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fast route

sublingual, IV, rectum, because it goes straight into peripheral system

slow route

by mouth - must go through stomach, HCL, liver, ect before getting into system

When do you need high concentration of drugs?

by mouth

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)

Litium antidote

charcoal

aspirin antidote

sodium bicarb

antagonist

inhibit/block certain chemicals from receptors or target sites, Sometimes given to enhance certain effects or slow down certain disease processes

agonist

mimic/stimulate certain target sites and actions, May enhance or inhibit hormone release

Benzodiazepines

DOC for anxiety, insomnia, and now seizures Valium also is muscle relaxant.

what is a TCA

antidepressant

TCA drug of choice

elavil - dont use with heart attack pt

what do MAOIs treat?

depression

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

SSRI DOC

lexapro

Barbituates

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

barbituates, benzodiazepine

DOC for Bipolar

Lithium, keeps manic and depressive state in balance

old DOC for Schizophrenia

Haldol

new DOC for schizophrenia

Chlorozil (treats pos and neg effects)

Drugs to treat Anxiety and Insomnia

benzodiazepine

Drugs to treat depression

SSRI, MAOI, TCA

Drug to treat Parkinson's

Anticholinergic Drug, increase dopamine.

DOC for Parkinson's

Levodopa

What drug can take 6 months to kick in?

Levodopa

What is a sure sign of parkinson's

pill rolling

What do ADHD meds do?

CNS stimulant

ADHD DOC

Ritalin

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

Acetocholineesterase inhibitor

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

Na

what foods should a person taking non K sparing diuretics take

foods with K (bananas)

Major depression

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.

Dysthymic Disorder

less severe depression symptoms that may prevent a person from feeling well or functioning normally

Postpartum Depression

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

Psychotic Depression

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

Akathisia

cant sit still (restless leg syndrome), can't relax

Dystonia

muscle spasm, nonstopping, continuous

Ataxia

uncontrolled or lack of gross muscle movements due to litium toxicity

Tardove dyskinesia

type of extrapyramidal effect from antipsychotic drugs and antiparkinson drug, classic sign: wormlike movement of tongue

NMS

due to antipsychotic drug toxicity

Extrapyramidal effects

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.

Thiazide Diuretics

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

Potassium-Sparing Diuretics

Increases diuresis without affecting K levels. Less effective than loop.

Resp Acidosis

pH below 7.35, CO2 above 45 caused by hypoventilation

Metabolic Acidosis

happens if given too much aspirin, diabetes and diarrhea excessive alcohol, starvation causes this; HCO3 below 22

Resp Alkalosis

pH above 7.45, CO2 below 35, cause by hyperventilation,

Met Alkalosis

HCO3 above 26, caused by constipation, excess sodium antacids, diuretics that cause potassium depletion, severe vomiting

Situational anxiety

anxiety about a test

Normal Osmolality

275-295

osmalality below 275

fluid deficit: dehydration and shock

osmolality above 295

fluid excess: heart failure, water retention, hypertension, pulmonary edema, liver failure, kidney failure

Normal sodium

135-145

hyponatremia

Na below 135, NV, anorexia, abdominal cramping

Hypernatremia

Na above 145, thirst, fatigue, weakness, muscle twitching, lowered level of consciousness.

Normal Potassium

3.5 - 5

Hypokalemia

K below 3.5, muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest

Hyperkalemia

k above 5, dysrhythmias, heart block, twitchin, fatigue, paralysis

Albumin is a

- colloid

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

Normal Salines

Crystalloids - give other than colloids because they are cheaper

what is the Best way for teens and adults to replace fluid

drink water

Levadopa treats

Parkinson's disease, may take 6 months to work

Lasix are a :

diuretic, makes you lose water, may get orthostatic hypotension

Flexiril

DOC muscle relaxant, works on CNS relaxant, relaxes muscle and decrease resp rate

on adult, what is the first thing to go if sick?

BP

Chlorozil

treats schizophrenia, pos and neg behaviors

Risperidol

antipsychotic drug

What do you give within 60 min if you give a toxic level of a drug?

activated charcoal

Haldol

schizophrenia, antipsychotic,

What might you get if you take too much psychotic drug?

TD (tardic dyskinesia)

Luminol

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

Lithium

bipolar disorder

Ritalin

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

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