ATI Pharmacology Review| NURSING MISC|Dyersburg State Community College|

ATI Pharmacology Review Nervous System Medications Anxiety and Trauma/ Stressor-related DO Benzodiazepines ● lorazepam/ Ativan, alprazolam/ Xanax, clonazepam/ Klonopin, diazepam/ Valium, chlordiazepoxide, clorazepate, oxazepam ● Enhances GABA NT (inhibitory NT) ● Indications: 1st line short term TX of GAD and panic DO. Alcohol withdrawal. SZ. ● SE: CNS depression, anterograde amnesia, acute toxicity (TX with flumazenil). Paradoxical response. Withdrawal effects in long-term use (diaphoresis, tremors, delirium, SZ. TX with tapered long term benzos) ● CI: Avoid in preggo. Glaucoma. Caution with liver DZ. ● Interactions: Increased effects if taken with CNS depressants (ETOH, antipsychotics, TCAs, antihistamines, opioids). Decreased effects with caffeine, cigarettes. ● No lab work required. Atypical nonbarbiturate anxiolytic: Buspirone/ Buspar ● Indication: long term TX of anxiety, panic DO, OCD and related. ● Nonsedating, no highs, no cross tolerance with ETOH or sedatives. Fewer drug interactions. ● Takes 1-6 weeks for onset of full effect. ● CI: MAOIs. No grapefruit, erythromycin, or St John’s Wort due to potentiation. ● SE: Dizzy and mild drowsiness (but it’s non-sedating..? ATI sux) ● Nsg consideration: take with meals, at same time everyday. SSRI ● Paroxetine/ Paxil, sertraline/ Zoloft, citalopram/ Celexa, escitalopram/ Lexapro, fluoxetine/ Prozac, fluvoxamine ● Inhibits serotonin reuptake, does not block uptake of dopamine or NorE. ● Indications: GAD, panic DO, OCD, PTSD, depression, dissociative DOs. ● Takes up to 4 wks for full effect. ● SE: Sexual dysfunction (tx with lowering dose, drug holiday, or bupropion). Also: insomnia, agitation (decrease caffeine, take in AM, relaxation skills). HA, GI upset, bruxism. Wt loss short term, or wt gain in the long term. Hyponatremia (in elderly especially. Obtain baseline serum NA and then monitor). GI bleed (interacts with warfarin, NSAIDS. Monitor PT and INR). [Fluox and paroxetine are teratogenic] ● Serotonin syndrome: 2-72 hrs after starting TX. ○ TX by withholding med and notify ○ S/S: ALOC, SZ, tachycardia, BP changes, N/V/D, high fever, ataxia, coma ● CI: MAOI, TCA, ETOH, bipolar (causes mania). Caution with liver/ renal/ SZ. ● Interactions: MAOI/ TCA/ St John Wort (serotonin syndrome), Warfarin (increases bleeding time), lithium (increased lithium levels), NSAIDS/ anticoags (risk of bleeding) ● Nsg teaching: Take in morning, with food, obtain baseline Na levels. Fluoxetine and escitalopram approved for children. ● Depression takes several weeks to work. For PMS takes a few days. ● Washout is 5 weeks. ● Efficacy: normal sleep patterns, anxiety reduction, social activity participation Depressive DO SNRI ● Venlafaxine/ Effexor, duloxetine/ Cymbalta ● Inhibits uptake of serotonin and NorE; minimal inhibition of dopamine ● Indications: major depression, panic, GAD ● SE: CNS stim (HA, agitation, anxiety, dry mouth, insomnia), Hyponatremia (with diuretics), Wt loss, sexual dysfxn ● CI: ETOH, MAOI ● Interactions: MAOI/ St John Wort (serotonin syndrome), NSAIDS/ anticoags Atypical Antidepressants ● Bupropion/ Wellbutrin ● Inhibits dopamine uptake ● Indications: Alternative to SSRI that cause sexual dysfunction. SAD, depression, smoking cessation ● SE: CNS stimulation, Wt loss, SZ at high doses. ● CI: SZ, MAOI, eating DO. Increased risk of SZ with SSRIs. TCA ● Amitriptyline, imipramine, doxepin, nortriptyline, amoxapine, trimipramine ● Blocks reuptake of NorE and serotonin. ● Indications: Depression. Also bipolar, anxiety. ● SE: orthostatic hypotension, sedation, anticholinergic effects, TOXICITY (give no more than a week supply for risky pts, obtain baselines, monitor for toxicity), wt gain, decreased SZ threshold ● CI: SZ, increased SI risk, MI, glaucoma. ● Interactions: MAOI (HTN crisis), additive anticholinergic effects, CNS depressants, sympathomimetics. ● Washout 2 weeks ● Nsg teaching: Take at bedtime, dysrhythmias. No smoking. MAOI ● Phenelzine/ Nardil, selegiline (as a patch- also used for parkinson’s) ● Block MAO in the brain, thereby increasing NorE, dopamine, and serotonin ● Indications: Depression, bulimia, atypical depression ● SE: CNS stim, orthostatic hypotension ● Hypertensive Crisis: especially with intake of tyramine ○ Tyramine foods: cheese, cured meats, beer, grapefruit/ citrus, overripe bananas/ avocados. ○ TX with IV phentolamine or nifedipine ● CI: SSRI or TCA (serotonin syndrome), DM, SZ, CV DZ, renal DZ, pheochromocytoma. ● Interactions: CNS stimulants, TCA, SSRIS, HTN meds ● Nsg teaching: No other meds unless approved. No tyramine foods. ● Washout is 2 weeks. Also SSRI and Other atypical antidepressants Bipolar DO Lithium Carbonate ● Mood stabilizer; Increases serotonin, decreases neuronal atrophy. ● Indications: bipolar, limits mania, decreases SI, prevents return of depression ● Olanzapine (antipsychotic) can be administered to calm manic pt while waiting for lithium to kick in. ● SE: ○ N/V/D, GI pain - take with food/milk ○ Fine hand tremors - give lower dosage, beta-ad blocker, tell client to report tremors ○ Polyuria/thirst - potassium-sparing diuretic like spironolactone, tell client to drink 1.5 to 3L of fluid ○ Weight gain - diet/exercise ○ Goiter/hypothyroidism - annual T3/T4/TSH, monitor for hypothyroidism, administer levothyroxine ○ Renal toxicity - Monitor I/O, assess baseline BUN/Creat ○ Hepatotoxicity - Routine monitoring of LFTs req’d ○ Bradyarrhythmias/hypotension/electrolyte imbalances - maintain sodium intake ● Lithium toxicity: occurs at lithium levels 1.5 ○ Initial S/S: N/V/D, polyuria, fine tremors, slurred speech, lethargy ■ Withhold med and notify. Adjust dose based on lithium/ Na levels ○ Progressive S/S: coarse tremors, ALOC, tinnitus, ataxia, SZ, stupor, severe hypotension, coma, death ■ Can treat with aminophylline ■ Emetic or lavage. Hemodialysis. ● CI: teratogenic. Liver/ renal/ cardiac DZ, schizophrenia, hypovolemia. Caution with DM, SZ, thyroid DZ ● Interactions: Diuretics (they cause Na secretion which leads to increased lithium levels in body). NSAIDS (increases renal reabsorption of lithium and toxicity - use ASA instead). Lithium and SSRI taken together can lead to serotonin syndrome. ● Nsg considerations: Increase water intake to 1.5-3 L/day. Monitor levels q 2-3 days initially, then q 1-3 months. Therapeutic range of 0.4-1.4. Toxic 1.5. Full effects within 2-3 weeks. Take with food. Maint