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ATI Pharmacology Exam Review| NURSING MISC, A+ Guide
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ATI Pharmacology Exam Review| NURSING MISC, A+ Guide
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A+ GuideATI 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
, A+ Guide
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
, A+ Guide
● 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
, A+ Guide
○ 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. Maintain normal Na intake.
Mood Stabilizing AntiSZ Meds
● carbamazepine/ Tegretol, valproate/ Depakote, lamotrigine/ Lamictal
● Potentiate GABA and slow entrance of Na and Ca prolonging neuronal refractory period.
● Indications: bipolar
● carbamazepine/ Tegretol:
○ SE: Blood dyscrasias (monitor CBCs and for indications of infection)
■ Teratogenic
■ FVE/ hypoosmolarity (monitor Na, edema, urine output, HTN)
■ Rash (SJS)
■ CNS effects (vision changes, vertigo, HA)
○ CI: Bone marrow suppression, bleeding DOs
○ Interactions: Warfarin, oral contraceptives (makes these drugs ineffective).
Grapefruit juice (increases plasma levels). SZ meds (decreased therapeutic
effect).
○ Nsg considerations: start low and titrate. SE should subside. Take at bedtime.
Monitor plasma levels of the medication.
● lamotrigine/ Lamictal:
○ SE: CNS stim (vision changes, N/V, HA, dizzy)
■ Rash (SJS)
○ Interactions: Oral contraceptives (decreased effectiveness)
○ Nsg consideration: Start low and titrate
● valproate/ Depakote:
○ SE: GI upset
■ Hepatotoxic
■ Pancreatitis
■ Blood dyscrasias (monitor for increased bleeding, plt counts, PTT/INR)
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