Pharmacology Notes PDF

gait, rigidity, bradykinesia, tremors at rest, pill-rolling NCM 106: PHARMACOLOGY [ CNS DRUGS ] motion of the hand. ANTIPSYCHOTIC DRUGS - treatment of psychosis Akathisia - restless, trouble standing still, paces the...

gait, rigidity, bradykinesia, tremors at rest, pill-rolling NCM 106: PHARMACOLOGY [ CNS DRUGS ] motion of the hand. ANTIPSYCHOTIC DRUGS - treatment of psychosis Akathisia - restless, trouble standing still, paces the floor, feet in constant motion, rocking back and Action: Block D2 dopamine receptors in the brain, forth. particularly in areas like the basal nuclei, to reduce schizophrenia symptoms by inhibiting dopamine's Acute dystonia - facial grimace, involuntary upward effects. eye movement, muscle spasms of tongue, face, neck and back, laryngeal spasms Effects: Control symptoms such as hallucinations, delusions, and stabilize mood. Tardive dyskinesia - protrusion and rolling the tongue, sucking and smacking movements of the lips, Schizophrenia chewing motion, facial dyskinesia, involuntary movements of the body and extremities. Positive Symptoms: CNS Stimulation; agitation, behavioral disturbances, delusions, disorganized Neuroleptic Malignant Syndrome (NMS) speech, hallucinations, insomnia, paranoia. Symptoms: Fever, muscle rigidity, tachycardia, Negative Symptoms: anhedonia (lack of pleasure), respiratory distress, renal failure. 24-72 hours lack of motivation, blunted affect, poor grooming symptoms develop rapidly. and hygiene, poor social skills, poverty of speech, social withdrawal. Nursing Considerations: Stop antipsychotics immediately, administer dantrolene or TYPICAL bromocriptine, provide supportive care, and monitor vital signs. Phenothiazines ATYPICAL (2nd Generation) PROTOTYPE DRUG: Chlorpromazine Hydrochloride (Thorazine) PROTOTYPE: Clozapine (Clozaril) THERAPEUTIC CLASS: Conventional Antipsychotic, Clozapine is chemically different from the older schizophrenia drug antipsychotic drugs. It blocks both dopamine and serotonin receptors in the brain. It is indicated for PHARMACOLOGIC CLASS: D2 dopamine receptor clients with schizophrenia, including those who have antagonist; phenothiazine exhibited recurrent suicidal behavior. ACTIONS: It provides symptomatic relief of positive Advantages of clozapine include improvement of symptoms of schizophrenia and controls manic negative symptoms, without causing the symptoms in patients with schizoaffective disorder. extrapyramidal effects associated with older Many patients must take chlorpromazine for 7 0r 8 antipsychotic drugs. weeks before they experience improvement. Extreme agitation may be treated with IM/IV The reason for the second-line status of clozapine is injections which begin to act within minutes. It can its association with Agranulocytosis, a also control severe nausea and vomiting. life-threatening decrease in white blood cells (WBCs), which usually occurs during the first 3 months of Non Phenothiazines therapy. Weekly WBC counts are required during the first 6 months of therapy; if acceptable WBC counts PROTOTYPE: Haloperidol (Haldol) are maintained, then WBC counts can be monitored First-Generation “Typical” Antipsychotics every other week. In addition, clozapine is reportedly more likely to cause constipation, dizziness, Frequently used, potent, long-acting drug. It is well drowsiness, hypotension, seizures, and weight gain absorbed after oral or intramuscular (IM) than other atypical drugs. administration, is metabolized in the liver, and is excreted in urine and bile. It may cause adverse NURSING MANAGEMENT: effects similar to those of the phenothiazines. 1. Prevent Falls: Supervise walking if the client is Usually, it produces a relatively low incidence of drowsy, elderly, or has low blood pressure. hypotension and sedation and a high incidence of extrapyramidal effects. 2. Manage Low Blood Pressure: Have the client lie down for an hour after large doses of antipsychotic ExtraPyramidal Syndrome (EPS): SIDE EFFECTS meds. Use elastic stockings. Encourage gradual Pseudo-parkinsonism - stooped posture, shuffling position changes, leg elevation when sitting, avoiding long standing, and avoiding hot baths. to 3 hours peak level, distributed in water, and Consider lowering the dose or splitting it into smaller excreted by kidneys. doses. Role of Sodium: Low sodium increases lithium 3. Prevent Dry Mouth and Infections: Brush teeth retention, risking toxicity; stable sodium intake is frequently, rinse with water, chew sugarless gum or essential. candy, and drink adequate water (but not too much to avoid electrolyte issues). Nursing Responsibilities: 4. Prevent Constipation: Increase fluid intake, eat 1. Obtain baseline: renal, cardiac, thyroid more fiber, and encourage regular exercise. 2. Monitor WBC for Leukocytopenia & ____________________________________________ Agranulocytosis BIPOLAR DISORDERS 3. Increase fluid intake Signs and Symptoms: Distractibility, Impulsivity, 4. Avoid excessive exercises and warm environment Grandiosity, Flight of Ideas, Activity increase, Sleep Deficit, Talkativeness 5. Assess for signs of lithium toxicity 6. Therapeutic level of lithium: 0.5 to 1.5meq/L Serotonin Syndrome Maintenance dose - 0.6 to 1.2 meq/L Triad Manifestation: Hyperreflexia, hypertension, hyperthermia. Elderly - 0.5 to 1.0 meq/L Additional Symptoms: Confusion, agitation, muscle Drug Interactions rigidity, tremors, diaphoresis. With TCA, SSRI, MAOI: Educate patients to Management: Discontinue serotonergic agents, avoid combinations to prevent risks like provide supportive care, use benzodiazepines for hypertensive crisis (MAOI) and serotonin muscle relaxation, and monitor hydration. syndrome (SSRI). Monitor mood and ____________________________________________ behavior, especially with TCAs. LITHIUM Orthostatic Hypotension Action: Alters sodium transport in nerve and muscle Monitoring: Track electrolytes and renal cells, stabilizes mood by decreasing norepinephrine function, monitor blood pressure changes and dopamine release. after starting or increasing dosages. Contraindications: ____________________________________________ Allergy to Lithium: Avoid use if there's a known allergy DEPRESSION to lithium. Criteria: Kidney or Heart Problems: Can worsen existing kidney Mood - depressed or heart conditions. Sleep - increased/decreased Interest - decreased Low Sodium, Dehydration, or Diuretic Use: Lithium Guilt lowers sodium levels, risking severe sodium deficiency and toxicity. Energy - decreased Concentration - decreased Pregnancy and Breastfeeding: Can harm the fetus or Appetite - increased/decreased newborn; birth control is recommended for women of Psychomotor - agitation/retardation childbearing age. Suicidal ideation Persistent Diarrhea or Excessive Sweating: Can lead to low sodium and increased lithium toxicity. Suicidal Thoughts, Impulsivity, or Infection with Fever: Lithium’s toxic effects may worsen in these cases. Pharmacokinetics: Absorbed in the GI tract 30 mins  Tricyclic Antidepressants (TCAs) Purpose SSRIs (Selective Serotonin Reuptake Inhibitors) Use: Prescribed when SSRIs or other antidepressants aren’t effective. A common type of antidepressant medication. How They Work: Help keep serotonin and norepinephrine available in the brain, which Used to treat depression by boosting serotonin can help improve mood. levels in the brain. Common TCAs How SSRIs Work Examples: Amitriptyline, Amoxapine, Clomipramine Serotonin is a chemical that promotes feelings of (Anafranil), Desipramine (Norpramin), Doxepin, well-being. Imipramine (Tofranil). SSRIs prevent serotonin from being absorbed too Side Effects quickly, keeping more in the brain, which helps with depression symptoms. Common: Constipation, dry mouth, fatigue. Serious: Low blood pressure, irregular heart Indications (Uses): Depression, rate, seizures. Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD), Other Uses Bulimia, Premenstrual Dysphoric Disorder (PMDD), Menopause-related hot flashes, Anxiety Treat OCD, chronic pain, migraines, panic disorder (often at lower doses). Common Side Effects: Nausea, Difficulty sleeping, Nervousness, Tremors, Sexual issues How They Affect the Body Pharmacokinetics (How SSRIs are Processed): Muscles & Digestion: Impact muscle control for Absorbed in the digestive tract, Processed by the body functions like secretions and digestion. liver, Excreted through urine and feces. Histamine Blockage: Can cause drowsiness, blurred vision, dry mouth, constipation, and Caution may worsen glaucoma. Patients with kidney or liver issues: May have Pharmacokinetics trouble processing the drug. Absorption: Well absorbed from the GI tract; Severe Depression or Suicidal Patients: Higher risk in peak in 2-4 hours. children, teens, and young adults. Distribution: Lipid-soluble and binds to proteins; crosses placenta and enters breast Pregnancy: SSRIs can lead to birth defects. milk. Nursing Considerations Cautions 1. Allergies: Check for any known allergies to 1. Cardiovascular Disorders: May worsen heart SSRIs. conditions. 2. Severe Depression or Bipolar Disorder: SSRIs 2. Other Conditions: Avoid with glaucoma, may worsen these conditions. urinary retention, prostate issues, or recent 3. Kidney and Liver Function: Important for GI/genitourinary surgery. processing and clearing the drug. 3. Mental Health Risks: Can worsen psychosis in 4. Pregnancy and Breastfeeding: Assess female psychiatric patients and may shift patients carefully. manic-depressive patients to mania. 5. Baseline Assessment: Record vital signs, 4. Risk of Seizures: Increases risk in those with weight, skin condition, mood, reflexes, vision, seizure history, the elderly, or those with and bowel sounds before starting treatment. hepatic/renal issues. ____________________________________________ Interactions Excretion: Excreted through urine. Alcohol: Decreases effectiveness, increases Patients with liver or kidney issues, or those with sedation. slow drug metabolism, may need lower doses. Epinephrine: Increases heart effects, can raise blood pressure and cause rhythm issues. Nursing Considerations Nursing Considerations 1. Check for allergies to MAOIs to prevent 1. Allergies: Check for any known drug allergies. hypersensitivity reactions. 2. Liver/Kidney Function: Monitor as issues here 2. Assess liver and kidney function, as these can affect drug processing. affect drug breakdown and excretion. 3. Pre Existing Conditions: Glaucoma, prostate 3. Cardiac, GI, or GU issues: Be cautious, as issues, cardiac problems, GI issues may these may worsen with MAOI use. worsen with TCAs. 4. Check for seizure disorders or suicidal 4. Mental Health History: Check for seizures, tendencies; MAOIs can increase these risks. psychiatric history, or recent MAOI use to 5. Pregnancy/breastfeeding: Avoid MAOIs, as avoid serious reactions. they are not safe during pregnancy or 5. Vitals & Baselines: Record vitals, weight, skin, lactation. affect, reflexes, vision, and bowel sounds to 6. Baseline assessment: Record vital signs, monitor therapy and side effects. weight, skin condition, mental status, ____________________________________________ reflexes, vision, and bowel sounds before starting therapy. Monoamine Oxidase Inhibitors (MAOIs) ____________________________________________ Purpose MAOIs are older antidepressants that work by ANXIETY AND ANXIETY-RELATED DISORDERS preventing the breakdown of norepinephrine, Anxiety dopamine, and serotonin. They are less commonly A state of worry or unease about a potential threat, used today due to their dietary and drug interactions. often without a clear cause. Side Effects Generalized Anxiety Disorder (GAD) Nausea Excessive, uncontrollable worry lasting 6 months or Dizziness more, affecting daily life. Drowsiness Panic Disorder Trouble sleeping Sudden, intense fear with physical symptoms (rapid Restlessness heartbeat, sweating, etc.). Important Interactions Anxiety-Related Disorders Food: Avoid foods high in tyramine (e.g., aged Phobias: Intense fear of specific objects or cheese, soy sauce, draft beer) to prevent situations (e.g., spiders, crowds). dangerous blood pressure spikes. Obsessive-Compulsive Disorder (OCD): Drugs: Don’t combine with other Repetitive thoughts or actions disrupting daily antidepressants or stimulants (risk of life. serotonin syndrome). Post-Traumatic Stress Disorder (PTSD): Anxiety after traumatic events, often with Pharmacokinetics flashbacks. Absorption: Absorbed well from the GI tract, Signs and Symptoms reaching peak levels in 2-3 hours. Restlessness, fatigue, muscle tension, nervousness, Metabolism: Primarily metabolized in the trouble focusing, sleep problems. liver.  Heart Issues: Slow heart rate, low blood pressure (especially when given by IV). BENZODIAZEPINES FOR ANXIETY Allergic Reactions: Skin rashes, severe reactions like Steven-Johnson syndrome. Examples 1. Alprazolam (Xanax) 2. Chlordiazepoxide (Librium) NURSING CONSIDERATIONS 3. Clorazepam (Klonopin) 4. Clorazepate (Tranxene) Check for Allergies: Prevents hypersensitivity 5. Diazepam (Valium) reactions. 6. Lorazepam (Ativan) Baseline Assessment: Check vital signs, skin color, mental state, and digestive health How They Work before starting therapy. Quickly absorbed in the stomach, reaching peak levels in 30 minutes to 2 hours. They spread throughout the body, including across the placenta and breast milk. Lower doses are needed for patients with liver issues. Who Shouldn’t Use Them 1. People allergic to benzodiazepines 2. Those with psychosis 3. Those with narrow-angle glaucoma 4. People in shock, coma, or under alcohol influence 5. Pregnant or breastfeeding women (risk to baby) 6. Elderly or frail individuals (risk of unpredictable reactions) Important Note Mixing with alcohol or other depressants increases the risk of severe CNS depression. BARBITURATES FOR ANXIETY AND SLEEP (Older Drugs) How They Work Depress the CNS, reducing brain activity. Can cause sedation, hypnosis, or in high doses, coma. Pharmacokinetics Absorbed within 20-60 minutes, metabolized in the liver, and excreted mostly unchanged in urine. Barbiturates can increase liver enzyme activity, affecting other drugs. Side Effects Common: Drowsiness, confusion, dizziness, "hangover" feeling, nausea, vomiting, breathing issues.