pharm test6
TRANSCRIPT
TEST 6 BLUEPRINT
Pharmacology
Extrapyramidal Effects
A group of adverse reactions occurring on the extrapyramidal portion of the nervous system
Parkinson like symptoms Akathisia Dystonia
Tardive Dyskinesia (TD) Syndrome of potentially irreversible involuntary rhythmic
movements of the tongue, face, mouth, jaw, or extremities. May occur in patients who are on antipsychotic drugs or
after discontinuing such drugs There is NO known treatment When it occurs the drug must be discontinued
Neuroleptic Malignant Syndrome
When taking an antipsychotic Neuroleptic Malignant Syndrome is developing: High fever Confusion Muscle rigidity
Precautions for stopping nervous system medication
Pg. 249 Abruptly stopping migraine agents after long term used can result in rebound migraines, therefore, they should be stopped slowly
Pg. 254 dependence can develop with indiscriminate use (barbiturates), and abrupt withdrawal is dangerous
Nursing interventions about meds + alcohol
Medications that work on the CNS should not be used with alcohol which is a CNS depressant.
Pg 253 synergistic effects with alcohol + barbituratesNurse should evaluate patient for med compliance
and alcohol usage pg. 255 when patient is taking anticonvulsives
Patients taking benzodiazepines should not drink alcohol within 24 hours of taking this medication pg. 257
Alcohol is contraindicated with the use of antiemetics and antivertigo drugs because of synergistic effects pg. 257
Sleep Meds
Sedative-hypnotic medications are often used in the hospital to relax patients and induce sleep and to treat patients with insomnia caused by mental/physical stress
Frightening dreams and “hangover” feeling are common
Once a patient has taken them it may take several weeks for normal sleep patterns to return
If used for more than 1 week they may cause further disturbances in the sleep cycle and rebound insomnia
Should be taken 15-30 minutes before bedShould be discontinued slowly to avoid reboundMAY be habit forming
Antidepressants Side Effects
Dizziness/drowsinessDysrhythmias/hypertension/hypotension/
tachycardiaDiarrhea/N/V/dyspepsia/anorexia/
constipationSedation/insomniaBlurred visionConfusion/hostility/deliriumTremor/twitchingSuicide
Antidepressant teachings…
Take medication in compliance with ordersDo not mix with alcohol or other CNS
depressantsInform doctor about new medicationsDo not stop the medication without doctor
supervisionAlert doctor to any new or troublesome side
effects
Lithium & BW
Primary drug used to treat patients in a manic state
Therapeutic levels are close to toxic levels, so serum lithium level must be monitored on a regular basis.
Blood should be drawn 12 hours after the dose of lithium is given.
Monitoring should be carried out every few days during the initial therapy and at least every 2 months thereafter
Therapeutic level is 1 to 1.5 mEq/L
Ritalin
CNS stimulant intended to treat ADD, ADHD, & narcolepsy
MAO inhibitors
Block the inactivation of the biogenic amines resulting in an increased concentration of dopamine, epinephrine, norepinephrine, and serotonin at neuronal synapses
Used to relieve the symptoms of severe reactive or endogenous depression that have NOT responded to tricyclic antidepressant therapy, electro-convulsive therapy, or other modes of psychotherapy
MAO inhibitor teachings…
What is the limbic system for?
The limbic system is a set of evolutionarily primitive brain structures located on top of the brainstem and buried under the cortex. Limbic system structures are involved in many of our emotions and motivations, particularly those that are related to survival. Such emotions include fear, anger, and emotions related to sexual behavior. The limbic system is also involved in feelings of pleasure that are related to our survival, such as those experienced from eating and sex.Certain structures of the limbic system are involved in memory as well. Two large limbic system structures, the amygdala and hippocampus play important roles in memory. The amygdala is responsible for determining what memories are stored and where the memories are stored in the brain. It is thought that this determination is based on how huge an emotional response an event invokes. The hippocampus sends memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieves them when necessary. Damage to this area of the brain may result in an inability to form new memories.
What is Elavil/Welbutrin used for?
Elavil Amitriptyline/elavil is a tricyclic antidepressant used
to treat the symptoms of endogenous depressionWelbutrin
Buproprion/welbutrin is an antidepressant that workd int eh brain to treat major depression, seasonal affective disorder, and for smoking cessation
What does an abrupt withdrawal of CNS dep. Cause?
Rebounding of symptoms
Tricyclic Antidepressants
Antidepressant effect of trycyclics is not completely understood
They are used primarily to relieve the symptoms of severe depression that has internal biologic causes (endogenous depression)
May be used to treat mild depression caused by factors in patient’s life (exogenous or reactive depression) which is NOT self-limiting and does not interfere with usual activities of daily living
Less commonly used for manic-depressive disorders
What is levdopa?
Antiparkinson medicationAlso used to treat muscular tremors caused
by other medicationsIt is turned into dopamine in the body
Antianxiety Teachings
Common Seizure meds
Barbiturates Luminal Phenobarbital
Benzodiazapines Klonopin Tranxene Valium
Hydantoins Cerebryx Dilantin
Succinimides Phensuximide
Miscellaneous Diamox Tegretol Neurontin Lamictal Topamax depakene
Side effects of seizure meds
What are neurotransmitters?
Chemical messengers that are released at the end of one neuron and passes across a small gap to activate the next neuron in the chain
At the end of the nerve chain it stimulates an organ, smooth muscle, or gland to produce a physiologic response
2 major: Norepinephrine-acts on sympathetic nerves Acetylcholine-acts on parasympathetic nerves
Nerve fibers that: Release norepinephrine are called adrenergic fibers Release acetylcholine are called cholinergic fibers
Status Epilepticus & meds
Status Epilepticus-a condition in which a series of severe grand mal seizures occur one after another without stopping
It is treated with long-acting barbiturates
What are common antimigraine meds?
Signs of Barbiturate OD
Exaggerated CNS depressionSlow, shallow respirationsMiosisTachycardiaAreflexiaShockcoma
What is phenobarb?
Phenobarbital is a barbiturate used for all forms of epilepsy, status epilepticus, severe recurrent seizures, & eclampsia
What is the special teaching about Dilantin?What is the initial dose?
Patients taking hydantoins (like Dilantin) should see a dentist every 6 months & maintain good oral hygiene brushing teeth and gums twice a day with a soft toothbrushing and rinsing well
Initial dose: Children 5 mg/kg/day PO in 2 or 3 equally divided doses
initiall Adults 100 mg PO 3 times daily intially
What are antivertigo medications?
Antivertigo medications agents are used to prevent and treat motion sickness and the N/V that occur with anesthesia and surgery or cancer treatments.
They are also used to treat severe, intractable vomiting and hiccups.
Special Teaching: If for motion sickness, take 30-60 minutes before departure
and 30 minutes after meals thereafter Patient should avoid all other CNS depressants including
alcohol Patient should not drive, operate dangerous machines, or do
anything that requires alertness
What are phentothiazines?
Phentothiazines are antidopaminergic agents used almost exclusively to control N/V.
Common phentothiazines: Thorazine Compazine Phenergen
What are dopaminergic agents?
Dopaminergic agents are Parkinson’s medications designed to elevate the functional levels of dopamine in motor regulatory centers
They: enhance the release of dopamine from pre-synaptic
nerve endings Directly stimulate dopamine receptors in corpus
straiatum
What are the signs of toxicity related to dopaminergic drugs?
Special Teaching for long-term use of dopaminergic drugs…
Overdosage is a common phenomenon with long-term therapy, so patients should be instruction to watch for signs of toxicity
Long-term use can cause Tardive DyskinesiaLong-term use often leads to akinesia (loss of
movelment) & dystonia (impairment of muscle tone)
To counteract these effects, the dosage is liekly to be reduced to the minimum effective level and dosages tapered as necessary to avoid overmedication
Best I could do on short notice!
Good Luck!