NUR 2474 - Test 1 Review.
Topics to review:
1. Lithium therapy (blood testing, therapeutic levels, toxicity levels, side effects, toxic effects)
a. Blood level drug testing should occur early in therapy every 2-3 days, until a therapeutic
dose has been established, then long term for every 3 to 6 months while using the drug.
b. Therapeutic Level= 0.8-1.4
c. Toxic Level= Greater than 1.5
d. SE at therapeutic level: GI effects, tremors, polyuria, renal toxicity,
goiter, hypothyroidism, teratogenesis.
e. Toxic SE: will be much worse and possibly life threatening i.e. tremor that
becomes larger with muscle incoordination.
2. BPD patients on Lithium and adjunct meds for mania/depression
a. The bipolar patient will have periods of mania, depression, and psychosis, and will
need a mood stabilizer lithium to control their mood, an antidepressant (SSRI), and
an antipsychotic (2nd gen-olanzapine, risperidone) to control the psychosis.
3. Benzodiazepines and alcohol withdrawal
a. The benzo will help one withdraw from alcohol by decreasing the withdrawal
manifestations and intensity, while making one sleepy and having CNS
depression. Plus, it is easy to give IM and will work quickly.
4. Alprazolam therapy and anxiety
a. Alprazolam is a benzo that is used to treat anxiety.
b. It works by reducing anxiety by inhibiting the GABA in the CNS, depressing the CNS.
c. SE: CNS depression, anterograde amnesia (patient cannot remember
much), sleep driving (not safe), paradoxical effects (still anxious, stays up,
rowdy), respiratory depression.
d. Interacts w/ CNS depressant medications (additive effects), and ETOH.
5. Treatment of anxiety patients with sedative/hypnotics
, a. Can use benzo’s (pam/lam), atypical anxiolytic buspirone, SSRIs
paroxetine/fluoxetine, TCAs, MAOIs, trazodone.
b. Sedative hypnotics can cause the patient to have sedation, sleepiness, CNS
depression, anterograde amnesia (patient cannot remember much), sleep driving (not
safe), paradoxical effects (still anxious, stays up, rowdy), respiratory depression.
c. They must always be taped by the HCP, not the patient.
d. Teach no ETOH use, no sleep driving.
e. Withdrawal can occur- PO= drowsiness, lethargy, confusion, IV= hypotension,
respiratory arrest, cardiac arrest.
6. Methylphenidate (Ritalin) therapy in children
a. Methylphenidate is used to increase attention and focus in children (NOTHING
DEALING W/ BEAHVIORS)
b. Use of methylphenidate with kids can decrease their appetite and cause
insomnia if given late in the day.
c. ALWAYS: give the drug in the morning, after breakfast, and give the last
dose before 4pm, or else the child will not sleep at night.
7. Donepezil (Aricept) therapy in pt’s with Alzheimer’s disease
a. Patients who have Alzheimer’s have treatment available to slow the
decline of the disease, but does not cure the disease.
b. Donepezil works to slow the progression of the disease by causing reversible
inhibition of cholinesterase and the cholinergic receptors.
8. Review therapy discontinuation for depression
a. If an antidepressant is stopped abruptly (cold turkey), the patient can go into withdrawal
syndrome (s/s HA, Nausea, visual disturbances, sweating, dizziness, tremors).
b. We must gradually taper the drug over weeks slowly and call the HCP to
have them guide the patient through the process.
c. DO NOT let patient discontinue antidepressants themselves!
9. Sertraline (Zoloft) and nursing infants
a. Sertraline is a SSRI, and when this drug is used with a patient who is pregnant
or nursing infants, the infant can have neonatal abstinence syndrome occur.
b. It is safe to use but may cause this.
c. We must educate the patient on potentially using other medications during this
time period, as it can cause potential birth defects and the baby to become sick.
10. Duloxetine (Cymbalta) and alcohol abuse
a. Duloxetine is a SNRI and when used with ETOH, it can interact with the
medication and make the patient very sick.
b. The patient must avoid ETOH while taking any of these medications.
11. Diazepam (Valium) for status epilepticus (seizures)
a. Diazepam, a benzo, can be used in first line to stop a seizure or a patient
in status epilepticus by a IM injection.
12. Side effects vs adverse effects vs allergies
a. Side Effects: unavoidable secondary drug effects produced at therapeutic
doses. May be unwanted, but unavoidable and expected.
b. Adverse Effects: undesired and unexpected severe responses to a medication.
They do have the potential to cause harm.
Topics to review:
1. Lithium therapy (blood testing, therapeutic levels, toxicity levels, side effects, toxic effects)
a. Blood level drug testing should occur early in therapy every 2-3 days, until a therapeutic
dose has been established, then long term for every 3 to 6 months while using the drug.
b. Therapeutic Level= 0.8-1.4
c. Toxic Level= Greater than 1.5
d. SE at therapeutic level: GI effects, tremors, polyuria, renal toxicity,
goiter, hypothyroidism, teratogenesis.
e. Toxic SE: will be much worse and possibly life threatening i.e. tremor that
becomes larger with muscle incoordination.
2. BPD patients on Lithium and adjunct meds for mania/depression
a. The bipolar patient will have periods of mania, depression, and psychosis, and will
need a mood stabilizer lithium to control their mood, an antidepressant (SSRI), and
an antipsychotic (2nd gen-olanzapine, risperidone) to control the psychosis.
3. Benzodiazepines and alcohol withdrawal
a. The benzo will help one withdraw from alcohol by decreasing the withdrawal
manifestations and intensity, while making one sleepy and having CNS
depression. Plus, it is easy to give IM and will work quickly.
4. Alprazolam therapy and anxiety
a. Alprazolam is a benzo that is used to treat anxiety.
b. It works by reducing anxiety by inhibiting the GABA in the CNS, depressing the CNS.
c. SE: CNS depression, anterograde amnesia (patient cannot remember
much), sleep driving (not safe), paradoxical effects (still anxious, stays up,
rowdy), respiratory depression.
d. Interacts w/ CNS depressant medications (additive effects), and ETOH.
5. Treatment of anxiety patients with sedative/hypnotics
, a. Can use benzo’s (pam/lam), atypical anxiolytic buspirone, SSRIs
paroxetine/fluoxetine, TCAs, MAOIs, trazodone.
b. Sedative hypnotics can cause the patient to have sedation, sleepiness, CNS
depression, anterograde amnesia (patient cannot remember much), sleep driving (not
safe), paradoxical effects (still anxious, stays up, rowdy), respiratory depression.
c. They must always be taped by the HCP, not the patient.
d. Teach no ETOH use, no sleep driving.
e. Withdrawal can occur- PO= drowsiness, lethargy, confusion, IV= hypotension,
respiratory arrest, cardiac arrest.
6. Methylphenidate (Ritalin) therapy in children
a. Methylphenidate is used to increase attention and focus in children (NOTHING
DEALING W/ BEAHVIORS)
b. Use of methylphenidate with kids can decrease their appetite and cause
insomnia if given late in the day.
c. ALWAYS: give the drug in the morning, after breakfast, and give the last
dose before 4pm, or else the child will not sleep at night.
7. Donepezil (Aricept) therapy in pt’s with Alzheimer’s disease
a. Patients who have Alzheimer’s have treatment available to slow the
decline of the disease, but does not cure the disease.
b. Donepezil works to slow the progression of the disease by causing reversible
inhibition of cholinesterase and the cholinergic receptors.
8. Review therapy discontinuation for depression
a. If an antidepressant is stopped abruptly (cold turkey), the patient can go into withdrawal
syndrome (s/s HA, Nausea, visual disturbances, sweating, dizziness, tremors).
b. We must gradually taper the drug over weeks slowly and call the HCP to
have them guide the patient through the process.
c. DO NOT let patient discontinue antidepressants themselves!
9. Sertraline (Zoloft) and nursing infants
a. Sertraline is a SSRI, and when this drug is used with a patient who is pregnant
or nursing infants, the infant can have neonatal abstinence syndrome occur.
b. It is safe to use but may cause this.
c. We must educate the patient on potentially using other medications during this
time period, as it can cause potential birth defects and the baby to become sick.
10. Duloxetine (Cymbalta) and alcohol abuse
a. Duloxetine is a SNRI and when used with ETOH, it can interact with the
medication and make the patient very sick.
b. The patient must avoid ETOH while taking any of these medications.
11. Diazepam (Valium) for status epilepticus (seizures)
a. Diazepam, a benzo, can be used in first line to stop a seizure or a patient
in status epilepticus by a IM injection.
12. Side effects vs adverse effects vs allergies
a. Side Effects: unavoidable secondary drug effects produced at therapeutic
doses. May be unwanted, but unavoidable and expected.
b. Adverse Effects: undesired and unexpected severe responses to a medication.
They do have the potential to cause harm.
