Anna Tran. NURS 663 EXAM 1/ Study Guide Maryville 100% Pass

Anna Tran. NURS 663 EXAM 1/ Study Guide Maryville 100% Pass SIADH Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water Causes of SIADH Carbamazepine (Tegretol) Is primarily metabolized by ______ (cytochrome P450) Is primarily metabolized by cytochrome P450 3A4 HORRIBLE D/T DRUG-DRUG INTERACTIONS ANTICONVULSANT •First line agent for acute mania and mania prophylaxis •Indicated for rapid cyclers and mixed patients Carbamazepine (Tegretol) LABS and DOSAGE •Before med is started: baseline LIVER function tests, CBC, THYROID, KIDNEY, PREGNANCY and an EKG •Monitoring: Steady state achieved after 5 days -check 12 hours after last dose and repeat CBC and LFT •Goal: Target levels 4-12mcg/ml 400-1200 mg/day •Need to check level and adjust dosing after around a month because induces own metabolism. Escitalopram (Lexapro) SSRI (NEUTRAL), MDD, GAD •Pros -Low overall inhibition of P450s enzymes so fewer drug-drug interactions -Intermediate 1/2 life -More effective than Citalopram in acute response and remission •Cons -Dose-dependent QT interval prolongation with doses of 10-30mg daily Nausea, headache Fluoxetine (Prozac) SSRI (ACTIVATING) LONG HALF LIFE MDD, OCD, PMDD, BULIMIA, PANIC DISORDER OK FOR KIDS Paroxetine (Paxil) SSRI (SEDATING/WT GAIN) INHIBIT CYP2D6 DRUG-DRUG SHORT HALF LIFE APPROX 24 HOURS- NASTY WITHDRAWAL - DISCONTINUATION SYNDROME •Pros -Short half life with no active metabolite means no build-up (which is good if hypomania develops) -Sedating properties (dose at night) offers good initial relief from anxiety and insomnia •Cons -Significant CYP2D6 inhibition -Sedating, wt gain, more anticholinergic effects -Likely to cause a discontinuation syndrome Paroxetine (Paxil) in pregnancy Cardiovascular malformations (risk small) Ventricular and atrial septal defects Sertraline (Zoloft) SSRI (Neutral) activating??? Less drug-drug GI side effects- Better on Full stomach •Pros -Very weak P450 interactions (only slight CYP2D6) -Short half life with lower build-up of metabolites -Less sedating when compared to paroxetine •Cons -Max absorption requires a full stomach -Increased number of GI adverse drug reactions Lamotrigine (Lamictal) anticonvulsant/mood stabilizer SLOW SLOW SLOW - ANY RASH STOP - NOT FOR CRISIS STOPPED 5 DAYS OR MORE MUST RESTART 25 MG X2 WEEKS 50 MG X2 WEEKS THEN 100 MG LOW drug-drug; LOW SIDE EFFECTS DRUGS INCREASE LEVELS EX. VALPROATE Lamotrigine (Lamictal) CYP450 metabolism NONE Valproic Acid (Depakote) Associated teratogenic effects anticonvulsant/mood stabilizer •Increased risk of neural tube defect 1-2% vs 0.14-0.2% in general population secondary to reduction in folic acid Valproic Acid Baseline laboratory testing CBC, LFT, COAG, PREGNANCY Valproic Acid CYP 450 metabolism Metabolized primarily by liver 2C9 and 2C19 INHIBITS 2C9 Valoroic acid (depakote) •Before med is started: baseline liver function tests (lfts), pregnancy test and CBC •Start folic acid supplement in women •Monitoring: Steady state achieved after 4-5 days -check 12 hours after last dose and repeat CBC and lfts •Goal: target level is between 50-125 SE: WT GAIN, SEDATION, HAIR LOSS START SLOW DANGEROUS OD ECT (Electroconvulsive therapy) side effects - confusion - disorientation - short-term memory loss Physical side effects. On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle ache. ECT maintenance schedule ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments Major Depressive Disorder Dx 5+ for at least a 2-week period; either #1 or 2 req 1. Depressed mood most of the day, nearly every day (can be irritability in children & adolescents) 2. Loss of interest. Diminished interest or pleasure in all, or almost all, activities 3. Change appetite/weight; kids not wt goalsInsomnia or hypersomnia nearly every day 4. Up or down Psychomotor 5. Fatigue or loss of energy 6. Worthlessness/excessive or inappropriate guilt 7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with ADHD, address mood first) 8. Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp then 2 wk not req.