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Module 11 Pharm

Terms in this set (27)

-Obtain drug history (look for use of alcohol, kava kava, valerian, and any other CNS depressant, assess use of grapefruit/grapefruit juice)​​
-Assess VS (can lower blood pressure, heart rate and RR, although not likely alone, this is more likely to occur with use of other CNS depressants)​​
-Assess renal function as renal impairment can prolong drug action​​
-Assess past medical history (look for appropriate use for the benzodiazepine in the patient's history;
assess for pregnancy and narrow angle glaucoma)​​
-Assess for suicidal thoughts (Suicidal ideation)​, ask about thoughts of self harm.​ While the benzo will help with anxiety, it also can put the patient at risk for suicide attempts with the use of the entire bottle of the medication.
Diagnosis (depends on why the patient is on benzo)​​
Anxiety ​
Risk for injury (True for every patient on a benzo)​​
Planning (this will depend on why the patient is taking the Benzo)​​:
-Patient will remain free from injury while on benzo​​
-Patient will experience less anxiety.​​

-Use bed alarm on older adults and patients receiving benzo for first time.​​
-Monitor vital signs​​
-Monitor renal function throughout therapy (urine output, creatinine level)​​
-Assess for "cheeking" of the medication (pocketing the pill in their cheek instead of swallowing), especially true in acute mental health facilities because the patient can save the pills and try to overdose and take their own life.​

Patient teaching​​:
-*Avoid alcohol and antidepressants, antipsychotics, and opioid drugs while on benzo (increased risk of sedation, respiratory depression: the patient is more apt to experience severe reactions that can even lead to death).​​
-Teach nonpharmacologic methods to help with anxiety​
-Warn patient to avoid Kava kava and valerian as they increase sedative effect​​
-Advise not to drive while on benzo (but since it causes amnesia and impaired cognitive abilities, they might drive anyway)
-Teach to gradually withdraw benzo, do not stop abruptly because that can cause withdrawal symptoms​
-Teach to take as prescribed (for anxiety, it could be prescribed as needed or it could be scheduled, make sure you teach to follow health care providers orders)​

-Patient will have less anxiety.
-MOA: Alteration of cation transport in muscle and nerve cells. Increased receptor sensitivity to serotonin.

-Indication: to treat manic episodes in bipolar disorder

-Side Effects: Headache, drowsiness, dizziness, hypotension, dysrhythmias, restlessness, slurred speech, dry mouth, metallic taste, GI distress, tremors, muscle weakness, edema, increased urination, blood dyscrasias, nephrotoxicity

-Toxicity: therapeutic range is 0.5-1.5 mEq/L. Davis's drug guide does state that the therapeutic lithium level can be up to 2.0; however, this needs to be monitored closely. Even levels slightly greater than 1.5 can result in toxic sign and symptoms in some patients. Most often, therapeutic effects are seen between 0.5-1.5 mEq/L and therefore, we do not need the level to be greater than 1.5.
-Signs and symptoms of toxicity: for mild-to-moderate toxicity: drowsiness, weakness, tremors and uncontrolled movements. Severe: seizures, heightened reflexes, low blood pressure, confusion, delirium, coma, and death. Treatment will depend on the severity of the toxicity. For mild-moderate toxicity, a dose or several doses may be withheld and the dose decreased. For severe toxicity, IV fluids and hemodialysis may be required.

-Lithium and sodium are similar in structure and the kidney can have trouble telling the difference between the ions.
-Maintaining adequate sodium levels helps keep the patient within the therapeutic range. The patient on a diuretic will be at greater risk of sodium depletion, which leads to toxic levels of lithium in the body.​

-Serotonin Syndrome is more likely to occur when taken with antidepressants
-Assess baseline vital signs and weight.​
-Assess hepatic and renal function​
-Assess mental status and for thoughts of suicide/self harm​
-Assess past medical history for seizure disorders. (antidepressants lower the seizure threshold).
-Obtain list of current medications, and ask about use of drugs and herbal substances [looking especially at MAOI's (tranylcypromine and phenelzine) , St. John's Wort)]

-Risk for self harm​

Outcome identification:
-Patient will complete activities of daily living independently
-Patient will verbalize positive feelings and be more interactive with others.

-Monitor vital signs.​
-Monitor mood for drug effectiveness. ​
-***Monitor for suicidal tendencies (all antidepressants)​
-Antidepressants lower seizure threshold, monitor for seizures.​

Patient teaching​:
-*Warn that foods that contain tyramine can cause a hypertensive crisis with MAOIs. ​ Teach the patient which foods contain tyramine (remember, it's a long list).
-Encourage taking drug as prescribed. ​
-Encourage avoiding alcohol, CNS depressants, and cold medicines. ​
-Teach to take drug with food if GI distress occurs.​
-*Warn patient against driving or using dangerous mechanical equipment until drug effect is known.​
-*Warn patient against abruptly stopping drug.​
-Instruct patient to take drug TCA' at bedtime and to rise in stages due to risk of orthostatic hypotension.​
-*Advise patient that a therapeutic response usually occurs in 2 to 4 weeks(at greatest risk for suicide during this early therapy)​
-*Inform patient that herbal supplements (e.g., St. John's wort) may interact with antidepressants.

-Look at what the patient is doing. Are the behaviors appropriate(are they getting up and getting dressed and interacting with others; are they more engaged and positive?)
-Look for signs of suicidal thoughts and ask the patient about thoughts of self-harm.