NURS 615 EXAM 2 STUDY GUIDE
ANTIDEPRESSANTS
• Tricyclic antidepressants (TCAs)
o NT: inhibits norepinephrine and serotonin reuptake
o Used for: Depression, OCD, migraines, insomnia
o Contraindications/Precautions
▪ Heart disease
▪ High risk of mortality with overdose
▪ Can lower seizure threshold
o Side effects
▪ Tardive dyskinesia
▪ Anticholinergic effects
▪ Prolonged QT (get baseline EKG)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
o First-line treatment drug
o NT: inhibits serotonin reuptake
o May take up to 2 weeks to take effect and up to 6 weeks for full therapeutic effect
o Side effects:
▪ Decreased libido/sexual side effects/ED
▪ Risk of suicide
▪ Nausea, diarrhea
▪ Serotonin syndrome
o Stop with taper, close follow-up
• Selective Norepinephrine Reuptake Inhibitors (SNRIs)
o NT: inhibit norepinephrine and serotonin reuptake
o Difficult to come off of
o Overdose can be lethal
o Side effects:
▪ Drug dependent
▪ GI upset, sleep changes, weight loss
▪ Sexual side effects
▪ Anticholinergic effects
• Monoamine Oxide Inhibitors (MAOIs)
o Non-selectively inhibit monoamine oxidase
▪ Norepinephrine, serotonin, and dopamine (irreversibly inactivates these metabolizing enzymes
and therefore increasing their bioavailability)
o Do not start any other antidepressant within 14 days
o Avoid tyramine
o Side effects:
▪ Delayed metabolism of dopamine
• Insomnia, anxiety, and agitation
▪ Anticholinergic effects
▪ Most common
• Dizziness, HA, insomnia, restlessness, and hypertension
▪ Hypertensive crisis
• HA, heart palpitation, stiff or sore neck, chest tightness, tachycardia, sweating,
dilated pupils, high blood pressure
rd
• 3 generation antipsychotic
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, NURS 615 EXAM 2 STUDY GUIDE
o Abilify – dopamine
• Buspar
o Anxiety
o Serotonin and dopamine
o Side effects: drowsiness, dizziness, nervousness, tremors
• Benzos
o High risk of dependency
o NT: GABA
o Uses: Anxiety, withdrawal, seizure (acute, status epilepticus)
ANTICONVULSANTS - Raises seizure threshold
• Topiramate (Topamax)
o Sodium bicarbonate level
▪ Hyperchloremia
▪ There is renal bicarbonate loss which could lead to metabolic acidosis.
▪ If the patient exhibits a change in LOC, unexplained lethargy, or emesis, then serum
ammonia levels need to be checked.
o Eye problems
• Levetiracetam (Keppra)
o Do NOT abruptly stop
o Safe in pregnancy and children
o Increase in suicidal thoughts
• Carbamazepine (Tegretol)
o Labs
▪ CBC 3 months (agranulocytosis)
▪ CMP (hyponatremia)
▪ LFTs (drug-induced liver injury)
▪ TSH
▪ Peaks and troughs (4 to 12 mcg/mL)
o Sodium channel blocker, which prevents an action potential from firing repetitively or ongoingly
o Steven Johnson syndrome
o Do NOT stop abruptly
o Not safe during pregnancy
• Valproate (Depakote)
o Pregnancy Category D
▪ Do NOT take in the 1st trimester
• Association with neural tube defects (i.e., spina bifida)
▪ Other meds are more appropriate (Keppra or lamotrigine)
▪ Folic acid needs to be increased to 4 mg/day
o Needs to be tapered down, do not stop abruptly
• Monitoring seizure activity
o Seizure activity
▪ Severity, duration
o CNS depression
o Suicidality or behavior changes
o Triggers
o Medications
This study source was downloaded by 100000848398116 from CourseHero.com on 07-25-2022 23:33:38 GMT -05:00
https://www.coursehero.com/file/151136324/NURS-615-Pharm-Exam-2-Study-Guidedocx/
ANTIDEPRESSANTS
• Tricyclic antidepressants (TCAs)
o NT: inhibits norepinephrine and serotonin reuptake
o Used for: Depression, OCD, migraines, insomnia
o Contraindications/Precautions
▪ Heart disease
▪ High risk of mortality with overdose
▪ Can lower seizure threshold
o Side effects
▪ Tardive dyskinesia
▪ Anticholinergic effects
▪ Prolonged QT (get baseline EKG)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
o First-line treatment drug
o NT: inhibits serotonin reuptake
o May take up to 2 weeks to take effect and up to 6 weeks for full therapeutic effect
o Side effects:
▪ Decreased libido/sexual side effects/ED
▪ Risk of suicide
▪ Nausea, diarrhea
▪ Serotonin syndrome
o Stop with taper, close follow-up
• Selective Norepinephrine Reuptake Inhibitors (SNRIs)
o NT: inhibit norepinephrine and serotonin reuptake
o Difficult to come off of
o Overdose can be lethal
o Side effects:
▪ Drug dependent
▪ GI upset, sleep changes, weight loss
▪ Sexual side effects
▪ Anticholinergic effects
• Monoamine Oxide Inhibitors (MAOIs)
o Non-selectively inhibit monoamine oxidase
▪ Norepinephrine, serotonin, and dopamine (irreversibly inactivates these metabolizing enzymes
and therefore increasing their bioavailability)
o Do not start any other antidepressant within 14 days
o Avoid tyramine
o Side effects:
▪ Delayed metabolism of dopamine
• Insomnia, anxiety, and agitation
▪ Anticholinergic effects
▪ Most common
• Dizziness, HA, insomnia, restlessness, and hypertension
▪ Hypertensive crisis
• HA, heart palpitation, stiff or sore neck, chest tightness, tachycardia, sweating,
dilated pupils, high blood pressure
rd
• 3 generation antipsychotic
This study source was downloaded by 100000848398116 from CourseHero.com on 07-25-2022 23:33:38 GMT -05:00
https://www.coursehero.com/file/151136324/NURS-615-Pharm-Exam-2-Study-Guidedocx/
, NURS 615 EXAM 2 STUDY GUIDE
o Abilify – dopamine
• Buspar
o Anxiety
o Serotonin and dopamine
o Side effects: drowsiness, dizziness, nervousness, tremors
• Benzos
o High risk of dependency
o NT: GABA
o Uses: Anxiety, withdrawal, seizure (acute, status epilepticus)
ANTICONVULSANTS - Raises seizure threshold
• Topiramate (Topamax)
o Sodium bicarbonate level
▪ Hyperchloremia
▪ There is renal bicarbonate loss which could lead to metabolic acidosis.
▪ If the patient exhibits a change in LOC, unexplained lethargy, or emesis, then serum
ammonia levels need to be checked.
o Eye problems
• Levetiracetam (Keppra)
o Do NOT abruptly stop
o Safe in pregnancy and children
o Increase in suicidal thoughts
• Carbamazepine (Tegretol)
o Labs
▪ CBC 3 months (agranulocytosis)
▪ CMP (hyponatremia)
▪ LFTs (drug-induced liver injury)
▪ TSH
▪ Peaks and troughs (4 to 12 mcg/mL)
o Sodium channel blocker, which prevents an action potential from firing repetitively or ongoingly
o Steven Johnson syndrome
o Do NOT stop abruptly
o Not safe during pregnancy
• Valproate (Depakote)
o Pregnancy Category D
▪ Do NOT take in the 1st trimester
• Association with neural tube defects (i.e., spina bifida)
▪ Other meds are more appropriate (Keppra or lamotrigine)
▪ Folic acid needs to be increased to 4 mg/day
o Needs to be tapered down, do not stop abruptly
• Monitoring seizure activity
o Seizure activity
▪ Severity, duration
o CNS depression
o Suicidality or behavior changes
o Triggers
o Medications
This study source was downloaded by 100000848398116 from CourseHero.com on 07-25-2022 23:33:38 GMT -05:00
https://www.coursehero.com/file/151136324/NURS-615-Pharm-Exam-2-Study-Guidedocx/
