Exam 2 Meds

Concepts of Health Maintenance: 1st generation drugs treat “1” symptom – Positive (hallucinations, delusions, bizarre behavior, paranoia, disorganized speech) Adverse Reactions-Tardive Dyskinesia, Neuroleptic Malignant Syndrome (muscle rigidity, confusion, delirium, and fever. Rare and life-threatening, idiosyncratic rxn), Agranulocytosis (anticholinergic effects, orthostasis, lowered seizure threshold) Extrapyramidal symptoms (EPS) – Akathisia, acute dystonia, pseudoparkinsonism 2nd generation drugs treat “2” symptoms – Positive AND Negative (Positive AND poverty of thought (alogia), loss of motivation (avolition), inability to experience pleasure or joy (anhedonia), feelings of emptiness, blunted affect, apathy, attention deficits). These medications are used as a first line defense! COGNITION- Conventional Antipsychotics/ Atypical Antipsychotics/ Cholinesterase Inhibitors Haloperidol (Haldol) antipsychotic 1st generation – given daily Assess for dizziness, faintness, palpitations Monitor: orthostatic BP, HR, dry mouth -causes Primary .Tardive Dyskinesia (causes stiff, jerky movements of your face and body that you can’t control) cannot be reversed -if the patient has problems with taking meds daily, give them a monthly shot of Haloperidol decanoate (Haldol) Fluphenazine (Prolixin) antipsychotic 1st generation – given daily Assess: gastric irritation, blurred vision, dry eye Monitor: BP, resp, bilirubin, CBC, LFT, eye sight -if the patient has problems with taking meds daily, give them a monthly shot of Fluphenazine decanoate (Prolixin) Clozapine (Clozaril) antipsychotic 2nd generation Assess: dizziness, seizures, fatigue, sweating, blurred, vision Monitor: BP, seizure precaution, myocarditis, HR, I/O, cardiac enzymes -side effect is shuffling gait, give Benadryl. - risk of blood discreatia - patient can go missing -requires you to go before a judge before med can be given Risperidone (Risperdal) antipsychotic 2nd generation Assess: muscle weakness, rhabdo, suicidal ideation, HR, Resp Monitor: BP, fatigue, constipation Ziprasidone (Geodon) antipsychotic 2nd generation Assess: increase HR, vision (blur), nausea, vomiting, rash Monitor: HR QT prolongation, mental status, urinalysis Donepezil (Aricept) anti-Alzheimer’s Assess: dizziness, a-fib, seizures, urinary frequency/incontinence Monitor: BP, HR, mood Memantine hydrochloride (Namenda) Anti-Alzheimer’s Assess: dizziness, heart failure (CHF), coughing, dyspnea Monitor: behavioral changes, hallucinations, confusion Concepts of Health Maintenance: MOOD AND AFFECT- SSRIs/ SNRI/Tricyclic Antidepressant/MAOI’s /Mood stabilizers Sertraline (Zoloft) Used for major depressive disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) panic disorder, social anxiety disorder, premenstrual dysphoric disorder (PMDD) - May take more than 1 weeks for therapeutic effect - May cause drowsiness - Taper off - Serotonin syndrome – agitation, nausea, vomiting, diarrhea, twitching, sweating, shivering; report to prescriber immediately Assess: diabetes, male sexual dysfunction, rash, sweating Monitor: Labs (Na), suicidal ideation appetite, decrease in BP, weights Fluoxetine (Prozac) Antidepressant – SSRI Used for major depressive disorder, obsessive compulsive disorder (OCD), bulimia nervosa, premenstrual dysphoric disorder (PMDD), panic disorder Black box warning: children, suicidal -Do not use MAOI’s with or ideation 14 days before - therapeutic effect may take 1-4 weeks – taper off - may cause orthostatic hypotension Paroxetine (Paxil) Antidepressant, SSRI -used for depressive disorder, obsessive – compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic stress disorder, premenstrual disorders. Social anxiety disorder -black box warning – children, suicidal ideation -do not sue with MAOI’s, pimozide, thioridazine; potentially fatal reactions can occur. Amitriptyline (Elavil) Antidepressant – tricyclic -used for major depression - black box warning – children <12, suicidal patients - black box warning – mood, sensorium, affect suicidal tendencies; increase in psychiatric symptoms: depression, panic; suicidal tendencies are higher in those <24 years, restrict amount of product available -therapeutic effects may take 2-3 weeks, taper off -may cause drowsiness -contraception recommended during the treatment -avoid breastfeeding – watch for suicide Venlafaxine (Effexor) Antidepressant – SNRI Used for prevention/treatment of major depression; depression at the end of life; long term-treatment of general anxiety disorder, panic disorder, social anxiety disorder - Black box warning: children, suicidal ideation - Avoid alcohol ingestion - Taper off - Wear sunscreen or large hot because photo sensitivity occurs - Avoid pregnancy or breastfeeding - Monitor BP w/hypertension Selegiline (EMSAM) Anti-Parkinson agent – MAOI, type B Used – adjunct management of Parkinson’s disease for patients being treated with levodopa/carbidopa Who had poor response to therapy; depression (trans-dermal) -Fatal interaction: opioids (especially meperidine); do not administer together - Serotonin syndrome - Due not use with tricyclics - death fluroxetine, Paroextine, sertialine FluvoxaMINE (discontinue 5 wks before selegiline treatment); do not use together Lithium Carbonate – LiCo2 – mood stabilizer, effects kidneys and thyroid (long term therapy leads to hypothyroidism) -effective in the acute treatment of mania and depressive episodes and in the prevention of recurrent mania and depressive episodes -no antidote for Lithium Toxicity (>2.0) – but you can try gastric lavage, treatment with urea, mannitol, aminophylline can hasten lithium excretion, or for extreme cases patient can be put on dialysis -patients need to drink 2-3L of water a day and eat a high sodium diet. -Therapeutic blood level – 0.8-1.4 mEq/dL -Maintenance blood level – 0.4-1.0 mEq/dL (typical is 300 mg, TID or QID) -Toxic blood level – >1.5 mEq/dL -Lithium levels are best obtained approx.. 12 hrs after the admin of the last dose. Valproic acid (Depakote) – taken in conjunction with Lithium Anti-Convulsant -black box warning- Hepatic studies: AST, ALT, bilirubin; hepatic failure has occurred -black box warning – pancreatitis; may be fatal; report immediate nausea, vomiting, anorexia, abdominal pain Carbamazepine (Tegretol) – taken in conjunction with Lithium