Pharmacology ATI Proctored

Benzodiazepines Atypical anxiolytic Trick to remember difference between Benzodiazepine and buspirone Selective Serotonin Reuptake Inhibitors (SSRIs) Includes "Pams" Alprazolam, diazepam, lorazepam, oxazepam, clonazepam, chlordiazepoxide, chlorazepate Enhances GABA: increased GABA means decreased neuron activity Treats anxiety, PTSD, seizures, alcohol withdrawal, muscle spasm, induction of anesthesia Usually short term; if long term do NOT stop abruptly Antidote is flumazenil Side effects: CNS depression - seda- tion and respiratory depression, amne- sia, dependency, and withdrawal effects Buspirone Can take 2-6 weeks to work, but can be long term! Treats panic disorder, anxiety, OCD, and PTSD Side effects: dizziness, nausea (take w/ food to relieve), headache (sedation and dependency is not seen like in benzo) "Pam" has anxiety, so she goes on a "benzo" and takes it for a long time but realizes that it is not healthy.So she takes a "bus" to a "pier" to sit "alone" and de- cides to treat her anxiety long term with "buspirone" Usually end in "ine": paroxetine, sertra- line, citalopram, escitalopram, fluoxetine, fluvoxamine Inhibits serotonin reuptake" increases serotonin Treats anxiety, OCD, PTSD, and depres- sion Side effects: nausea, fatigue, sexual dys- function, weight gain, insomnia (paroxe- tine), serotonin syndrome (agitation, hal- Pharmacology ATI Proctored e 2 / 46 Atypical Antidepressants Tricyclic antidepressants Anticholinergic efffects Monoamine oxidase inhibitors Foods that contain tyramine lucinations, tremors, fever, diaphoresis) Takes about four weeks after treatment begins to take full effect. Bupropion, Trazodone - more important Others: Vilazodone, mirtazapine, rebox- etine Treats depression and aid for smoking cessation Side effects: headache, GI distress, in- somnia, nausea, weight loss, seizures Amitriptyline Treats depression, neuropathic pain, fi- bromyalgia, anxiety disorders, insomnia Side effects: Anticholinergic effects, Se- dation, Seizures, Sweating (SSS) "Amy tripped over a tricycle in the desert." Amitriptyline is a tricyclic antidepressant and causes effects that make you feel like you're in the desert. dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipa- tion, tachycardia Phenelzine (Prototype), Isocarboxazid, tranylcypromine, selegiline Side effects: CNS stimulation, Orthosta- tic hypotension, hypertensive crisis (es- pecially with phenelzine). Tyramine rich foods can lead to hyperten- sive crisis aged cheese, pepperoni, salami, avoca- dos, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine Pharmacology ATI Proctored e 3 / 46 Mood stabilizer Mood - stabilizing antiepileptic Lithium Carbonate Treats bipolar disorder Side effects: GI distress, fine hand tremors, polyuria, weight gain, renal tox- icity, renal toxicity, hypothyroidism, elec- trolyte imbalance Lithium toxicity: occurs with levels over 1.5; presents with COARSE (not fine) hand tremors, confusion, tinnitus, seizures, hypotension, coma, possibly death. Do not give with diuretics, NSAIDs, or anticholinergics Need a balance of sodium and water. Carbamazepine, valproic acid Treats Bipolar disorder and seizure dis- order Carbamazepine side effects: blood dyscrasias, hypo-osmolality Valproic acid side effects: *hepatotoxici- ty,* pancreatitis, thrombocytopenia Antipsychotics: First-generation (con- ventional) Chlorpromazine, Haloperidol TONS of side effects-will only list impor- tant ones Extrapyramidal side effects: Acute dys- tonia- spasms of tongue, neck, face, or back; Parkinsonism- rigidity, shuffling gait, drooling, tremors; akathisia- unable to sit or stand still; tardive dyskinesia - in- voluntary movement of tongue and face EPS effects may be able to be treated with anticholinergic medication if the pa- tient does not have anticholinergic side effects. Neuroleptic Malignant Syndrome: sud- den high grade fever, dysrhythmias, mus- cle rigidity Pharmacology ATI Proctored e 4 / 46 Antipsychotics: second and third gener- ation (atypical) Central Nervous system stimulants Medications to support withdrawal from alcohol Disulfiram There is a long lasting injection for non-compliant patients. Risperidone and Clozapine - most impor- tant Often first line in treating schizophrenia Treats negative and positive symptoms Side effects: diabetes mellitus, weight gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects Do not take with alcohol. IM every two weeks available for those who are not compliant Methylphenidate and Amphetamine mix- ture Treats ADHD and Conduct disorder Can cause insomnia, decreased ap- petite, weight loss, and growth suppres- sion Do not give at night. Give immediately before or after a meal. Monitor weight. Benzodiazepines: Chlordiazepoxide, lorazepam, diazepam First line treatment of alcohol withdrawal Keeps vitals within expected limits, de- creases risk of seizures Clonidine and Propranolol depress auto- nomic response and decrease vitals Carbamazepine Further decreases risk of seizure Daily oral medication to sustain absti- nence of alcohol; type of aversion thera- pyCauses nausea, vomiting, sweating, pal- pitations, and hypotension if alcohol is consumed Naltrexone Pharmacology ATI Proctored e 5 / 46 Acamprosate Medications to support withdrawal/absti- nence from opiods Withdrawal/abstinence from nicotine Cholinesterase inhibitors Suppresses the craving and pleasurable effects of alcohol. Can have monthly IM injection Decreases unpleasant effects resulting from abstinence like dysphoria, anxiety, restlessness Methadone Substitution Slow weening process Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a physical dependence It prevents abstinence syndrome and re- moves the need for the client to obtain illegal substances. Used for withdrawal and long term main- tenance. Bupropion Nicotie gum, patch, or nasal spray Varenicline: a nicotine receptor agonist. Reduces cravings as well as withdrawal effects. Depression and suicidal effects can occur. Neostigmine, Physostigmine, Edropho- nium (dx MG) Prevents the enzyme cholinesterase from inactivating acetylcholine thereby increasing the amount of ACh available. Treats myasthenia gravis and parkin- son's Reversal for neuromuscular blocking agents Excessive muscarinic stimulation: in- creased GI motility, diaphoresis, in- creased salivation, bradycardia, and uri- nary urgency (too moist) Cholinergic crisis: give atropine! Atropine reverses this! Pharmacology ATI Proctored e 6 / 46 Levodopa/Carbidopa Benztropine Antiepileptics Neuromuscular Blocking Agent Giving together to increase dopamine Used for parkinson's Decreases tremors and muscle rigidity Levodopa is converted to dopamine in the CNS and carbidopa prevents the breakdown of levodopa Side effects: quite a few: nausea, vom- iting, drowsiness, dyskinesia, orthostat- ic hypotension, darkening of urine and sweat, possible psychosis High protein meals decreases effective- ness. Decreases Acetylcholine Used for Parkinson's, helps with muscle rigidity and tremors Side effects relate to too little acetyl- choline which means we will have anti- cholinergic side effects Teach to chew gum, wear sun glasses, increase fiber and fluids Phenytoin, Carbmazepine, Valproic acid, lamotrigine Phenytoin: Side effects: gingival hyper- plasia!, diplopia, stigmas, rash, ataxia, hypotension Closely monitor plasma levels! Narrow range! Range is 10-20 mcg/mL Decreases effectiveness of oral contra- ceptives. Succinycholine and Pancuronium Blocks acetylcholine at the neuromuscu- lar junction resulting in muscle relaxation and hypotension. They do not cross the blood brain barrier, so complete paralysis is achieved without loss of conscious- ness or decreased pain sensation. Used in anesthesia. Side effects:respiratory depression, pro- Pharmacology ATI Proctored e 7 / 46 Peripherally acting muscle relaxants Centrally Acting muscle relaxants Urinary Tract Stimulant Muscarinic antagonist longed apnea, muscle pain, and malig- nant hyperthermia (MH) MH: muscle rigidity with increased tem- perature. Need to give oxygen at 100%, initiate cooling measures and administer dantrolene. Dantrolene Treats: spasticity related to cerebral pal- sy, spinal cord injury, and multiple sclero- sis Inhibits muscle contraction by preventing release of calcium in skeletal muscles. Side effects: drowsiness, muscle weak- ness, hepatic toxicity Baclofen (diazepam, baclofen, cycloben- zaprine, tizanidine) Used for muscle spasticity related to spinal injury cerebral palsy, multiple scle- rosis, as well as malignant hyperthermia Enhances effect of GABA Drowsiness, GI upset, constipation (in- crease fiber and fluid) Bethanechol (Cevimeline, pilocarpine, acetycholine) "Beth has is shy and has a shy bladder" Used for nonobstructed urinary reten- tion. Stimulates the cholinergic receptors in GU tract. Side effects: r/t cholinergic effects like flushing, sweating, urinary urgency, bradycardia, hypotension One hour before or two hours after meal, not at meal time Oxybutynin (darifenacin, solifenacin, tolterodine, fes- oterodine, trospium) Used for overactive bladder symptoms: frequency, urgency, nocturia Pharmacology ATI Proctored e 8 / 46 Nonbenzodiazepines for insomnia Intravenous anesthetics Beta2-adrenergic agonist MethylXanthines Inihibts muscarinic receptors Side effects: Anticholinergic! Zolpidem Enhances GABA Can cause day time sleepiness and dizziness. Ensure they have eight hours of sleep. Pentobarbital: Barbiturate Medazolam: Benzo Propofol Initiate or maintain anesthesia, con- scious sedation, intubation Depresses CNS, promote loss of con- sciousness Side effects: respiratory/cardiac depres- sion. Propofol: pain at IV site, high risk of infection. Use within six hours For all: have rescue equipment available and constantly monitor EKG and vitals. Albuterol and salmeterol Bronchodilation Treats COPD and asthma Side effects: Tachycardia, angina, tremors Albuterol - short acting; salmeterol - long acting If using with a glucocorticoid, use beta2-adrenergic agonist first to dilate the bronchioles Theophylline "Theo means God and if you use this, you may be seeing God sooner than you intended due to side effects." Can be used long t