Nur 334 Cocurricular 6-28-24 (1).pptx

PROFESS NUR 334 OR COCURRICULAR SEGEBART H   Sertraline (Zoloft), Fluoxetine (Prozac), Escitalopram (Lexapro), Citalopram SELECTIVE (Celexa), Paroxetine (Paxil) SEROTONIN  MOA: inhibits reuptake of serotonin to...

PROFESS NUR 334 OR COCURRICULAR SEGEBART H   Sertraline (Zoloft), Fluoxetine (Prozac), Escitalopram (Lexapro), Citalopram SELECTIVE (Celexa), Paroxetine (Paxil) SEROTONIN  MOA: inhibits reuptake of serotonin to increase serotonin effects  Indications: depression, anxiety, REUPTAKE obsessive compulsive disorder  Off label: premature ejaculation INHIBITORS  SE/AE: insomnia and sexual dysfunction (SSRI)  BBW: inc risk for suicide  First line for depression and anxiety  Relatively safe in pregnancy   Duloxetine (Cymbalta), Venlafaxine (Effexor) SEROTONIN  MOA: inhibit reuptake of serotonin NOREPINEPHRIN and norepinephrine to inc effects  Indications: anxiety, major E REUPTAKE depression, migraine prevention, fibromyalgia INHIBITORS  SE/AE: sexual dysfunction, insomnia, hypertension, ortho (SNRI) hypotension, hepatoxicity  BBW: inc risk for suicide  Amitriptyline (Elavil), Nortriptyline, Imipramine (Tofranil) MOA: inhibit reuptake of serotonin and norepinephrine Indications: depression Off label: fibromyalgia, IBS, migraines, TRICYCLIC anxiety and withdrawal syndrome SE/AE: anticholinergic effects, ECG changes like tachycardia, CNS depression, ortho ANTIDEPRESSAN hypotension, sedation, weight gain, urinary retention, blurred vision BBW: inc risk for suicide TS (TCA) Not first line tx as takes many weeks to work Doxepin (Silenor) MOA: histamine antagonist for insomnia Indications: depression, insomnia  Phenelzine (Nardil) MOA: monoamine oxidase inhibits MONOAMINE norepinephrine, dopamine, epinephrine and serotonin. MAO Inhibitors block this so it inc amount of these neurotransmitters Indication: depression OXIDASE Off label: anxiety BBW: inc risk for suicide Interferes with many medications INHIBITORS Not first line treatment SE/AE: ortho hypotension, hypertension when interacting with tyramine foods (aged cheese, cured meats, bananas, citrus (MAOI) fruits), insomnia, anticholinergic effects Pt education: avoid foods with tyramine, need about 7-14 days in-between stopping an MAOI med and starting up another antidepressant  MOA: inhibits uptake of norepinephrine and dopamine Indication: depression. If used for BUPROPION smoking cessation called Zyban Off label: ADHD, bipolar (WELLBUTRI SE/AE: risk for seizures and insomnia BBW: inc risk for suicide and N) neuropsychiatric events (psychosis, seizures, suicidal or homicidal ideation)  MOA: inhibits reuptake of serotonin. Blocks histamine and alpha one adrenergic receptors TRAZADONE Indication: depression Off label: aggression or agitation from dementia and insomnia (OLEPTRO) SE/AE: dizziness, drowsiness, dry mouth, ECG changes, ortho hypotension BBW: inc risk for suicide  MOA: monoaminergic neuronal activity, suppressing serotonergic activity while enhancing dopaminergic and noradrenergic cell firing BUSPIRONE Indication: anxiety (BUSPAR) Off label: depression SE/AE: sexual dysfunction and CNS effects or extrapyramidal symptoms (EPS; movement disorders: akathisia, parkinsonism, dystonia)  Lorazepam (Ativan), Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonopin) MOA: GABA agonist, GABA is an inhibitory neurotransmitter that slows down cerebral functions Indications: seizure disorder, insomnia, anxiety, BENZODIAZEPINE sedation, muscle relaxant, panic disorder SE/AE: muscle weakness, hypotension, sedation, S respiratory depression, lightheaded BBW: do not mix with other CNS depressants. Can cause addiction and dependency Controlled substance First line for cessation of acute generalized seizures Pt education: do not mix with alcohol or other CNS depressants Tx for overdose: Flumazenil   Lithium (Lithobid)  MOA: reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission; broad effects are underpinned by complex neurotransmitter systems that strive to achieve homeostasis by way of compensatory changes  Indication: bipolar disorder  Off label: depression MOOD  Requires serum concentration monitoring as narrow STABILIZER therapeutic index  Therapeutic response: 0.4-1.2mEq/L  Toxic usually above 1.5 mEq/L  SE/AE: cardiac/renal/CNS effects, polyuria, polydipsia, bradycardia, weight gain  BBW: monitor lithium levels for toxicity  Pt education: requires lab monitoring, due to interfering with antidiuretic hormone (ADH) pt must drink adequate fluids  Valproic Acid (Depakote) MOA: inhibition of voltage-gated sodium channels which decrease neuron excitability and firing rate. This prevents the generation and propagation of abnormal electrical VALPROATE impulses responsible for triggering seizures. Enhancement of GABA synthesis Indications: seizure disorder, migraines, bipolar disorder BBW: hepatoxicity, teratogenic, pancreatitis, thrombocytopenia, bleeding, inhibits platelets   MOA: prolongs sodium channel inactivation, blocks specific calcium channels and blocks glutamate  Indications: seizure and bipolar disorder LAMOTRIGINE Off label: panic disorder, anxiety, migraines and headaches, binge eating disorder, (LAMICTAL) borderline personality disorder, posttraumatic stress disorder (PTSD)  BBW: steven johnson syndrome, hemophagocytic lymphohistiocytosis, angioedema, toxic epidermal necrolysis   Methylphenidate (Ritalin), Amphetamine (Adderall), Dextroamphetamine (Dexedrine)  MOA: cause release of norepinephrine and dopamine CNS STIMULANTS  Indications: ADHD and narcolepsy  SE/AE: weight loss and insomnia  BBW: abuse and dependence  Controlled substance  First line for ADHD  May recommend a “drug holiday” during the summer for kids  MOA: blocks reuptake of norepinephrine to inc its effects ATOMOXETINE Indication: ADHD Less effective than CNS stimulants (STRATTERA) so second line Not a controlled substance  MOA: inhibits reuptake of dopamine to inc levels MODAFINIL Indications: daytime fatigue from narcolepsy, ADHD, obstructive sleep (PROVIGIL) apnea, shift work sleep disorder Off label: depression and fatigue Controlled substance DUAL OREXIN RECEPTOR ANTAGONIST (DORA) Daridorexant (Quviviq), Suvorexant (Belsomra) MOA: blocks orexin A and B which suppress the wake drive Indication: insomnia Not for long term use Controlled substance Monitor for safety at night HISTAMINE ONE RECEPTOR ANTAGONIST (ANTIHISTAMINE) Doxylamine (Unisom), Hydroxyzine (Vistaril) MOA: decreases histamine which leads to sedation Indications: insomnia, nausea in pregnancy, anxiety, allergies BENZODIAZEPINE RECEPTOR AGONIST (BZRA) Zolpidem (Ambien), Eszopiclone (Lunesta) MOA: enhances the inhibitory activity of GABA receptors to suppresses neural transmission in the brain and induce sleep Indication: insomnia Not for long term use Controlled substance SE/AE: dizziness, drowsiness, falls BBW: abuse and dependence Goal is to reduce the number of times you wake up at night Monitor for safety at night MELATONIN RECEPTOR AGONIST Ramelteon (Rozerem) MOA: activates melatonin receptors which control circadian rhythm and sleep/wakefulness Indication: insomnia Not a controlled substance Relatively safe for long term use FIRST  Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol) GENERATION  MOA: blocks dopamine 2 receptors ANTIPSYCHOTIC  Indication: schizophrenia  Off label: bipolar disorder and nausea S  Haloperidol used for acute psychosis  SE/AE: drowsiness, anticholinergic effects, sexual dysfunction, ortho (TYPICAL) hypotension  Associated with extrapyramidal symptoms (EPS; CNS system affected) and neuroleptic malignant syndrome (NMS; rigidity, high fever)  BBW: not for use in dementia related psychosis (inc risk for falls, heart dx and DM)  Pt education: med compliance and can take many weeks to work SECOND  Lurasidone (Latuda), Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasiodone (Geodon) GENERATION  MOA: blocks dopamine 2 and serotonin receptors ANTIPSYCHOTIC  Indications: bipolar disorder, depression and schizophrenia  Off label: delusional disorder and obsessive compulsive disorder S  SE/AE: weight gain, hyperglycemia, dyslipidemia, Central Nervous System effects or EPS (less likely than first gen), NMS, (ATYPICAL) ortho hypotension  Ziprasidone used for acute psychosis  BBW: not for use in dementia related psychosis (inc risk for falls, heart dx and DM)  Pt education: pt compliance   Aripiprazole (Abilify) THIRD GENERATION  MOA: partial agonist and antagonist of dopamine 2 receptors ANTIPSYCHOTIC  Indications: bipolar I disorder, irritability associated S with autism spectrum disorder, schizophrenia, and Tourette's disorder (ATYPICAL)  SE/AE: skin rash, angioedema, hyperglycemia, NMS, EPS, seizures, priapism, stroke, impulsive behaviors  BBW: inc risk for suicide, not for use in dementia related psychosis DRUGS FOR ANXIETY Anxiolytics: Antidepressa Benzodiazepi nts: TCA, nes, SSRI, SNRI Buspirone DRUGS FOR INSOMNIA  DORA  Antihistamines  BZRA  Melatonin Receptor Agonist  Modafinil  TCA DRUGS FOR DEPRESSION  Antidepressants: SSRI, SNRI, TCA, MAOI, Bupropion, Trazadone  Antiseizure Mood Antipsychotic Drugs: Stabilizer: s: Valproic Acid, Lithium Risperidone Lamotrigine DRUGS FOR BIPOLAR DRUGS FOR ADHD  CNS Stimulants  Atomoxetine  Modafinil DRUGS FOR SCHIZOPHRENIA Second First Gen Third Gen Gen Antipsycho Antipsycho Antipsycho tics tics tics TAKE AWAY NURSING IMPLICATIONS/PT EDUCATION Some people utilize St. John’s Wort for Meds should be used mental health but this Meds may take in conjunction with does increase several weeks to nonpharm options; serotonin level; need work therapy, music, to remember exercise, journaling serotonin syndrome (SES) Remind pts and Meds need to be family members that Avoid alcohol tapered off some meds inc risk for suicide PREVIEW FOR MODULE 6-RESPIRATORY  SABA  LABA  Anticholinergics  Systemic/Inhaled/Intranasal Glucocorticoids  Methylxanthines  Leukotriene Receptor Antagonists  Antitussives  Expectorants  Mucolytics