Antipsychotics
First generation antipsychotics can cause what type of movement related adverse effects?
Extrapyramidal symptoms
What is the primary therapeutic goal for agents that treat Parkinson Disease?
Improve the patient’s ability to carry out the activities of daily life and promote independence. Unfortunately, drugs that reverse neuronal degeneration do not exist.
Which neurotransmitter are patients with Alzheimer's lacking?
Acetylcholine
How is serotonin syndrome treated?
Discontinuing the drug, provide supportive care (maintain safety)
Therapeutic level of phenytoin (Dilantin)
10 to 20 mcg/mL
Therapeutic level of lithium
0.8 to 1.4 mEq/L
How does levodopa/carbidopa (Sinemet) work?
It promotes activation of dopamine receptors. Remember, our patient with Parkinson Disease is lacking the NT dopamine.
Why are cholinesterase inhibitors used in patients with Alzheimer's?
They prevent breakdown of acetylcholine, and patients with Alzheimer's are lacking this NT. (Cholinesterase is the enzyme that breaks down Ach. If we stop the breakdown of Ach, we will have more available.)
What are some adverse effects of TCAs?
Orthostatic hypotension, anticholinergic effects, diaphoresis, sedation, cardiac toxicity
What is the medication given for status epilepticus (SE)?
lorazepam (Ativan), a benzodiazepine
What are depot preparations of antipsychotics?
Long-acting injections used for the long-term maintenance therapy of schizophrenia
Levodopa/carbidopa (Sinemet) "wears off" near the end of the dosing interval. The patient will begin experiencing increased symptoms. What can providers do to combat this?
Shorten the dosing interval (giving it more frequently throughout the day). We can also give a drug that prolongs levodopa's half-life.
How does donepezil (Aricept) work?
It is a cholinesterase inhibitor. It stops the breakdown of acetylcholine, so the patient will have more available.
Bupropion (Wellbutrin) is an atypical antidepressant that may also be used to:
Help the patient quit smoking.
What are the goals of treating a patient who is actively withdrawing from alcohol?
Safety!! Prevent seizures, prevent falls, prevent delirium tremens
Lithium has a short half-life and therefore the patient must:
Take multiple doses throughout the day
True or false: Vivid dreams or nightmares are some of the adverse effects of levodopa/carbidopa (Sinemet).
True! Important to teach the patient and especially family about this.
How does memantine (Namenda) work?
Increases the effects of glutamate to help promote learning and memory
How does lorazepam (Ativan) work?
Intensifies the effects of gamma-amino-butyric acid (GABA) (drug class is benzodiazepine)
What is important patient teaching regarding AEDs?
Do not stop treatment abruptly--risk of seizures and SE
First generation antipsychotics may cause anticholinergic side effects which include:
Dry mouth, blurred vision (due to dryness), urinary retention, constipation (can't see, can't pee, can't spit, can't sh*t)
What should patients on levadopa/carbidopa (Sinemet) be taught about their diet?
Meals with a high protein content can reduce therapeutic responses to the drug. Spread out your protein intake throughout the day.
What is the goal of drug therapy for the patient with Alzheimer's Disease?
To improve symptoms and reverse cognitive decline. Also, think about the s&s in these patients, we always want to provide for safety (prevent falls, etc.).
What is the antidote for benzodiazepines?
Flumazenil (Romazicon)
Gingival hyperplasia is a common adverse effect of what medication?