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Alz, Parkinsons, Depression, Antipsychotics

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cdunbar4's version from 2017-09-29 20:18

Neurodegenerative Drugs

Question Answer
Parkinson's: dopaminergicslevodopa, carvidopa (pre-cursor that crosses BBB to increase dopamine synthesis by stimulating the dopamine receptors
Parkinson's drugs: anticholinergics benztropine, biperiden, diphenhydramine (inhibits over-activity of Ach in corpus striatum)
Dopaminergics CInarrow angle glaucoma
Common SE levodopa, carvidopaortho hypoTN, urine & perspirations darken in color
AE dopaminergics EPS dyskinesia & psychosis
benztropine, biperiden antidote phystogimine salicylate (reverses SEs)
Alzheimer anticholinesterase inhibitors donepezil, galantamine, rivastigmine: inhibits enzyme that degrades Ach (slows symptoms)
SE donepezil, galantamine, rivastigiminediarrhea, n/v (take with food); can increase ulcers, urinary or intestinal blockage (avoid NSAIDs)
Multiple sclerosis immunomodulators interferon beta, betaseron, glatiramer acetate: Work by decreasing severity of symptoms of MS
SEs of immunomodulators: interferon beta, betaseron, glatiramer acetateflu-like symptoms; local injection site rejection
MS immunosuppressants/antitumor Abs (chemo drug)mitoxantrone: SE will decrease immune system
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Antidepressants

Question Answer
Benzoslorazepam, midazolam, valium
Benzos tx foranxiety, insomnia, manic episodes for Bipolar disorder
Antidote benzosflumazenil (shorter half life than benzo, must monitor for resedation)
High dose of benzosdoes NOT produce respiratory depression
Benzos and elderlymay have a paradoxical stimulation: rage, excitement and increased anxiety-may need a different med or other non-pharm therapies
Benzos dependencemild, w/d can resemble anxiety (dc over several weeks or months)
Barbituates, why are these rarely used today?tolerance develops quickly AND they have a cross tolerance to other opioid meds. EXTREME resp. depression can be fatal with OD!
Barbituates prototypephenobarbital (usually used for seizures) Depresses CNS AT ALL LEVELS
MAOIs prototypephenelzine 3rd line choice for depression (older class), used when others don't work
Why are MAOIs last choice?Many drug-drug/drug-food interactions AND hepatotoxicity
Foods to avoid with MAOIscontaining tyramine (can cause HTN crisis!): aged cheese, smoked meats, beer, wine, avos
Other serious SE MAOIssedation/insomnia, parasthesias, anticholinergic effects
Tricyclics (TCAs) prototypesimipramine, amitriptyline (antidepressant)
Atypical use of TCAsenuresis in children
Serious SE of TCAssignificant drug interactions, anticholinergic effects
SSRIs protosertraline, citalopram, fluvoxamine, paroxetine, fluoxetine
SSRIs med of choice for which condition and why?depression/GAD, FEW side effects!
SSRI black box warningfor teens (increased suicide risk in first 2 weeks of starting drug)
SSRI adherence is affected by what side effects?common SE of weight gain, sexual dysfunction, insomnia (take in am with food
Serotonin Syndromeaccumulation of serotonin with multiple drugs, can be fatal.
Serotonin Syndrome symptomsHTN, tremors, sweating, hyperpyrexia, ataxia
Do NOT use SSRIs with which herbal drug?St. John's Wort increases RF serotonin syndrome
SNRIs (atypical antidepressants) prototypesbuproprion, mirtazapine, trazadone (sleep aid), St. John's Wort
Do not use SNRIs with which other antidepressants?MAOIs
Side effects SNRIstakes several weeks for therapeutic effect; nausea (usually subsides w.in 2 weeks), dizziness, sweating, constipation & decrease in appetite
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Antipsychotics

Question Answer
Lithium MOAserotonin receptor antagonist, mood stabilizer, treats manic episodes of bipolar disorder
Normal target blood level of lithium1-1.5, need to check levels 2-3x/week when starting, then monthly while on maintenance (check serum levels in morning before administration
Patient teaching Lithiumincrease fluid intake 2500-3000 & adequate salt intake; avoid ETOH; do not stop abruptly
Symptoms to report for client on lithiumdiarrhea, fever, drowsiness, muscular weakness, ataxia, vomiting (signs of intoxication)
Phenothiazines and nonphenothiazines used for which condition? Prototypes?schizophrenia: chlorpromazine and haloperidol. Blocks excitement of + signs and symptoms of shizophrenia
Time it takes for schizo symptoms to improve with haloperidol7-8 weeks, difficult to get to therapeutic effect because adverse effects limit adherence to pharmacotherapy
What can develop (and be permanent) for clients taking phenothiazines (chlorpromazine)?EPS may develop and be permanent in order to control s/s Report NMS asap, don't stop meds abruptly
nonphenothiazines (haloperidol) benefits over phenos?fewer SE and less sedation *EPS more common in elderly*
Haloperidol is CI withParkinson's, ETOHism, seizures, CNS depression and children <3yo`
risperidoneatypical antipsychotic for schizophrenia; controls both + and - s/s
SE risperidonewt gain, DM, increased triglycerides; CVA risk causes a decrease in adherence
therapeutic doses of risperidone do not produceEPS, but teach s/s
DSSS/dopamine stabilizersaripiparzole for schizo, acute bipolar mania, MDD
SE aripiparzolegenerally well-tolerated, ha, nv, agitation, dizziness
ADHD medicationmethlyphenidate; improves attention and focus (does NOT change behavior or better study skills)
methlyphenidate is CI in which conditionsCVD, HTN, hyperthyroidism, seizure disorders
Priority patient teachingeat high calories meals, monitor weight weekly
Nonbenzo/nonbarb Misc CNS depressant for seizuresvalproate
Nonbenzo/nonbarb Misc CNS depressant for anxietyeszopiclone, zolpidem (should only be used for short term treatment bc people can get dependent on them)
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