Pharm test6


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Pharm test6

  1. 1. T E S T 6 B L U E P R I N T Pharmacology
  2. 2. 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
  3. 3. Neuroleptic Malignant Syndrome  When taking an antipsychotic Neuroleptic Malignant Syndrome is developing:  High fever  Confusion  Muscle rigidity
  4. 4. 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
  5. 5. 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 + barbiturates  Nurse 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
  6. 6. 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 bed  Should be discontinued slowly to avoid rebound  MAY be habit forming
  7. 7. Antidepressants Side Effects  Dizziness/drowsiness  Dysrhythmias/hypertension/hypotension/tachycardi a  Diarrhea/N/V/dyspepsia/anorexia/constipation  Sedation/insomnia  Blurred vision  Confusion/hostility/delirium  Tremor/twitching  Suicide
  8. 8. Antidepressant teachings…  Take medication in compliance with orders  Do not mix with alcohol or other CNS depressants  Inform doctor about new medications  Do not stop the medication without doctor supervision  Alert doctor to any new or troublesome side effects
  9. 9. 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
  10. 10. Ritalin  CNS stimulant intended to treat ADD, ADHD, & narcolepsy
  11. 11. 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
  12. 12. MAO inhibitor teachings… Patient must not eat/drink: • Cheese/yogurt/sour cream • Raisins • Bananas • Avacados • Bean pods • Chicken livers • Pickled herring • Meat tenderizers • Soy sauce Limited amounts of: • Coffee • Tea • Cola • Chocolate Teachings: • Compliance is essential • Increases alcohol effects • Effects continue 2 weeks after cessation • Move slowly when changing positions • Avoid driving • Discontinue 2 weeks before surgery • Keep out of reach of children • MedicAlert bracelet
  13. 13. 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.
  14. 14. What is Elavil/Welbutrin used for?  Elavil  Amitriptyline/elavil is a tricyclic antidepressant used to treat the symptoms of endogenous depression  Welbutrin  Buproprion/welbutrin is an antidepressant that workd int eh brain to treat major depression, seasonal affective disorder, and for smoking cessation
  15. 15. What does an abrupt withdrawal of CNS dep. Cause?  Rebounding of symptoms
  16. 16. 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
  17. 17. What is levdopa?  Antiparkinson medication  Also used to treat muscular tremors caused by other medications  It is turned into dopamine in the body
  18. 18. Antianxiety Teachings MAY be habit forming Not for use by pregnant women Pt. should not drink alcohol with this medication Patient should keep doctor informed of any new medications Keep out of reach of children Notify health care provider with any new or troublesome symptoms Can cause dizziness, etc. so patient shouldn’t drive/operate machinery until response to drug has been established Pt. must keep regular appts. w/ doctor Medication dosing schedule should be followed with strict compliance
  19. 19. Common Seizure meds  Barbiturates  Luminal  Phenobarbital  Benzodiazapines  Klonopin  Tranxene  Valium  Hydantoins  Cerebryx  Dilantin  Succinimides  Phensuximide  Miscellaneous  Diamox  Tegretol  Neurontin  Lamictal  Topamax  depakene
  20. 20. Side effects of seizure meds Barbiturates • Dizziness/drowsiness/lethargy • Hangover headache • Rash/urticaria • Paradoxical restlessness • Photosensitivity • Diarrhea/N/V • Joint pain • CNS depression • Slow/shallow respirations • Tachycardia • coma Benzodiazepines • hypotention • Shortness of breath • Blurred vision • Flushing • Drowsiness/weakness/confusion • Pradocixal reactions • Anorexia & bitter taste in mouth • Diarrhea/N/V/heartburn • Rash/pruritus • Coma Hydantoins • Ataxia • Dizziness/drowsiness • Hallucinations/inattentiveness/poor memory • N/V • Ocular disturbances • Blood cell disturbances • Bruising • Acne like eruptions • Gingival hyperplasia • Lupus erythematosus • Hepatitis w/ jaundice • Coma Succinimides • Dizziness • Headaches • Hiccups • Hyperactivity • Lethargy • Mood/mental changes • Diarrheas/cramping/N/V • Lupus • Night terrors • Urinary frequency • Vaginal bleeding • Alopecia
  21. 21. 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
  22. 22. 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
  23. 23. What are common antimigraine meds?Ergotamine derivatives Migranal Ergomar Cafergot Ercaf Va-Zone Serotoning(5-HT) ReceptorAgonists Axert Amerge Maxalt Imitrex Zomig
  24. 24. Signs of Barbiturate OD  Exaggerated CNS depression  Slow, shallow respirations  Miosis  Tachycardia  Areflexia  Shock  coma
  25. 25. What is phenobarb?  Phenobarbital is a barbiturate used for all forms of epilepsy, status epilepticus, severe recurrent seizures, & eclampsia
  26. 26. 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
  27. 27. 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
  28. 28. What are phentothiazines?  Phentothiazines are antidopaminergic agents used almost exclusively to control N/V.  Common phentothiazines:  Thorazine  Compazine  Phenergen
  29. 29. 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
  30. 30. What are the signs of toxicity related to dopaminergic drugs? Muscle twitching Blepharospasm (eyelid spasms) Rapidly worsening Parkinson’s symptoms
  31. 31. 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 Dyskinesia  Long-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
  32. 32. Best I could do on short notice!  Good Luck!