ATI Proctored Pharmacology Exam Notes

NEURO / ANTIPSYCHOTICS

Haloperidol, chlorpromazine “antipsychotic”

○ For schizo, manic states, drug-induced psychosis, aggressive/ agitated patients

○ EPS symptoms

■ Dystonia - abnormal muscle movements, twitching

■ Akathisia- inability to sit still

■ Parkinsonism - tremor, slow movement, stiffness (rigidity)

■ NPS - fever, fluctuating BP

■ Tardive dyskinesia - movement of face, tongue sticking out, blinking of eyes

○ Anticholinergic symptoms (inhibits parasympathetic = increase sympathetic)

■ Tachycardia, palpitations, orthostatic hypotension

■ Sedation, hallucinations

■ Decreased sweating/ secretions

■ Blurred vision, mydriasis “pupil dilation”, dry eyes, dry mouth

■ Urinary retention

■ Constipation

■ Increased intraocular pressure (Risk for glaucoma)

● Monitor ECG

● Get up slowly

● Oral hygiene & sugar-free candy for dry mouth

● Stool softeners & bulk fiber diet for constipation

● Use sunscreen & sunglasses for photosensitivity

○ Contraindicated in BPH, glaucoma

○ Report abnormal movements & twitches

○ Avoid alcohol or CNS depressants (due to drowsiness)

○ Amantadine “antiParkinson” - relieves tremor & involuntary movements

○ Benztropine “anticholinergic” - control EPS symptoms

○ Dantrolene “muscle relaxant” - treat NMS (muscle rigidity, fever, BP fluctuations)

Clozapine, olanzapine, risperidone “2nd-gen Atypical antipsychotic”

○ Cause diabetes, weight gain, increased cholesterol (metabolic disturbances)

○ Monitor WBC - due to (severely low neutrophils) - Agranulocytosis Risk for infection

■ Monitor elevated temperature

■ Weekly WBC for first 6 months

■ Every 2 weeks up to 1 year

○ MYOCARDITIS (inflammation of heart muscle) within 30 days starting med

■ Report chest pain, palpitations, tachycardia, tachypnea, dyspnea, fever, arrhythmias,

edema, fatigue

Lithium “mood stabilizers”

● 0.6 - 1.2

● For bipolar / acute mania

● SEIZURE, ARRHYTHMIAS, FINE HAND TREMORS

● DO NOT LIMIT SODIUM (Maintain sodium levels)

● AVOID DIURETICS → HYPO-Na → toxicity

● Toxicity over 1.5 = COARSE TREMORS, ataxia, slurred speech

NEURO / ANTIDEPRESSANTS

*** Higher risk for suicide

- Take a few weeks for therapeutic effect

MAOIs - Phenelzine, Isocarboxazid, Selegiline

○ ORTHOSTATIC HYPOTENSION

■ Get up slowly

○ Risk for HYPERTENSIVE CRISIS

■ Avoid tyramine food (aged cheeses, fermented meats, smoked meat, beer, soy sauce)

○ Avoid taken with SSRI

Fluoxetine “SSRI”

○ Risk for bleeding, if taken w/ NSAIDs

○ Avoid St. John’s Wort = cause serotonin syndrome

○ Risk for Serotonin Syndrome

■ Confusion, hallucinations, hyperreflexia, excessive sweating, fever ,restless

○ Avoid taken w/ MAOI, wait 14 days

○ Antidepressants take 1-4 weeks

Amitriptyline “tricyclic”

○ Anticholinergic symptoms (inhibits parasympathetic = increase sympathetic)

■ Tachycardia, palpitations, orthostatic hypotension

■ Sedation, hallucinations

■ Decreased sweating/ secretions

■ Blurred vision, mydriasis “pupil dilation”, dry eyes, dry mouth

■ Urinary retention

■ Constipation

■ Increased intraocular pressure (Risk for glaucoma)

○ OD *** Sodium bicarbonate can reverse effects of prolonged QRS”

Bupropion “antidepressant/ CNS depressant”

● Help SMOKING CESSATION

● Drowsiness & blurred vision

● Risk for SEIZURES !

● Report suicidal ideation

● Less sexual dysfunction than SSRI “antidepressant”

NEURO / CNS DEPRESSANTS

→ Avoid Kava, valerian, chamomile = increase CNS depressant

→ Avoid other CNS depressants & alcohol

→ Risk for falls & injuries

Benzodiazepines (diazepam, lorazepam, alprazolam, ) “an chlordiazepoxide “long-acting” ti-anxiety / alcohol

withdrawal/ sedative”

● Used to stabilize VS, decrease seizures & delirium

● Enhances GABA effect

● SEDATION, respiratory depression, amnesia

○ Monitor apnea, laryngospasms, bronchospasm, coughing

● Dizziness, drowsiness for 24 hrs

● Antidote *** Flumazenil ***

● Taper over few months to prevent withdrawal

Buspirone “antianxiety/ CNS depressant”

● Drowsiness & dizziness (NO SEDATION)

● Assess for anxiety

● Report palpitation, faintness, HTN, hyperventilation

● LONG TERM USE OKAY → replace benzo (short-term use due to dependency)

Zolpidem “hypnotic”

○ Used for short-term - prolong use cause dependence

○ Improved sleep within 2 days - treat insomnia

○ DIZZINESS, DROWSINESS

■ Avoid other CNS depressants & alcohol

○ Monitor for confusion in elders

Propofol “general anesthesia/ sedation”

● Sedation for intubated, on mechanical ventilation in ICU

● Rapid onset 40 secs

● Altered LOC, AMNESIA, BRADYCARDIA, HYPO/HYPERTENSION, APNEA

● Maintain patent airway