NCLEX-RN ATI COMPRHENSIVE

NCLEX-RN ATI COMPRHENSIVE

REVIEW PART 4D PHARMACOLOG Y

Neurological, Pain, Reproductive, & Complementary

ANTIANXIETY MEDICATIONS

• Antianxiety • Antidepressants • Bipolar disorder medications • Antipsychotics • ADHD medications • Sedative/hypnotic medications • Abstinence maintenance medications

Antianxiety • Increase GABA to reduce anxiety • Benzodiazepines-Alprazolam, Chlordiazepoxide, Diazepam, Lorazepam • Buspirone • Antidepressants- Venlafaxine, Duloxetine, Paroxetine, Escitalopram • Uses- anxiety disorder, panic disorder, insomnia, alcohol withdrawal, induce anesthesia • Side effects- CNS depression, paradoxical response, withdrawal (not w/ buspirone), risk for abuse/OD • Monitor vitals, never stop abruptly, avoid alcohol

Antidepressants • SSRI/SNRI- Citalopram, Fluoxetine, Paroxetine, Sertraline / Duloxetine, Venlafaxine − Side effects- weight gain, sexual dysfunction, fatigue, drowsiness − Other- take SSRI in AM, no alcohol, DO NOT stop abruptly, monitor for serotonin syndrome during first 72hrs (if occurs, discontinue immediately) • TRICYCLIC- Amitriptyline, Imipramine − Side effects-anticholinergic, orthostatic hypotension, cardiac dysrhythmias, decrease seizure threshold − Contraindication- pt. with seizure, alcohol, MAOI, St. John Wart • MAOI- Isocarboxazid, Tranylcypromine, Phenelzine − Side effects- CNS stimulation, orthostatic hypotension, & hypertensive crisis with tyramine, SSRI, and Tricyclics − Other- no tyramine foods, antihypertensives, SSRI/Tricyclic, HF, CVA, renal insufficiency • Assess for suicide risk “Are you thinking of harming yourself?”. Give pt. list of foods to avoid

Bipolar Disorder Medications • Lithium Carbonate • Uses- bipolar, alcohol use disorder, bulimia, schizophrenia • Side effects- GI distress, fine tremors, polyuria, hypothyroidism, renal toxicity

• Caution- pt. with renal dysfunction, heart disease, hyponatremia, dehydration • Other- Monitor therapeutic level 0.8-1.2. Therapeutic effect begins 1-2 weeks, given 1-3 times daily, given with food, WATCH SODIUM LEVELS Antipsychotics • Typical − Haloperidol, Fluphenazine, Chlorpromazine, Thiothixene − Side effects- sedation, EPS, anticholinergic effects, tardive dyskinesia, agranulocytosis (monitor WBC), neuroleptic malignant syndrome, seizures • Atypical − Aripiprazole, Clozapine, Olanzapine, Paliperidone, Quetiapine, Ziprasidone − Side effects- Agranulocytosis, weight gain, diabetes, dyslipidemia, orthostatic hypertension, EPS • Other- Monitor side effects, CBC, stop if pt. develops neuroleptic malignant syndrome (In NMS pt. will have fever, muscle rigidity, altered mental status, autonomic dysfunction. LIFE THREATENING)

ADHD Medications • Stimulants − Dextroamphetamine, Amphetamine − Side effects- insomnia, headache, suppressed appetite, abdominal pain − Give in AM, DO NOT stop abruptly, abuse, agitation • Nonstimulants − Atomoxetine, Guanfacine − Side effects- GI upset, insomnia, mood swings

Sedative/Hypnotic Medications • Benzodiazepines- Lorazepam, Temazepam • Other- Zolpidem, Eszopiclone • Uses- insomnia • Caution- with alcohol and other meds that depress CNS • Side effects- amnesia, respiratory depression, drowsiness/dizziness • Take right before bed; avoid alcohol

Abstinence Maintenance Medications • Disulfiram − For alcohol − Side effects- drowsiness, headache, metallic taste, hepatotoxicity − Wait 12hrs after alcohol to use. Tell pt. what will happen if they have alcohol (throbbing, syncope, flushing) • Methadone − For opioids − Side effects- sedation, respiratory depression, paradoxical CNS excitation (opposite of slowing down) − Contraindication- pt. with QT syndrome, severe asthma, respiratory disease, history of head injury

CHRONIC NEUROLOGICAL DISORDER MEDICATIONS

• Cholinesterase Inhibitors • Antiparkinsons • Antiseizure • Ophthalmologic Medications/Antiglaucoma

Cholinesterase Inhibitors • Neostigmine, Ambenonium, Edrophonium • Uses- Myasthenia Gravis • Side effects- slow HR, chest pain, weak pulse, feel like passing out, urinating a lot, seizures, trouble swallowing • Have pt. keep a diary of side effects and wear a med alert bracelet. Watch for cholinergic crisis

Antiparkinson • Benztropine, Carbidopa/Levodopa, Levodopa • Side effects- muscle twitching, headache, dizziness, dark urine, orthostatic hypotension • Keep med away from light, moisture, and heat. If darkened, discard.• Contraindication- (with benztropine) pt. with narrowed angle glaucoma, discontinue 8hr before anesthesia

Antiseizures • Carbamazepine − Side effects- anemia, leukopenia, Steven Johnson Syndrome − Contraindication- bone marrow depression, bleeding disorder, decreases oral contraceptive and warfarin • Gabapentin − Side effects- headache, weight gain, CNS depression • Phenobarbital − Side effects- drowsiness, hypotension, respiratory depression − Contraindication- history of substance use disorder • Phenytoin − Side effects- gingival hypertrophy, diplopia, drowsiness, hirsutism • Valproic acid − Side effects- hepatotoxicity, teratogenic effect, pancreatitis − Contraindication- liver disease and pregnancy • Other- if status epilepticus (seizure for more than 5 minutes or one after another): give diazepam or lorazepam IV push followed by IV phenytoin

Next page Ophthalmologic Medications/Antiglaucoma • Levohunolol, Timolol, Pilocarpine, Lantanoprost • Interactions- beta blockers, calcium channel blockers • Side effects- bradycardia, HF, bronchospasm, brown discoloration of iris, retinal detachment (emergency) • Use sterile technique when handling applicator, apply pressure on the duct after instill drops for 30-60 seconds, and monitor the pulse

PAIN & INFLAMMATION MEDICATIONS

NSAIDs • Acetaminophen • Uses- analgesics, antipyretic • Side effects- N/V; long term → liver disease • Monitor- liver/kidney function test • No more than 4000mg/24hrs; based on child’s age no more than 5x/day • Overdose- ACETYLCYSTEINE

OPIOID ANALGESICS

• Fentanyl, Hydromorphone, Morphine Sulfate, Meperidine, Codeine, Oxycodone • Uses- pain and sedation • Side effects- orthostatic hypotension, constipation, urinary retention, blurred vision, respiratory depression, abstinence syndrome (anticholinergic effects) • Other- monitor vitals and watch for respiratory depression • Overdose- NALAXONE