sublingual, IV, rectum, because it goes straight into peripheral system
by mouth - must go through stomach, HCL, liver, ect before getting into system
When do you need high concentration of drugs?
what to do if give pt wrong dose
1. antidote 2. lithium or stomach lavage if within 60 min 3. if after 60 min, monitor pt, tell boss (for consoling not punishment), contact dr (may just tell you its fine)
inhibit/block certain chemicals from receptors or target sites, Sometimes given to enhance certain effects or slow down certain disease processes
mimic/stimulate certain target sites and actions, May enhance or inhibit hormone release
DOC for anxiety, insomnia, and now seizures Valium also is muscle relaxant.
what is a TCA
TCA drug of choice
elavil - dont use with heart attack pt
what do MAOIs treat?
What is mechanism for MAOIs treating depression?
prevents enzymatic breakdown of norepinephrine at target site
What type of food should ppl taking MAOIs avoid
food with tyramine
what types of food contain tyramine?
asparagus, avocados, alcohol - wine, processed meat, beans, chocolate
Side effects for MAOIs, TCAs, benzodiazepines, SSRIs
orthostatic hypotension, sexual dysfunction, and weight gain
what do SSRIs treat?
first line of drugs to treat depression
suppress CNS, used to use for seizures, gone away from using because benzodiazepines have less side effects, and are highly addictive, have suicidal tendencies.
Drugs to treat Seizure
DOC for Bipolar
Lithium, keeps manic and depressive state in balance
old DOC for Schizophrenia
new DOC for schizophrenia
Chlorozil (treats pos and neg effects)
Drugs to treat Anxiety and Insomnia
Drugs to treat depression
SSRI, MAOI, TCA
Drug to treat Parkinson's
Anticholinergic Drug, increase dopamine.
DOC for Parkinson's
What drug can take 6 months to kick in?
What is a sure sign of parkinson's
What do ADHD meds do?
How does Ritalin Work?
makes them focus
when should you give ritalin
In the morning
At what time should you stop giving ritalin
4 o clock, once they hit evening they will be very hungry
Dif in gender for ADHD
Boys tend to have overt behavior, girls have social withdraw,
What other drugs may be needed in adjuct with Ritalin
may need other enhancement drugs to fall asleep.
Type of drug for Alzheimer's
DOC for alzhiemers
aricept (breaks down acetylcholine, want levels outside of cells circulating through cerebellum)
What happens if you take too much antipsychotic drugs?
may have NMS (neuroleptic malignant syndrome)
what is NMS?
look for altered level on conscious, increased temp, first thing to go down is increase BP, difficult breathing
How should we end antipsycotic/alzheimers/parkinsons etc meds?
slowly - Don't want to get off drugs abruptly, if we do tend to have a 60-80% of relapse and resuming symptoms. This is why some pts given depo meds in shot forms that they give every 2-3 weeks, compliance is better because don't have to take every day
Generalized Seizure Absence (petit mal)
lasts a few seconds, usually in kids, staring off to space, no response to verbal commands, fluttering eyelids or jerking, misdiagnosed as ADD or day dreaming
Simple Partial (focal) Seizure
1 extremity/side (olfactory, auditory, and visual hallucinations, intense emotions, twitching
Complex Partial (psychomotor) seizure
aura, brief period of confusion or sleepiness after with no memory of seizure, fumbling with or attempting to remove clothing, no response to verbal commands
Generalized Seizure Atonic (drop attack)
falling or stumbling for no reason, fasts a few seconds, aura (preceding)
Generalized Seizure Tonic-Clonic (grand mal)
aura (preceding), intense muscle contracting (tonic phase) followed by alternating contraction and relaxation of muscles (clonic phase) , cry at beginning as air leaves lungs, loss of bowel/bladder control, shallow breathing with periods of apnea, lasts 2-3 minutes, disorientation and deep sleep after seizure (postictal state)
Special Syndromes Febrile Seizure
tonic-clonic activity lasting 1-2 min, rapid return to consciousness, occurs in kids 3 months to 5 years
Special Syndromes Myoclonic Seizure
large jerking movements of major muscle groups (like an arm); falling from a sitting position or dropping what is held
Special Syndromes Status Epilepticus
considered a medical emergency, continuous seizure activity that can lead to coma or death, lasts more than 30 min, concerned with airway, O2 saturations, monitor for change in color, and prevent injury
what food should a person with kidney failure avoid
what foods should a person taking non K sparing diuretics take
foods with K (bananas)
affects 5-10% of adults in US, diagnosed by having a depressed affect and at least 5 of the following symptoms (difficulty sleeping or sleeping too much, extremely tired or without energy, abnormal eating patterns, vague physical symptoms, inability to concentrate or make decisions, feeling of despair, guilt or misery; lack of self worth, obsessed with death (expressing a wish to die or commit suicide), avoid psychosocial and interpersonal interactions, lack of interest in physical appearance or sex, delusions or hallucinations.
less severe depression symptoms that may prevent a person from feeling well or functioning normally
up to 80% of women experience this during first several weeks after birth of newborn. 10% experience major depression within 6 months related to dramatic hormonal shift that occur during post delivery. Additional situational stresses like more responsibility may affect onset. Medical treatment may help
Seasonal Affective Disorder
associated with enhanced release of the brain neurohormone melatonin due to lower light levels. Exposing pts on regular basis to specific light therapy may relieve SAD depression and prevent further episodes
expression of intense mood shifts and unusual behaviors. Depressive signs and loss of contact with reality, hallucinations, delusions, disorganized speech patterns are usually observed. Often treatable with antipsychotic meds
cant sit still (restless leg syndrome), can't relax
muscle spasm, nonstopping, continuous
uncontrolled or lack of gross muscle movements due to litium toxicity
type of extrapyramidal effect from antipsychotic drugs and antiparkinson drug, classic sign: wormlike movement of tongue
due to antipsychotic drug toxicity
adverse side effect of drug toxicity, could be sticking tongue out (from reglin)
what do Diuretics do?
increase urine output
when do you know diuretics are working?
a lot and your daily weight and edema and BP and heart rate starts to go down.
Loop Diuretics (High Ceiling)
most effective, treat general edema associated with heart failure, hepatic cirrhosis and chronic renal failure, used with moderate/severe fluid retention and when other diuretics don't work.
largest most frequently prescribed class, treats mild-moderate hypertension and mild-moderate edema from heart, liver, and renal failure. Less effective at producing diuresis than loop and ineffective in pts with severe renal failure
Increases diuresis without affecting K levels. Less effective than loop.
pH below 7.35, CO2 above 45 caused by hypoventilation
happens if given too much aspirin, diabetes and diarrhea excessive alcohol, starvation causes this; HCO3 below 22
pH above 7.45, CO2 below 35, cause by hyperventilation,
HCO3 above 26, caused by constipation, excess sodium antacids, diuretics that cause potassium depletion, severe vomiting
anxiety about a test
osmalality below 275
fluid deficit: dehydration and shock
osmolality above 295
fluid excess: heart failure, water retention, hypertension, pulmonary edema, liver failure, kidney failure
Na below 135, NV, anorexia, abdominal cramping
Na above 145, thirst, fatigue, weakness, muscle twitching, lowered level of consciousness.
3.5 - 5
K below 3.5, muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest
k above 5, dysrhythmias, heart block, twitchin, fatigue, paralysis
Albumin is a
a colloid is a :
blood product and volume expander
what should you look for If you give volume expanders
increase in BP and urine output because introducing more fluids
Crystalloids - give other than colloids because they are cheaper
what is the Best way for teens and adults to replace fluid
Parkinson's disease, may take 6 months to work
Lasix are a :
diuretic, makes you lose water, may get orthostatic hypotension
DOC muscle relaxant, works on CNS relaxant, relaxes muscle and decrease resp rate
on adult, what is the first thing to go if sick?
treats schizophrenia, pos and neg behaviors
What do you give within 60 min if you give a toxic level of a drug?
What might you get if you take too much psychotic drug?
TD (tardic dyskinesia)
Phenobarb, treats seizures, works on GABA - increases release which brings down excitability of brain
what shhould you educate pts on Dilantin about?
good oral care
what shouldnt you do with Dilantin, antiseizure, antipsychotic meds?
stop suddenly because may enhance symptoms
treats ADHD, don't give after 4 (last dose at noon or 2),
when should you give give beta 1 and 2?
to asthmatic to relax smooth muscles, some drugs may excite this.
what is the wrost thing you can do to an asmatic?
inhibate - will throw into bronchospasms