Beginning of antipsychotic med therapy |
|
|
Term
| What are early indications of neuroleptic malignant sydrome? |
|
Definition
- High fever (toxic to hypothalamus)
- Facial tic (like a rabbit chewing lettuce)
|
|
|
Term
| Which group of drugs cause sun sensitivity that can lead to blisters and rash? |
|
Definition
|
|
Term
| What is the typical drug regimen before you try lifetime meds for affective disorders? |
|
Definition
| Start with 9 months, then taper off. If disorder returns, try 12 months, then taper off. If disorder returns, lifetime therapy may be indicated. |
|
|
Term
| Depression classifications and definitions |
|
Definition
- Exogenous - Response to loss
- Endogenous - Genetic, biochemical alterations
- Bipolar - Mixed depression and mania
- Major Depression - Unipolar along with atypical affective disorder
|
|
|
Term
|
Definition
- Tricyclics (TCAs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Monoamine Oxidase Inhibitors (MAOIs)
|
|
|
Term
|
Definition
|
|
Term
| Amitriptyline (Elavil) action |
|
Definition
| Block reuptake of released NE and prevent it from reentering adrenergic nerve |
|
|
Term
| Amitriptyline (Elavil) indications |
|
Definition
- Depression, especially with anxiety component
- Induce restful sleep for chronic pain pt
- Phobic attacks
|
|
|
Term
| Amitriptyline (Elavil) ADME |
|
Definition
- Well absorbed
- Effective within 2-3 weeks
- Duration longer in elderly and young
|
|
|
Term
| Amitriptyline (Elavil) SE |
|
Definition
- Antimuscarinic - Dry mouth, blurred vision,dry eyes, photophobia
- Orthostatic hypotension, tachycardia, arrhythmias
- CNS sedation, anxiety, insomnia, nightmares
|
|
|
Term
| Amitriptyline (Elavil) drug-drug |
|
Definition
- Additive with ETOH, CNS depressants, or antimuscarinic drugs
- MAOIs - fatal HTN crisis
- Sympathomimetics
|
|
|
Term
| Amitriptyline (Elavil) effects |
|
Definition
- CNS sedation (timing of doses important)
- Improved appetite (weight gain) - Good for men who tend to not eat when depressed, but not good for women, who tend to eat when depressed
|
|
|
Term
| Amitriptyline (Elavil) OD/toxicity |
|
Definition
- Common, due to small margin of safety
- Heart block, dysrhythmias, hypotension (monitor QT interval)
- Respiratory depression
- Seizures, coma
|
|
|
Term
| Tx for Amitriptyline (Elavil) OD |
|
Definition
- Emesis
- Gastric lavage
- Cardiac monitoring
- Physostigmine
- Anticonvulsants
|
|
|
Term
| What is the antidote for Amitriptyline (Elavil)? |
|
Definition
| Physostigmine (a parasympathetic alkaloid, specifically, a reversible cholinesterase inhibitor) |
|
|
Term
| Hallmarks of Amitriptyline (Elavil) |
|
Definition
- Fatal HTN crisis with MAOIs
- Used for depression with anxiety component
|
|
|
Term
| How do SSRIs differ from TCAs |
|
Definition
- Selective for serotonin, whereas TCAs affect wider group of neurotransmitters
- Long t 1/2 so onset is slow, but dosage is daily (TCAs are dosed multiple times/day)
- Fewer/milder SE than TCAs
- More costly than TCAs
|
|
|
Term
|
Definition
|
|
Term
| Fluoxetine (Prozac) action |
|
Definition
Blocks reuptake of serotonic in CNS |
|
|
Term
| Fluoxetine (Prozac) indications |
|
Definition
Depression without anxiety |
|
|
Term
|
Definition
| Can take 2-4 weeks to reach therapeutic effect |
|
|
Term
| Fluoxetine (Prozac) onset |
|
Definition
- Queasy
- Feel fuzzy
- More active dreams (often in color)
|
|
|
Term
| Fluoxetine (Prozac) longer-term effects |
|
Definition
- Dry mouth, constipation
- Anorexia, weight loss
- Sexual dysfunction
- Anxiety, HA, insomnia, nervousness, diarrhea, tremor, pruritis
|
|
|
Term
| Fluoxetine (Prozac) drug-drug |
|
Definition
- MAOIs, St. John's Wort
- Cuases Dilantin and theophylline toxicity
- Incr concentrations of beta blockers
- ETOH
|
|
|
Term
What do you monitor with Fluoxetine (Prozac) and why? |
|
Definition
| Monitor liver function tests because can't use if there is hepatic impairment |
|
|
Term
| Do the other SSRIs cause weight loss like Fluoxetine (Prozac)? |
|
Definition
|
|
Term
| Hallmarks of Fluoxetine (Prozac) |
|
Definition
- Depression without anxiety
- Active/colorful dreams
- Anorexia, weight loss
- Causes dilantin/theophylline toxicity
- Incr concentrations of beta blockers
|
|
|
Term
| 3 SSRIs (besides Fluoxetine (Prozac)) |
|
Definition
- Paroxetine (Paxil) - More sedating than others
- Sertraline (Zoloft)
- Citralopram (Celexa) (Lexapro)
|
|
|
Term
| 2 causes of serontonin syndrome |
|
Definition
- Mix SSRIs with MAOIs
- Rapidly stop SSRIs (esp Paroxetine (Paxil))
|
|
|
Term
| What is serontonin syndrome? |
|
Definition
- Widely changing VS/Autonomic instability
- Flu-like symptoms
- HA, rigidity, possible death
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Term
Do SSRIs cause withdrawal if stoppd abruptly? |
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Definition
| Yes, must taper over a few weeks |
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Term
| SSNI found to improve hot flashes |
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Definition
| Effexor (though it's now known any SSRI/SSNI/SNRI will help) |
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Term
| Antidepressant that has the highest risk of seizures |
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Definition
| Bupropion (Wellbutrin) (Zyban) |
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Term
| Hallmarks of Bupropion (Wellbutrin) (Zyban) |
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Definition
- 1/2 of pt notice fewer nicotine cravings
- Highest risk of seizures
- Claims fewer libido problems (research shows 1% fewer)
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Term
| Antidepressant used for insomnia |
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Definition
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Term
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Definition
| Alpha adrenergic blocker (can decr BP) |
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Term
Why use Trazadone with diabetics? |
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Definition
| Helpful in diabetic neuropathic pain |
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Term
Is Trazadone used in men? |
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Definition
| Not usually, as it can cause priapism |
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Term
| Prototype antimanic/bipolar therapy |
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Definition
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Term
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Definition
- Not well known
- Theory that it accelerates destruction of serotonin, dopamine, and NE
- Na in cells of manic clients incr by 200%
- Lithium is actively transported in with Na, but not pumped out, and thus might stabilize cell membranes
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Term
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Definition
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Term
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Definition
| Decr number and severity of episodes |
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Term
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Definition
| Effective in 80% of cases |
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Term
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Definition
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Term
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Definition
- Dry mouth, nausea, thirst, drowsiness, weight gain, sleeplessness in earlier weeks
- Higher blood levels produce more weight gain, metallic taste, altered taste in food, HA, pruritis, edema of hands and feet
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Term
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Definition
- Doesn't take much to alter to toxic levels
- Diuretics, because they alter Na levels
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Term
| Lithium and thyroid hormones |
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Definition
| Secretion inhibited and may need replacement therapy |
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Term
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Definition
- Very low margin of safety
- Therapeutic 0.8-1.2 mEq/L
- Toxic 1.5-2.0 mEq/L
- GI upset even in normal doses
- Early - Drowsiness, diarrhea, nausea worsens
- Late - Vomiting, muscle weakness, ataxia, polyuria, circulatory collapse
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Term
| Incr Lithium serum levels |
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Definition
- Diarrhea
- Diuretics
- Dehydration
- Low salt diets
- High fevers
- Strenuous exercise
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Term
| Decr Lithium serum levels |
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Definition
- High salt intake
- High sodium bicarbonate intake
- Pregnancy
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Term
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Definition
- Weight gain
- Na in cells incr by 200%
- Edema in hands and feet
- Diuretic drug-drug interaction
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Term
| Differences between Lithium and valproic acid (Depakote) (Depakine) |
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Definition
- Fewer SE
- Extended release has fewer GI SE
- Still need blood draws
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Term
| CNS stimulant indications |
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Definition
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Term
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Definition
- Act as cortical and RAS stimulant by releasing catecholamines
- Paradoxically calms hyper children
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Term
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Definition
- Rapidly absorbed from GI tract
- T 1/2 of 2-15 hours (may need redosing at school)
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Term
| CNS stimulant contraindications |
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Definition
- Allergy
- Marked anxiety, agitation, glaucoma
- Severe fatigue, cardiac disease, pregnancy
- Caution in seizure disorder, or ETOH/drug dependance
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Term
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Definition
- CNS - Nervousness, insomnia, dizziness, HA, blurred vision
- GI - Anorexia, weight loss, nausea
- CV - HTN, angina, dysrhythmias
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Term
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Definition
- Incr toxicity with MAOIs
- Decr effect of HTN meds
- Incr toxicity with TCAs, Dilantin
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Term
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Definition
- Methylphenidate (Ritalin) (Concerta)
- Dextroamphetamine (Dexedrine)
- Pemoline (Cylert)
- Strattera
- Modafinil (Provigil)
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Term
| Which CNS stimulant is used for narcolepsy? |
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Definition
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Term
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Definition
| Methylphenidate (Ritalin) (Concerta) |
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Term
| Methylphenidate (Ritalin) (Concerta) indications |
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Definition
| Moderate to severe ADHD (may incr cognition) |
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Term
| Methylphenidate (Ritalin) (Concerta) SE |
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Definition
- High incidence
- Insomnia, suppressed appetite, tremor, restlessness, euphoria
- Can exacerbate psychotic illnesses
- Stimulate HR and raise BP
- Slowing of growth pre-puberty
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Term
| Users of CNS stimulants are more likely to _____ |
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Definition
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Term
| Hallmarks of CNS stimulants/Methylphenidate (Ritalin) (Concerta) |
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Definition
- Appetite suppression
- High abuse potential
- Slowing of growth pre-puberty
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Term
| Where is the monoamine enzyme found? |
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Definition
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Term
| What is the result of an MAOI? |
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Definition
| More NE avilable for release and in the synapse |
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Term
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Definition
- CNS depressants
- Anesthetics
- Antidepressants
- Antidiabetic agents
- Dextromethorphan
- Opioids
- Ritalin
- Sympathomimetics
- OTCs
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