NURS 180 Final Exam Key Points- West Coast University

NURS 180 Final Exam Key Points


WEEK 8

ANXIOLYTICS

Manage GAD, Panic Disorders, Phobias, OCD, Drug/Alcohol Withdrawal, and Insomnia

Short-Term Management of Anxiety

 Benzodiazepines
 Work by enhancing GABA [relaxation]
 Pregnancy Category D
 Controlled Substance IV
 If combined with CNS depressants, alcohol, or kava/ Valerian root it increases sedation
 Do not discontinue abruptly
 Long-term use can lead to mental disorders and memory impairment
 Antidote is flumazenil
 Barbiturates
 Work by enhancing GABA and inhibiting the reticular activating system (RAS), which is
responsible for regulating wakefulness and sleep-wake transitions
 Used mainly for short-term sleep disorders, surgery, migraines, and seizure disorders
 Pregnancy Category D
 Controlled Substance II
 Can cause CNS depression including apnea and hypotension
 If combined with CNS depressants, alcohol, or kava/ Valerian root it increases sedation
 Drug serum levels increase if combined with valproic acid
 Long-term use can lead to coma and death
 Do not discontinue abruptly
 Airway intubation, mechanical ventilation, and vasopressors may be needed in cases of
overdose or prolonged use
 Sleep hypnotics
 Work by enhancing GABA [relaxation]
 Used mainly for short-term sleep disorders
 Controlled Substance IV
 Quick onset; must be taken 30 minutes before bedtime
 Side effects include daytime sedation, depression, suicidal thoughts, N/V, hallucinations,
sensory distortion, somnambulism or sleepwalking, and nocturnal eating
 Do not discontinue abruptly
 Long-term use can lead to mental disorders and memory impairment
 If combined with CNS depressants, alcohol, or kava/ Valerian root it increases sedation

Long-Term Management

 Antidepressants
 SSRIs are the safest choice and produce the least amount of side effects




I.Delgado, APRN-C, MSN-Ed.

,NURS 180 Final Exam Key Points


ANTI-SEIZURE [Antiepileptic] DRUGS

Manage seizure disorders including status epilepticus

 Fast Onset Benzodiazepines
 Diazepam
 Midazolam
 Temazepam
 Intermediate Onset Benzodiazepines
 Alprazolam
 Lorazepam
 Slow Onset Benzodiazepines
 Oxazepam
 Clonazepam
 Barbiturates
 Phenobarbital
 Hydantoins/ Phenytoin-related Drugs
 Phenytoin
 Work by desensitize sodium channels to manage seizure disorders including status
epilepticus
 Pregnancy Category D
 If given IV, infuse slowly to avoid dysrhythmias
 Side effects include ataxia, headache, confusion, slurred speech, dysrhythmias,
hypotension, hyperglycemia, agranulocytosis, folate deficiency, SJS, LSE,
hypertrichosis, hirsutism, and gingival hyperplasia
 Decreases efficacy of tetracyclines, oral contraceptives, steroids, theophylline and TB
drugs
 Valproic acid and cimetidine can increase phenytoin levels and lead to toxicity
 Valproic Acid
 Work by desensitize sodium channels to manage seizure disorders including status
epilepticus and as an alternative to lithium for patients with bipolar disorder
 Pregnancy Category D
 Side effects include hair loss, headache, sleep disturbances, drowsiness, aggression,
prolonged bleeding time, visual disturbances, tremor, skin rash, photosensitivity, and
hepatotoxicity
 LFTs must be monitored
 Risk for valproic acid toxicity increases if combined with aspirin, cimetidine, and
erythromycin
 If combined with topiramate, risk for hyperammonemia increases
 Risk for bleeding increases if combined with warfarin, aspirin, and alcohol
 Iminostilbene Derivatives
 Carbamazepine
 Oxcarbazepine
 Both work by acting as sodium channel blockers preventing repetitive and sustained
firing of action potentials

I.Delgado, APRN-C, MSN-Ed.

, NURS 180 Final Exam Key Points


 Can be used alone or in combination with other medications to control seizures,
trigeminal neuralgia, and episodes of mania and/ or depression in patients with
bipolar I disorder
 May cause SJS or TENS and bone marrow suppression and high doses can lead to
visual disturbances, vertigo, and ataxia
 Teach patients to report sore throat, fever, chills, or other signs of infection,
SOB, fatigue, abnormal bleeding or bruising
 Monitor LFTs and CBC
 Do not discontinue abruptly
 Phenyltriazines
 Lamotrigine
 Works as a sodium channel blocker and suppresses the release of glutamate and
aspartate, two of the dominant excitatory neurotransmitters in the CNS
 Can be used alone or with other medications to prevent and control seizures and to
help prevent the extreme mood swings of bipolar disorder
 Pregnancy Category D
 Adverse effects include SJS/TENs especially in pediatric patients and when combined
with valproate or high doses of lamotrigine

ANTIDEPRESSANTS

Manage chronic anxiety disorders such as GAD and OCD, major depressive disorders, and bipolar
disorder when combined with a mood stabilizer

 SSRI
 Escitalopram
 Works by keeping more serotonin
 Avoid taking with other drugs that keep more serotonin such as other
antidepressants, triptans, ergots, and St. John’s wort to prevent serotonin
syndrome
 Increased risk for suicide in young adults and children with major depressive
disorder
 Causes the most sexual dysfunction
 SNRI
 Venlafaxine
 Works by keeping more serotonin and norepinephrine
 Approved to treat anxiety and panic disorder
 High doses may cause dangerous abnormal heart rhythms
 Avoid taking with other drugs that keep more serotonin such as other
antidepressants, triptans, ergots, and St. John’s wort to prevent serotonin
syndrome
 Increased risk for suicide in young adults and children with major depressive
disorder
 TCAs
 Amitriptyline
 Imipramine

I.Delgado, APRN-C, MSN-Ed.