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neuromalignant syndrome
occurs with typical antipsychotic like haloperidol haldol dopaminergic carbidopa levodopa s/s fever, sweats, tachycardia, muscle rigidity, tremor, delirium
hypertensive crisis
occurs with MAOI phenelzine (from tyramine foods) s/s HA, heart palpitations, increased BP, N/V, dilated pupils
seratonin syndrome
occurs with SSRIs s/s CNS problems, confusion, restlessness
anticholinergic crisis
occurs with TCA nortriptaline MAOI phelezine atypical antipsychotic olanzapine antipsychotic cholorpromazine s/s mad as a hatter. blind as a bat. red as a beet. dry as a bone
EPS extra pyrimidal symptoms
occurs with typical antipsychotic haloperidol haldol atypical antipsychotic olanzapine s/s from lack of dopamine and increased cholinergic stimulation parkinson like efffects (cog wheel, rigid muscles) akathesia (restless) dystonia (muscle contraction, spasms) tardive dyskinesia (lip smack, tongue protrusion, blinking)
use for benzodiazapine lorezepam
status epilepticus, ETOH withdrawl, anxiety, induce sleep, pre surgery
adverse effects of SSRI sertraline TCA nortriptaline MAOI phelezine
serotonin syndrome anticholinergic anticholinergic AND HTN crisis
lithium toxicity
coarse hand tremor, GI prob, CNS (blur vision, drowsiness, slurred speech)> can lead to to ceizure and coma. also, arrthmia, stumbling, ataxic, increased VS. *treat the symptoms not the lab results!
adverse effects of typical antipsychotic haloperidol atypical antipsychotic olanzapine antipsychotic chlorpromazine
EPS, neuromalignant syndrome EPS, anticholinergic anticholinergic
preg category A
no risk
prep category B
no risk no human tests
prep category C
risk no human tests
preg cat D
in life threatening situations if benefit> risk
preg cat X
risk, contraindicated
valporic acid
mood stabilizer treats mania aspect of bipolar larger TI than lithium
lithium
mood stabilizer treats both aspects of bipolar small TI .6-1.2 therapeutic dose (imp to monitor blood levels!) <2 lethal, fatal OD level .5-3 hrs steady state competes with NA for reabsorption in the proximal renal tubule. dehydration + lithium intake=increased lithium in the system
benzodiazepine lorazepam (ativan)
treat anxiety, induce sleep, presurgery, plus *status elipepticus seizure from ETOH withdrawl* dont give to pt with resp probs (COPD), admin slowly, dont take with ETOH b/c it depresses the CNS
SSRI (selective seratonin reuptake inhibitor) sertraline
major depression, anxiety, ocd -first line of defense -takes 10 days-4 weeks onset -take same dose for 6-9 months -good because you cant OD on them -SERATONIN SYNDROME=CNS s/s, hyporeflexia, shiver, n/v
TCA (tricyclic) nortriptaline
treats major depression, anxiety -second line of defense -ANTICHOLINERGIC CRISIS -can OD on it, dont give too many meds -cardiotoxic, can cause fatal arrythmia
MAOI phenelzine (nardil)
major depression, anxiety. -last resort! -no tyamine foods, can lead to hypertensive crisis -also, anticholinergic crisis -no herbs, no cold remedy, no adrenergic agonists
typical antipsychotic haloperidol (haldon)
psychotic disorders, treats POSITIVE symptoms ONLY, treats tourettes. -neuromalignant syndrome -EPS effects -very very potent! -typical antipsychotic targets ALL dopamine receptors
atypical antipsychotic olanzapine (zyprexa)
psychotic disorders, treats BOTH POSITIVE AND NEGATIVE symptoms. -adverse are EPS (but better than haldol) -adverse are anticholinergic -increased lipids in blood> weight gain -watch cholesterol, blood glucose
antipsychotic chlorpromazine (thorazine)
psychotic disorders. -high dose, low potency (not as likely EPS) -anticholinergic
acethylcholinesterase enzyme inhibitor (rivastigmine)
mild to moderate alzheimers dementia -not a cure, minimizes symptoms -monitor weight, give nutritional supplements -enchances cholinergic function by increasing Ach through inhibition of AchE. -GI effects, bradycardia
dopaminergic carbidopa-levodopa
parkinsons disease and restless leg syndrome -second line of defense, first use anticholinergics (benadryl) -takes 1-6 months to take effects -increase risk for falls -pt gets involuntary movements -GI effects -on-eff effect with akinesia -neuroleptic malignant syndrome
anticholinergics benzotropine and diphenydramine (benadryl)
parkinson syndromes, and control of tremors dystonias akinesia -OTC so easier to access, its easier to fix Ach than dopamine -anticholinergic S/E
phosphodiesterase type 5 inhibitor slidenafil (viagra)
erectile dysfunction -NO NITRATES -vasodilation (alpha 1 blocker) -take 1 hr before activity, no high fat foods, need sex stimulation, no nitrates. -s/e facial flushing, HA, blue-tinged vision, orthostatic hypotension
5 alpha reductase inhibitor (finasteride)
BPH and male pattern baldness -s/e is erectile dysfunction -converts testoterone to dihydrotestosterone -alpha 1 blocker -effects seen in 6-12 monthts
biphosphonate alendronate (fosamax)
osteoporosis in post menopausal women -hypocalcemia -electrolyte disturbance -*take 30 min before eating, dont lie down for 30 min after. take CA supplements
oxytocic (oxytocin)
initiate or augment labor contractions, stop post partum bleeding -effect seen within for min -give via IV piggyback -WATER INTOXICATION= CNS problems, plus cramps, N/V -UTERINE HYPERSTIMULATION=cld lead to uterine rupture, contraction 90 sec in duration, base ton 15mmhg, contraction tone 50mmhg
tocolytic terbutaline (retrodine)
inhibit uterine activity, controls preterm labor betw 20-34 wks -beta 2 agonist -at risk for maternal and fetal heart probs
tocolytic MGSO
treat seizure, preclampsia, eclampsia, PIH -antidote is calcium gluconate -adverse=headache, resp probs, monitor cardiac -monitor for hypotonia
testosterone
-for normal growth dev male sex organs, 2ndary male sex characteristics -alteration in body musculature/fat distrib -stimulation/growth of skel muscle tissue -enhance long bong growth in males -ossification of epiphyseal plates -causes retention of NA, K, Phosporous, and decreased excretion of CA -stimulates RBC productions by enhancing erythropoietic stimulating factor -prepubescent male risk b/c stops bone growth, closes epiphyseal plate early -normally given as a patch (on scrotum, shave 1st)
estrogen
-in lifespan females have a lot of it, til menopause. then we get osteoporosis
progestins
-help maintain pregnancy
neonate risk!
problems excreting b/c immature renal system
typical antipsychotic
targets ALL dopamine receptors
alpha 1 receptor
-vasoconstriction
-increase peripheral resistance
-increase BP
-mydriasis
-close internal bladder sphincter
-NONSELECTIVE SNS effects
alpha 2 receptor
-presynaptic -decrease release of NE, changes SNS outflow -vasodilation (corrects vasoconstriction from alpha 1 overstim) -negative feedback system
beta 1 receptor
-acts mainly on the heart -tachycardia -increased myocardial contractility -increased liplysis -increased speed of conduction
beta 2 receptor
-mostly acts on lungs
-bronchodilation
-vasodilation (in lungs)
-slightly decreased peripheral resistance
-increased glycolysis, changes blood glucose
-increased glucagon release
-relaxation of uterine smooth muscle
cholinergic effects
-decreased intraocular pressure
-miosis
-sweating, salivation, secretions
-bronchoconstriction
-increased GI tone, diarrhea
-decreased BP
-bradycardia
-contraction bladder detrusor muscle
anticholinergic effects
-increase intraocular pressure -mydriasis -photophobia -decrease sweating, salivation -resp depression -decrease GI motility, constipation -decrease BP then increase BP -tachycardia with palpitations -vasodilation -confusion   excess anticholinergic= mad as a hatter blind as a bat red as a beet dry as a bone
drugs in kids
pharmadynamics=immature organs increase risk of toxicities, must change doses for therapeutic effects
-pharmakinetics=absorption increase GI PH, decrease blood flow, increase absorption of topicals, increase surface area.
distribution=**increase h20 conc, decreased fat conc> increase in hydrophilic drugs needed b/c of dilutions and increased toxicity possible with lipophilic, decrease of albumin levels leads to decrease protein binding, immature BBB
metabolism=immature liver, increase in metabolism of oxidized meds b/c of increased reabsorption
excretion=altered b/c immature kidneys
drugs in older adults
metabolism=increased 1/2 life b/c decreased oxidation, decreased liver functioning and size distribution=increase body fat, decrease water > lipophilic drugs have increase adverse effects from increased distribution. decreased body mass, decreased albumin, less effective BBB. aborption is least effected> increase GI PH, decrease in blood flow rate, GI motility, surface area excretion=decrease kidney function, CREATINe LEVELS stay normal because decrease of muscle mass
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