NR 566 FINAL EXAM V2

NR 566 FINAL EXAM V2

• Benztropine (Cogentin): minimizes resting tremor and drooling but not as efficacious as

other meds in treating rigidity, bradykinesia and gait problems

• Rivastigimine (Exelon) transdermal patch: used for dementia associated with parkinsons

disease

• Alzheimers disease: progressive memory loss and decreased brain function from protein

deposits in the brain impairing function of neurons causing them to lose connection with other brain cells and die

• major pathologic findings: cerebral atrophy, degeneration of cholinergic neu- rons, neuritic

plaques and neurofibrillary tangles

5. hippocampus: memory

• cerebral cortex: central to speech, perception, reasoning and other higher functions
• B-Amyloid Neuritic plaques: spherical bodies of neuritic plaques made up of beta

amyloid. B amyloid found in high levels in AD patients and can occur 10-20 years before first symptoms appear

• Memantine: used to treat severe dementia/AD and reduces actions of chemi- cals in the

brain contributing to AD. use in caution w pts hx of cardiovascular dz, hepatic/renal impairment or ophthalmic dz

9. Donepezil (Aricept): tx moderate to severe AD.

10. Cholinesterase inhibitors: donepezil, rivastigimine and galantamine

11. NMDA antagonist: memantine

12. Bipolar dz treatment (other drugs): anticonvulsants, clonazepam, lorazepam,

oxcarbazepine, antidepressants, mood stabilizers and antipsychotics

13. Mood stabilizers: lithium and divalproex sodium

• Divalproex Sodium (Valproate): controls sx in acute manic episodes and can help prevent

relapse into mania. Teratogen and can cause thrombocytopenia, pan- creatitis and liver failure

• Carbamezepine (Tegretol, Equetro): approved for tx and prevention of manic episodes.

Neuro side effects-- visual disturbances, ataxia, vertigo, unsteadiness, headache

• Lithium: drug of choice for controlling manic episodes and for long term ppx against

recurrence of mania or depression. monitoring is mandatory

• Lithium can accumulate to toxic levels in what sodium level...: LOW SODI- UM. edu

patients to maintain normal sodium intake

• Diuretics and lithium: these promote sodium loss and can increase r/f lithium toxicity
• NSAIDs and lithium: increase lithium levels by 60% 1 / 2

• NSAIDs to prescribe when on lithium if necessary: aspirin or sulindac bc they do not

increase levels

21. Lithium drug interactions: diruetics, NSAIDs and anticholinergics

• Anticholinergics and lithium: cause urinary hesitancy + lithium induced polyuria which

can cause discomfort. AVOID antihistamines, phenothiazine, antipsy- chotics and TCAs

• Lithium level monitoring: measure levels every 2-3 days during initial therapy and every

3-6 months during maintenance. Serum levels checked 5 days after any dosage change and 6 months thereafter

• LIthium can be toxic to what other organs: renal and thyroid. Check renal/thy- roid function

every 6 months

• SSRIs for MDD: fluoxetine, citalopram, escitalopram, fluvoxamine, paroxetine and

sertraline

• Adverse effects of Venlafaxine: nausea, HA, anorexia, nervousness, sweating, somnolence,

insomnia, dose related sustained diastolic HTN, mydriasis, sexual dysfunction.

• Venlafaxine drug interaction: combo with MAOI is contraindicated. (this drug is an SNRI)
• MAOI adverse effects: hypertensive crisis triggered by foods containing tyra- mine.

29. s/s hypertensive crisis: HA, tachycardia, palpitations, N/V, sweating

• Foods containing tyramine: strong aged cheese, cured meats with salt or nitrate, dry

summer sausages, pepperoni, sausage, avocado, figs, yeast extract, chianti wine, shrimp paste and soy sauce

• Pt appropriate for MAOI: patients who do NOT respond well to first line drugs (SSRIs)
• Baseline data/education for SSRI: serum sodium. Edu not to abruptly stop med. report

suicide thoughts

33. Baseline data/pt edu for TCAs: ECG in pts with known dysrhythmia or

>40years. Edu ortho hypotension and anticholinergic effects

34. Tricyclic Antidepressants drugs: amitriptyline, nortriptyline, doxepin etc.

• MAOI baseline data/pt edu: blood pressure. Edu pts on tyramine containing foods and s/s

hypertensive crisis

36. Preferred tx for panic disorder: SSRIs + CBT. Can use benzos, SNRIs too.

• Social anxiety disorder tx: psychotherapy + paroxetine or sertraline (SSRIs). PRN use

benzo.

• Raloxifene (Evista) and bisphosphonates (alendronate, calcitonin): alterna- tives for

hormone replacement therapy

• Selective Estrogen Receptor Modulators (SERMs): Tamoxifen, toremifene, raloxifene --

provide estrogen benefits while avoiding its drawbacks

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