Transcript: - It is the most widely used TCA and is an efficacious treatment for major depressive disorder - Common effects: Dizziness, headache, tremor, sweating and anxiety - Common overdose symptoms: Tachycardia (high heart rate), severe hypotension, congestive heart failure, coma and drowsiness Assessment of the situation Conclusion - Commonly used to treat insomnia, anxiety and panic attacks - Common effects: Supression of REM sleep, impaired motor functions and depression - Common overdose symptoms: Coma, dizziness, hypotension and drowsiness - Patient is 78 year old man who has sleeping problems and lives in a care home - Patient uses amitriptyline and diazepam for his mental and sleeping problems - Phsysiotherapist walks into the room around noon and finds patient sleeping and undressed Amitriptyline and Diazepam used together Justification - It is very likely that the patient is feeling drowsy because of the combination of both medications - Doctor should examine and determine the cause of the drowsiness. Tests may include: Blood tests, CT scan, sleep studies and urine tests - Patients quality of life should be improved - Assistive devices should be introduced so that the patient would go out and exercise more - Amount of medications should be reduced - Physical activity should be increased so that the body would naturally require the sleep Effects of Diazepam Medication presentation Effects of amitriptyline - Call for help - Check past medical and patient records - Check the surroundings (possibility of a concussion or a fall) - Interview if Neighbours have seen or heard anything - Finding out the effects of the medications - They are classified as a safe combination when used together - However, some side effects of using both at the same time have been found: Increases sedation and makes the patient more drowsy Information about the situation
Transcript: Generic Name Side Effects Adult Dosage BUSPIRONE Patient Education Medication Compliance Do not use OTC drugs Do not drive or engage in hazardous activities Report signs of repetitive motions Avoid Grapefruit juice & St. Johns's Wort- both can increase drug levels Tachycardia Palpitations Arthralgias Hyperventilation Shortenss of Breath Trade name How it works: CLozapine interferes with the binding of dopamine to D1 and D2 receptors It also blocks Serotonin Receptors Agranulocytosis Orthostatic Hypotension Tachycardia ECG changes Seizures Hyperglycemia Urinary Retention EPS: Dystonic Reaction Monitor Blood Glucose Compliance with Blood tests Caution while driving/use of machinery Rise slowly due to orthostatic hypotension Do not take OTC meds or alcohol without physician's permission No breastfeeding CLOZAPINE Action ORAL: 12.5mg QD or BID to start, then increase by 25mg-50mg QD and titrate to a target dose of 300mg-450mg/day in 3 divided doses. (MAX 900mg/QD) Range: 100mg-150mg/per dose. Side Effects CLassification BUSPAR BRAND NAME GENERIC NAME Pt Use: Mx of Schizophrenia-decreases both Pos & Neg Sx. Prototype: Clozapine CLOZARIL Site of Action: Limbic region of the brain Trade Name Classification Summary Adverse Effects Nonproprietary name Site of Action: In the brain Mainly on the D2 receptor Agonist effects on the presynaptic Dopamine Receptors High affinity for serotonin CLOZARIL and BUSPAR Quiz Handout Background Information Dizziness Drowsiness Headache Light-headedness Nausea Insomnia Blurred Vision Mechanism of Action Weight Gain Drowsiness Sedation Dizziness Constipation Dry mouth Restlessness Hypersalivation Increased Metabolic Syndrome Brand Name Patient Education Adult= Oral dose: 7.5-15mg/day in divided doses, may increase by 5mg/day every 2-3 days as needed. (MAX 60mg/day) Geriatrics= Oral dose: 5mg BID, may increase (MAX 60mg/day) Note* Give with food to decrease nausea. Background Information Advantages to Buspirone: Group: Anxiolytic/Anti-anxiety Group: Atypical Antipsychotic Nonproprietary Name Prototype: Lorazepam CLozapine: Preceded by Haldol Introduced to U.S. in 1990 Advantages: Produces fewer EPS SE in comparison to 1st generation antipyschotics Adverse Effects Uses: Mx of Anxiety Disorders (GAD) Adult Dosage Nonsedating No potential for addiction unlike benzodiazepines Does not interact with CNS depressants ie alcohol
Transcript: Julia Niven & Havilah Brown MEDICATION PRESENTATION ORAL ROUTE ORAL ROUTE Perform standard greeting & prep Perform standard greeting & prep Hand hygiene Hand hygiene Greeting Greeting Introduce yourself and make sure your patient knows what you're about to do 5 Rights of Medication Administration 5 Rights of Medication Administration Right Patient Right Patient Patient name Patient medical record numer Right Medication Right Medication Right Dose Right Dose Right Time Right Time Right Route Right Route Complete assessments Complete assessments Appropriate to the medication Also, assess ability to safely swallow the medication Order: Spironolactone, hold if SBP <100 Prepare accurate medication dose Prepare accurate medication dose Assist patient to a high-Fowler's position Assist patient to a high-Fowler's position Place medication in patient's mouth, or hand dose to patient Place medication in patient's mouth, or hand dose to patient Remain with patient until medication has been swallowed Remain with patient until medication has been swallowed NASAL ROUTE NASAL ROUTE Most common forms of nasal medications Most common forms of nasal medications Mist Mist Drops Drops Tampon Tampon Administration Administration Mist Mist Drops Drops Atomizer Atomizer
Transcript: AVANDIA GENERIC: ROSIGLITAZONE *CATAGORY: C COUMADIN GENERIC: WARFARIN *CATAGORY: X ACIPHEX GENERIC: RABEPRAZOLE *CATEGORY: B ARICEPT GENERIC: DONEPEZIL *CATEGORY: C CLONAZEPAM GENERIC: KLONOPIN *CATEGROY: D-POSITIVE CLOBAZAM GENERIC: ONFI *CATEGORY: C ZOLPIDEM GENERIC: AMBIEN *CATEGORY: C ZYLOPRIM GENERIC: ALLOPURINOL *CATEGORY: C ZANTAC GENERIC: RANITIDINE CATEGORY: B XANAX GENERIC: ALPRAZOLAM CATEGORY:D-POSITIVE Similarities N/A CLONAZEPAM PANIC DISORDER AXIETY HAVEA GREAT DAY!!! Avandia Treats Type 2 Diabetes Brookline College - MOD A By: Luis D Manzanares Villa Differences Coumadin Prevent new blood clots & helps from any clots getting worse Category C Studies have shown a development effect on the fetus on animal reproduction, and there are no accurate or well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Category X Studies in animals/humans have shown fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Category B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. ZYLOPRIM ALSO TREATS SOME KIDNEY STONES Differences TREATS SEIZURES ZYLOPRIM USED TO TREAT GOUT ZOLPIDEM SLEEP DISORDER SIMILARITIES Aciphex Treats problems such as heartburn, stomach ulcers, GERD (Gastroesophageal reflux disease), damaged esophagus, or the stomach making too much acid DIFFERENCES CLOBAZAM Lennox-Gastaut syndrome (LGS) ZOLPIDEM USED TO TREAT INSOMNIA DIFFERENCES http://www.drugs.com/pregnancy-categories.html http://www.healthline.com/drugcompare?ref=global Medications Medication Presentation SIMILARITIES ZANTAC TREATS & PREVENTS HEARTBURN. TREATS "GERD" & CONDITIONS THAT CAUSE STOMACH TO MAKE TOO MUCH ACID THANK YOU!!! Aricept Treats symtoms of Alzheimers Disease XANAX TREATS ANXIETY PANIC DISORDER Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Avandia VS Coumadin Aciphex VS Aricept Clonazepam VS Clobazam Zolpidem VS Zyloprim Zantac VS Xanax DIFFERENCES
Transcript: citalopram (Celexa): si-tal-oh-pram To minimize dry mouth advise pataint to maintain good oral hygene and to chew gum or suck on candy. Mechanism of Action Drug/Food Interactions Drug to Drug: Potentially fatal reactions when used with MOA inhibitors Linezolid or methylene blue may increase seretonin syndrome Primozide may result in QT prolongation Drugs that affect serontonergic neurotransmitters systems: tricyclic antidepressants, SNRIs, fentanyl, buspirone, tramadol and triptans all increase seretonin syndrome NSAIDS, Clopidogrel, opiods analgesic increase bleeding ALCOHOL- HIGHLY CONTRAINDICATED Peer Review Study: Peer Review Study Peer Review Study: Evaluation of Medication: Forms: Dosage: for older adults Route: oral route Half-Life: 35 hrs Allow 14 days MOA inhibitors and Citalopram administration Advice patient to notify health care provider of OTC and Rx medications, vitamin and herbal products being used To minimize dry mouth advise pataint to maintain good oral hygene and to chew gum or suck on candy. Advise patient to avoid driving or activities that require alertness until drug response is known. Side/Adverse Effects References: Advise patient to avoid alcohol ans other CNS deoressants during therapy Stephen Blank and colleagues University of Pittsburgh School of Medicine in Pennsylvania, USA. 30 patients aged 60 years and older Most of the participants met criteria for generalized anxiety disorder, or panic or posttraumatic stress disorders 32-week trial of citalopram Results: 3 subjects discontinued study medication due to side effects 5 were terminated because of nonresponse 5 dropped out of the study for other reasons; = 17 subjects (57%) completed 32 weeks of treatment. Reduction in HAM-A to < 10 during the trial Patient /Caregiver Teaching ANSWER: 1. QT prolongation 2. Potassium and Magnesium Neuroleptic malignant syndrome, suicidal thoughts (black box warnings), increased apathy, drowsiness, insomnia, weakness, abdominal pain, tremor. QT interval longation and ventricular tachycardia. (geriatric warning) Nursing Interventions/Client Education Nursing Interventions increases concentration of Serotonin in the brain by decreasing its "reuptake" and breakdown making more of it available for the brain's neurons to use. keeping serotonin levels higher is believed to help make the communication between nerve cells better "strengthening circuits in the brain which regulate mood" (Goldberg, 2013). Evaluation/ Desired Outcomes Increased sense of well-being Renew interest in surrounding May take 1-4 weeks before taking on anti- depressant effects. Physical Assessment Monitor patient/residents mood changes during therapy Patient may experience suicidal tendencies especially during early therapy Patient is to be seen by their healthcare provider weekly for at least 4 weeks Assess for: Serotonin Syndrome: Mental changes, such as agitation; hallucinations; coma Autonomic instability: Tachycardia, frequent increase and decrease BP, hyperthermia Neuromuscular aberrations: in coordination and hyperreflexia Advice Family/ Caregiver to continually monitor patient for suicidal tendencies and to report any changes in mood Naomi-Jean Bautista Jacqueline Delgado William Herrera Alejandra Huerta Sally McMann is 87 years old. She recently lost her husband. She enjoys going to church every week but hasn't attended in months since the passing of her husband. She has battled with depression in the past and with the loss of her husband her depression has worsened. She hasn't been eating, or sleeping and has isolated herself from her church community. Her family worries that her depression is affecting her physical health. At her recent doctors visit her physician prescribes Celexa to help. Instruct patient to take dose as directed. OTC: St. Johns Warts and SAMe increase risk for serontonergic side effects Peer Review Study: Citalopram in the treatment of late-life anxiety disorders. (2006). Brown University Geriatric Psychopharmacology Update, 10(8), 3-4. Goldberg, J. (2013, June 25). How Antidepressants Work. In WEB MD. http://www.webmd.com/depression/how-different-antidepressants- work?page=3 Vallerland, A., & Sanoski, C. (2014). citalopram. In Davis' Drug Guide for Nurses (14thth ed.). http://davisplus.fadavis.com/3976/meddeck/pdf/citalopram.pdf Beware of the dose perscribed to your elderly patient. (20mg/day max dose) Frequent monitoring for irregular heartbeat, tachycardia, fainitng, dizziness, and shortness of breath. An electrocardiogram (ECK, EKG) to monitor HR and rythm may be ordered and is recommended for patients with risk for QT prolongation. Monitor Lab test: K+ and Mg+ blood test. Pataint at risk for electrolyte imbalance check basline lab results before administration. Asses for suicidal tendencies Advice patient to wear sunscreen Advice patient to wear sunscreen Method: Patients had been randomly assigned to receive either: Citalopram for up to 32 weeks OR Placebo for 16 weeks followed by citalopram
Transcript: WATCH FOR QSEN (Omeprazole) I am a Proton Pump Inhibitor I decrease the amount of acid made in the stomach GUESSES? Keep Guessing: Be aware of -pt allergies -pt with liver dz -when pt is taking med -recommended dosages 20-40 mg I am a medication used for - Tx GERD - Allow esophageal healing (Prevent further damage) -Tx Zollinger- Ellison Syndrome -Tx H-Pylori infections -Tx and prevent ulcers -Tx-GI Bleeding -OTC version is used for heartburn -I am an extended release capsule, and also come in packet form (to mix with liquid ) -Take me 1 hour before meals (usually only 1/day) -pt complaining of Chest pains -Incre BP -dry mouth -muscle weakness -Pts on Penicillin therapies (anaphylactic reactions) -Pregnant pts (incre congenital anormalities in 1st trimester.) constipation gas N.V.D stomach pains headache Severe: Osteoporosis related fractures Patient Centered Care "Recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs." THE NURSE The Big Picture GUESS WHO! Prilosec My Side Effects
Transcript: Brand: Amoxil Generic: Amoxicillian Classification: Antidepressant (used for the treatment of depression) Recommended Dosage: 20 mg in the morning or evening may be increased to 40 mg daily after one week *Prescription needed Form: Tablets, Solution Route: Oral Mechanism of action: management of depression and anxiety Precautions: All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidal signs, and unusual changes in behavior How/when to take: 1 time per day with or without food Medication Presentation Health Careers Blessing M. Gbemisola Picture medicinenet.com/ Google Images Brand: Claritin Generic: Loratadine Classification: Antihistamines (medicines that help stop allergy symptoms) Recommended Dosage: 10 mg once daily * OTC Med Form: Tablets, Syrup, and Rapidly-Disintegrating Tablets Route: Oral Mechanism of action: relief of nasal and non-nasal symptoms of seasonal allergic rhinitis Precautions: Patients with liver impairment or renal insufficiency should be given a lower initial dose How/when to take: taken once per day swallow Swallow the pill whole Classification: Penicillin (treat infections caused by bacteria) Recommended Dosage: 250 mg every 8 hours, 500 mg every 8 hours, 500 mg every 12 hours or 875 mg every 12 hours *Prescription needed Form: Capsules, Tablets, Chewable tablets, Powder for suspension Route: Oral Mechanism of action: treat infections due to bacteria bacterial infections Precautions: Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy including amoxicillin How/when to take: be taken with or without food Classification: macrolide antibiotic (useful in treating lung and chest infections) Recommended Dosage: 500-2000 mg in multiple or single doses *Prescription needed Form: Tablets, Powder, Suspension Route: Oral Injection Mechanism of action: fights against susceptible bacteria Precautions: Because azithromycin is principally eliminated via the liver, caution should be exercised when azithromycin is administered to patients with impaired hepatic function How/when to take: be taken with or without food, but food reduces stomach upset Picture Picture Brand: Celexa Generic: citalopram Picture Sources Brand: Zithromax Generic: Azithromycin
Transcript: Medication Presentation Fentanyl Morphine Hydromorphone Ketamine Narcan Medication Presentation Discussion: -The drug -Indications -Precautions -Interactions -Half life -Adverse effects -Patient education Discussion: Indications for use: -Premedication for surgery, general anesthesia, analgesia to manage moderate to severe pain and breakthrough pain. -Fentanyl is available as a skin patch, lozenge, pills, shots, a film that dissolves in your mouth, nasal spray, or by IV. Fentanyl Precautions: -Hypersensitivity, caution in: geriatric, debilitated or critically ill patients, diabetes, severe renal, head trauma. Fentanyl Interactions: - Should not use within 14 days of MAO inhibitors, avoid alcohol and other CNS depressants that would further depress the CNS. Fentanyl Half life: -Adults 2-4 hours IV route. Fentanyl Adverse effects: -Confusion, delirium, postoperative depression, drowsiness, nausea, cns depression, hypotention, bradycardia, itching. Fentanyl Patient teaching: -Side effects such as dizziness, risk for falls, avoid other CNS depressants, alcohol and driving. Fentanyl Indications: -Severe pain. Pumonary edema. Pain associated with MI. Morphine Precautions: -Allergy/reaction, use cautiously with head trauma, increase ICP, severe renal, ect... Morphine Interactions: -Extreme caution in patients receiving MAO inhibitors within 14 days prior and other CNS depressants. Risk for serotonin syndrome when taking other medications that raise serotonin levels. These include other antidepressants certain pain and headache medications. Morphine Half life: -Adults 2-4 hours IV. Morphine Adverse Effects: -Confusion, sadation, dizziness, hypotension, bradycardia, tolerance. Morphine Patient teaching: -Side effects, avoid alcohol, driving and other depressants, risk for falls, constipation. Morphine Indications: -Moderate to severe pain. Extended release product for opioid-tolerant patients requiring around the clock management of petsistant pain. Antitussive (lower doses). Hydromorphome Precautions: -Allergy/reaction to, Increased risk for falls, monitor for decrease in BP and HR, and respiratory depression. Hydromorphone Interaction: -Extreme caution in patients receiving MAO inhibitors, discontinue MAO inhibitors 2 weeks prior to hydromorphone. Also avoid other CNS depressants, driving and alcohol. Hydromorphone Half life: -Oral, immediate release, or injection 2-4 hours. Hydromorphone Adverse effects: -Confusion, sedation, dizziness, headache, hypotension, bradycardia, urinary retention, constipation. Hydromorphone Patient education: -Medication instruction, side effects, avoid alcohol, driving and other depressants, risk for falls, constipation. Hydromorphone Differences: -Hydromorphone is ER. -Has antitussive properties at low doses. Fentanyl, Morphine, hydromorphone Indication: -Anesthetic medication used to put patient to sleep for surgery and to prevent pain and discomfort during certain medical tests or procedures. It induces a trance like state while providing pain relief, sedation, and memory loss. Ketamine Precautions: -Hypersensitivity, head trauma, HTN, angina, stoke, underlying psychiatric disorder. Ketamine Interactions: -Drug is incompatible with barbituates and diazepam. Ketamine Half life -10 to 15 minutes. Ketamine Aderse effects: - Bradycardia, blurred vision, N/V, insomnia, drowsiness, painful urination. Ketamine Patient teaching: -Explain purpose and effects of medication. Ketamine Indication: -Reversal of CNS depressants and respiratory depression because of suspected opioid overdose. Precauctions: -Hypersensitivity, caution in cardiovascular disease and opioid dependent patients. Interactions: -Can precipitate withdrawal in dependent patients. Half life: -60 to 90 minutes. Narcan Advers effects: -Ventricular arrhythmias, hypertension, hypotension, nausea, vomiting. Patient teaching: -Explain purpose and effects of medication. Narcan Resource: Davis's Drug Guide for Nurses, 12th edition. Thank You!!
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