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
What is mechanism for MAOIs treating depression?
prevents enzymatic breakdown of norepinephrine at target site
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
suppress CNS, used to use for seizures, gone away from using because benzodiazepines have less side effects, and are highly addictive, have suicidal tendencies.
At what time should you stop giving ritalin
4 o clock, once they hit evening they will be very hungry
What other drugs may be needed in adjuct with Ritalin
may need other enhancement drugs to fall asleep.
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
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
type of extrapyramidal effect from antipsychotic drugs and antiparkinson drug, classic sign: wormlike movement of tongue
adverse side effect of drug toxicity, could be sticking tongue out (from reglin)
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.
happens if given too much aspirin, diabetes and diarrhea excessive alcohol, starvation causes this; HCO3 below 22
HCO3 above 26, caused by constipation, excess sodium antacids, diuretics that cause potassium depletion, severe vomiting
osmolality above 295
fluid excess: heart failure, water retention, hypertension, pulmonary edema, liver failure, kidney failure
Na above 145, thirst, fatigue, weakness, muscle twitching, lowered level of consciousness.
what should you look for If you give volume expanders
increase in BP and urine output because introducing more fluids
Phenobarb, treats seizures, works on GABA - increases release which brings down excitability of brain
what shouldnt you do with Dilantin, antiseizure, antipsychotic meds?
stop suddenly because may enhance symptoms
when should you give give beta 1 and 2?
to asthmatic to relax smooth muscles, some drugs may excite this.