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prevent feelings of tension or fear


anxiolytics


make GABA more effective


benzodiazepine


acute narrow angle glaucoma is a contraindication with what class of meds?


benzodiazepines


acute alcohol intoxication, liver disorders are contraindicated with what class of meds?


benzodiazepines


what class of meds should be used with caution in elderly people because of unpredictable reactions?


benzodiazepines


what increases the effects of benzodiazepines?


cimetidine [tagamet], disulfiram [helps alcoholism], and oral contraceptives


what decreases the effects of benzodiazepines?


theophylline or ranitidine [zantac]


Diazepam [benzodiazepine] overdose


confusion
seizures
abnormal perception of movement
respiratory depression
excessive sedation


what anxiolytic and hypnotic med must be tapered off over 2 weeks?


chloral hydrate [Aquachloral]


abrupt stop of anxiolytic and hypnotic meds can cause...


withdrawal effects such as
insomnia
seizures
palpitations


the number or sensitivity of post synaptic receptors may increase, depleting what levels?


neurotransmitter levels

so increase of post synaptic receptors deplete neurotransmitter levels


reduces or inhibits the reuptake of 5HT and NE into nerves


TCA\'s [line]


what are contraindications of TCA\'s


liver disease
dry mouth
pregnancy & lactation
recent MI
myelography
known allergy


TCA\'s adverse reactions


dry mouth
sedation
fatigue
hallucinations
ataxia
constipation
nausea
vomiting
sleep disturbances


Phenelzine [Nardil] Naedine


MAOI\'s used for patients whi did not respond to newer safer antidepressants.


Tranylcypromine [Parnate]


Used for adult outpatients with reactive depression


MAOI\'s peak in...


peak 2 to 3 hours


MAOI\'s adverse reactions


hypoglycemia


MAOI\'s drug to drug interactions


other antidepressant - hypertensive crisis, coma
insulin or oral diabetic agents - additive hypoglycemia
no OTC meds should be taken



SSRI\'s adverse reactions


indomnia,
headache,
tremor,
agitation,
weight loss,
dry mouth








how are Alferon-N produced?


they are interferons produced by harvesting human leukocytes & injected directly into warts


how is avonex produced?


Chinese hamster ovary cells


actions of interferons


preventing virus particles from replicating inside other cells


what interleukins produced by?


dna technology using E Coli


3 things inteferons are used for


viral infections
autoimmune disorders
cancer


inhibits tumor cells and enhances the immune response


interferon


chemicals produced by T cells to communicate between leukocytes


Interleukins


avoid these while on interferons


oral contraceptives & alcohol


[neumega] oprelvekin


interferons for chemo


increase the amount of killer cells and stop tumor growth


interleukins


increase production of regular cells


inteferons


Aldesleukin


interleukin med known to stop the growth of tumors


immun stimulators diagnosis


acute pain related to CNS, GI, and flu like symptoms.


patients on immune stimulators should be taught to avoid what


avoid pregnancy use barrier method.


Cyclosporine [sandimmune]


Suppression of rejection in transplant patients, RA, and psoriasis


immune suppressors are used with?


corticosteroids, especially wit trasplant pts because they block the effects of the normal immune system


prevents rejection of transplant patients. used for patients who have not responded to traditional rheumatoid arthritis therapy


Anakinra


antibodies that attach to specific receptors


monoclonal antibodies


nursing diagnosis for immune suppressors


acute pain related to CNS, GI, and flu iike effects


interleukin receptor antagonist interactions


etanercept may cause severe / life threatening infections


it\'s provided by stimulating production of antibodies to a specific anntigen


active immunity


preformed antibodies are injected into the system and react eoth specific antigen.


passive immunity


limited immunity


passive immunity


lifelong immunity


active immunity


recommended for all children who have not been exposed to varicella


chickenpox vaccine


when is MMR vaccine given?


12 to 15 months and between 4 to 6 years old


give what vaccine for small pox?


dryvax


pneumococcal vaccine is given


once in a lifetime or again when over 65 years old.


how do you test immunity?


titers-serum antibody levels are drawn


vaccine contraindications


patients who received immune globulin or blood to vlood products within the last 3 months.
caution wirh history of febrile convulsions or cerebral injury
acute infection
where high fever would be dangerous
immunosuppressed patients
patients on corticosteroids


nurse diagnosis for vaccines


acute pain related to injection
GI
flu like symptoms
ineffective tissue perfusion if severe reaction occurs
deficient knowledge of therapy


dont give vaccines with what meds


immunosuppressants or corticosteroids


provides passive immunity to a specific antigen or disease


immune sera ex: tb shot given every 10 yrs


bring information into the CNS


peripheral nervous system [pns] sensory receptors


what nerves carry info away from the CNS?


motor nerves


carry information into the neuron from other neurons


dendrites


energy required by nerves are provided by ?


oxygen and glucose


electrolytes involved in nerve cell action


calcium
Sodium
potassium


action of depolarization


sodium goes into the cell abs potassium leaves the cell


what increases synaptic transmission


neurotransmitters


communicates between nerve & muscle


acetylcholine


inhibits nerve activity & is important in preventing over-excitability or stimulation such as seizure activity


GABA


important in arousal, sleep, & in preventing depression and promoting motivation. mood


serotonin


injury to this part of the brain can cause changes in basic vital functions


hindbrain [medulla oblongata]


this part of the brain relays motor impulses from the cortex to the spinal cord


mid brain [thalamus]


a person with damage to the mid brain may have difficulty determining


hot & cold


limbic system contains high levels of which neurotransmitters?


epinephrine
norepinephrine
serotonin


limbic system controls


behavior


a catecholamine thst is classed as a hormone also


norepinephrine


forbrain


receives and sends nerve impulses, coordinate speech and communication, and facilities learning


when a person learns [forbrain] the action begins as an electrical circuit called


Engram


what increases actual learning?


oxytocin


regulate. the communication between sensory and motor neurons


the 2 brain hemispheres


which side of the brain if damaged will make you unable to distinguish a spoon from a fork?


right side (artistic)


extreme sedation resulting in further CNS depression and sleep


hypnosis


antidote to Diazepam [Valium]


flumezanil [romazicon or anexate]


benzodiazepines peak levels achieved in ?


30 minutes to 2 hrs


when giving barbiturates, nurses should observe for what?


excitability


what 2 meds are given preoperative and postoperative to decrease the need for narcotics, prevents anxiety, nausea and vomiting?


phenergan [promethazine] and benadrl [diphenhydramine]


use off label for s/s of premenstrual syndrome


Buspirone [BuSpar]


which med unique because it lacks muscle relaxant & anti convulsion effects.


Buspirone [BuSpar]


Deficiency of which two chemicals can result in depression because more is left in the body?


Norepinephrine [NE] & Serotonin [5HT]


these breaks down serotonin and NE left in the body so that they are recycled or restored in the neuron.


MAO\'s


there is a black box warning about the increase risk of suicide in children and adolescents on which meds?


antidepressants


classifications of antidepressants


TCA\'s
MAOI\'s
SSRI\'s


MAOI\'s food interactions


Tyramine
fermented cheeses, caffeine, alcohol, chocolate


given to patients who do not respond or can\'t tolerate safe antidepressants


MAOI\'s


the newest group of antidepressants



SSRI\'s


specifically block the reuptake of 5HT wirh little to no effect on NE


SSRI\'s


allows NE, 5HT, snd dopamine to accumulate in the synaptic cleft


MAOI\'s


prototype of SSRI\'s


Prozac [fluvoxamine]


class of med given for OCD, bulimia, panic attacks, PMDD, PTSD, social phobias


SSRI\'s


stabdard drug of choice to treat OCD


Prozac


Newly approved med to treat OCD


Clomipramine


nursing diagnosis for SSRI\'s


disturbed thought process
disturbed sensory perception [visual, auditory, kinesthetic, tactile, olfactory] related to CNS effects


people on these meds should be placed on suicide watch


SSRI\'s


SSRI\'s evaluation


should be taken QD in the am


Bupropion [Welbutrin, Zyban]
Venlafaxine [Effexor] -comes in ER


miscellaneous antidepressants