NURS 261 1st Edition Final Exam Study GuideLorazepam: BenzodiazepinePT: used in treating anxiety disorders and insomniaPK: oral/IVDistribution-body tissuesMetabolism—liverExcretion—kidneysPD: increases the effect of GABAContraindications: hypersensitivityPsychosesAcute narrow-angle glaucomaNot for children younger than 6 months AE: sedationCognitive and motor impairmentToleranceAbuseRespiratory impairmentHypotensionTeratogenicityMild drowsinessAtaxia (especially in elderly and debilitated)ConfusionRespiratory disturbances if excessive Lorazepam is given before a procedureInteractions: digoxin, antacids, and oral contraceptivesLabs: Liver and renalHealth Status: assess for renal or hepatic impairmentPregnancy: DLifestyle: Assess for patient use of CNS depressants*Wide therapeutic index: hard to overdose unless given with other CNS depressants, alcohol, sedative drugsCulture: longer half-life in Asians due to different hepatic enzymesGender: women may metabolize lorazepam differently and may have different adverse effects than menMaximizing: give at schedules intervals or at bedtime (to reduce sedation during the day)Minimizing: If GI distress occurs, give with foodMonitor for paradoxical effects and stop drug if they occurDilute injectable lorazepam with equal volume of compatible solutionTaper slowly to reduce withdrawal symptomsDo not take with alcoholMonitor labsPt education: no alcoholAssess: effective if anxiety is reducedshort duration of action so divide into 2-3 doses throughout the day*Not approved for insomnia (only used this way off-label), if using lorazepam for sleep, choose drug with shortest half life that will produce the least amount of daytime drowsiness*Buspirone: NonbenzodiazepinePT: short-term treatment for anxietyPK: well absorbed following administrationMetabolism—first pass effect through liverTake 3-4 weeks to develop anxiolytic effectsPD: unclear-binds with high affinity to receptors for serotonin and with lower affinity dopamine receptors. Does NOT bind to receptors for GABA or benzodiazepinesAE: DizzinessNauseaHeadacheNervousnessExcitement*This is a non-sedating drug so there is little risk of suicide*Interactions: Erythromycin, ketoconazole, grapefruit juiceMaximizing: takes several weeks for therapeutic peak responseMinimizing: no withdrawal symptoms have been observedSertraline: Selective Serotonin ReceptorPT: treats depression, anxiety, and PTSDPK: oralMetabolism—liverSteady state-7 daysPD: Potent and selective inhibitor of neuronal serotonin reuptake and has a weak effect on Norepinephrine and dopamine neuronal reuptakeContraindications: decreased liver functionAE: (most are mild and transient) GI distressHeadacheFatigueInsomniaSexual dysfunction (in long term use)Decreases coagulationAnticholinergic effects-rareCardiovascular effects-rareWeight gain-rare*Children/Adolescents are watched for suicide during treatment initiation*Interactions: highly protein bound drugsPregnancy: CLifestyle: can affect sexual functionMaximizing: takes several weeks to achieve maximum effect Assess for depressionPt education: set realistic expectations for antidepressantsDo NOT abruptly stop taking the drugAssess: patient’s mood and observe increase in anxiety, nervousness, restlessness, or insomnia *Not approved for insomnia (only used this way off-label), if using lorazepam for sleep, choose drug with shortest half life that will produce the least amount of daytime drowsiness*Haloperidol: AntipsychoticPT: treats psychotic disorders or deliriumPK: protein boundTakes several days to produce therapeutic effects (Delayed onset)PD: Blocks dopamine (D2), alpha, and serotonin receptorsDecrease in movement disorders, hallucinations, delusions, and psychosis, blocks nausea and vomitingContraindications: hypersensitivityParkinson’s diseaseAE: Extrapyramidal effectsDrowsinessSedationSomnolenceLethargyDysphoriaInteractions: smoking, alcoholLifespan: Preg (C), safety not determined for childrenCulture: Asians have 50% higher serum levels than whitesMaximizing: take routinelyMinimizing: EPS is more likely to occur if the patient repeatedly stops and restarts therapyPt education: provide realistic expectations of antipsychotic therapy, avoid alcoholAssess: Treatment is effective if psychotic symptoms are controlled and patient does not develop serious adverse effectsMonitor for Neuroleptic malignant syndrome:- Rare but fatal- Occurs with any antipsychotic drug- Signs and Symptomso Fevero Sweatingo Tacchycardiao Muscle rigidityo Tremorso Incontinenceo Stuporo Leukocytosiso Elevated creatinine phosphokinase levelso Renal failure- Large doses of haloperidol and dehydration increase risk for neuroleptic malignant syndromeLevothyroxine: Replacement Thyroid HormonePT: hypothyroidism and myxedema comaPK: oral (IV for myxedema coma)Absorption—GI tract (increased on empty stomach)Metabolism—liverExcretion—bilePD: replacement for natural thyroid hormone—should see an increase in HR, RR, and growth maturation after /during therapyContraindications: hypersensitivityThryotoxocosis issues without signs and symptoms of hypothyroidism (could send them into hyperthyroidism)Acute MI or CAD (may lead to or worsen MI and cardiac arrhythmias)Uncorrected renal problems (may cause adrenal crisis)Be cautious with diabetics (exacerbates diabetic symptoms)AE: hypertensionTachycardiaArrhythmiasAnxietyHeadacheNervousnessGI irritationSweating/heat intoleranceIncrease bone resorption (leads to decreased bone density in long term use in women)Partial hair loss (typically in children—not permanent)Interactions: grapefruit juice, sympathomimetic drugs, anorectic drugs, foodHealth Status: Current history (skin lesions, current weight, current muscle tone, BP, RR, HR, temp, pulse, thyroid function test, ECG)Past history (previous cardiac problems, diabetes, adrenal insufficiencies)Lifespan/gender: elderly are at risk for cardiovascular and neuro effects (start at low dose and gradually increase)Women are at risk of decrease bone density in spine and hipChildren need to be monitored for proper growth and developmentMaximizing: take dailyTake before breakfastWatch cardiac function and thyroid levelsMonitor growth and development in children Minimizing: Give lose dose and gradually increase to elderly or any patient with cardiac history or renal problemsDiabetics may need insulin