Galen NUR 210 Questions and Answers Latest Update 2023/2024

Galen NUR 210 Questions and Answers Latest Update 2023/2024 Pharmacokinetics *** The process in which medications move through the body What are the 4 phases of pharmacokinetics? *** absorption, distribution, metabolism, excretion Absorption *** happens with drug movement from the GI tract into the bloodstream. Most meds are taken by mouth. Oral absorption *** Takes awhile to get absorbed because it has to go through the GI system Usually takes 2-4 hours •Enteric coated aspirin - hard on stomach can not crush pill •Extended release absorbed in the small intestine IM absorption *** Absorbed 1-2 hours IV absorption *** Absorbed 30-60 minutes dissolution *** Dissolution happens when a po medication breaks down into particles, disintegrates, and dissolves to combine with liquid so absorption from the GI tract into the bloodstream occurs. Liquid medications are absorbed faster than solids. Food can interfere with the absorption of drugs. Drugs that resist dissolution *** Parenteral medications (SL, eyedrops, inhalants, transdermal) do not pass through the GI tract. Enteric coated medications are designed to resist disintegration until the pill reaches the small intestine. EC and sustained release meds should not be crushed. Factors that affect absorption *** •Lack of muscle and increased fat changes medicine absorption •Food consumption - will change medicine potency (delayed) •Stress - Exercise, medicine goes to muscle •pH - Medicine is made for acidic environments •Antacid changes absorption •Taken alone so it doesn't change the action Excipients *** Fillers and other substances that make up tablets as a pill is not 100% drug. Sometimes an excipient enhances the absorption of a drug such as with PCN, which is not well absorbed from the GI tract. Adding Na to PCN, which makes it penicillin sodium, will increase the absorption of PCN first pass effect *** •the oral drugs go to liver via portal vein where some of the drug becomes inactive •Only happens with oral medications delayed gastric emptying *** Food doesn't move like it should Distribution *** refers to the movement of the drug from the circulation to body tissues Factors affecting distribution *** -blood flow to tissues -protein binding -blood brain barrier -drug's affinity to the tissue protein binding *** Drugs bind with proteins in blood Some drugs are highly protein bound and other are weakly protein bound free drugs *** drugs not bound to protein Drug Toxicity *** -Two highly protein bound drugs compete and one might accumulate and cause a toxicity -it is important to know if you are administering highly protein bound medications and monitor albumin levels in patients with liver or kidney disease. -Some drugs that are highly protein bound include: Warfarin Furosemide Diazepam Drug distribution and albumin *** -A decrease in albumin levels decrease the protein-binding sites, which means more of the free drug is circulated. -This can be fatal with some meds. -Free drugs are those not bound to protein, which means they are active in the body and cause a pharmacologic response. -Older adults, malnourished individuals, and those with liver or kidney disease have low albumin levels. Blood Brain Barrier (BBB) *** -The BBB protects the brain from most drugs. -Some meds are able to cross the BBB such as benzodiazepines. -Drugs can cross the placenta and cause spontaneous abortion or alter fetal growth and development. Metabolism *** •Chemically changes drug to a form that can be excreted •Liver primary site half-life *** •the time it takes for the drug in the body to be reduced by half Loading dose *** use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration (therapeutic level) sooner •Blood thinner •Antibiotic Exceretion *** the removal of waste products from medications which is done mainly through the kidneys Other routes for include lungs, sweat, saliva, and bile Factors effecting excretion *** Disorders in which the blood flow to the kidneys is reduced will influence drug excretion. Dehydration, CKD, and glomerulonephritis are examples. Drug Elimination and Patients with Kidney Disease *** Lab tests to determine kidney and renal function include: Creatinine (0.5-1.1 female, 0.6-1.2 male) BUN (10-20) eGFR (60-90+) You should be aware of patients kidney function status as this will determine drug dosage.) Drug Elimination and patients with liver disease *** Lab tests to determine liver function include: ALT (4-36) and AST (0-35) Onset *** time it takes for drug to start working Peak *** highest concentration in blood duration *** length of therapeutic effect Peak and Trough *** •highest (30 minutes after giving) and lowest (right before giving second dose) amount of drug in blood Agonist *** desired response Antagonist *** undesired response side effects *** Expected Secondary effects Can be desirable or undesirable Report if effects are desirable or not Adverse Reactions *** •Unexpected •Mild to severe Drug toxicity *** •Overdose •Drug level exceeds therapeutic range additive effect *** Sum effect of 2 drugs synergistic effect *** •On purpose •2 drugs given together is greater than either drug by itself Food-drug interactions *** •Grapefruit juice (increases drug potency), Warfarin (leafy vegetables) Changes that take place with aging *** •decreased kidney, liver function, GI changes, body composition, malnourished Polypharmacy *** •5 more more medication/pharmacies adherence *** •Cost, hearing, sight, organization, timing, side effects, knowledge rights of med administration *** Right drug Right dose Right client Right route Right time Right documentation 3 checks of drug administration *** Pulling medication, MAR, bedside Non-pharmacological methods for sleep *** No: daytime naps Caffeine Alcohol Nicotine Heavy meals Yes: Warm bath Warm milk Relaxing music Sedatives / Hypnotics *** Sedatives mildest form of CNS depressant daytime to produce anxiety relieve avoid if severe respiratory disorder barbiturates Benzodiazepines Nonbenzodiazepines Hypnotics Nighttime Can become dependent Anesthetics *** Work to promote CNS depression Barbiturates *** •Many side effects •Not first choice •Highly sedating •Used for seizures •Maintaining sleep •Procedural sedation Benzodiazepines *** •Midazolam, Alprazolam •Antianxiety, sleep Nonbenzodiazepines *** Zolpidem Short term treatment of insomnia local anesthesia *** •Lidocaine •Rapid onset •Long duration •Topical, Cream, Sprays •Dental •sutures general anesthesia *** •Inhalation •Nitrous oxide •IV •Midazolam and propofol (white in color, endo procedures, effects reverse quickly) •Spinal/epidural anesthesia *** •Blocks •Watch respiratory system •Side effect: •Headache •Hypotension: patient to lay flat after, increase fluids Anesthetics *** •Major adverse effects are on respiratory and cardiovascular system •Goal is balanced anesthesia •Combination of drugs Midazolam (Versed) *** Classification: benzodiazepine Uses: anxiety, pre-op sedation, sleep disorders Side Effects: lethargy, drowsiness, dizziness, blurred vision, headache Adverse Effects: hypotension, depression, dependence, liver failure Contraindications: respiratory depression, allergy Interactions: other CNS depressants, alcohol Eval/Monitor/Teach: monitor for signs of depression/ suicidal ideation, monitor renal/ hepatic function, use caution in older adults Alprazolam (Xanax) *** Classification: benzodiazepine Uses: anxiety, pre-op sedation, sleep disorders Side Effects: lethargy, drowsiness, dizziness, blurred vision, headache Adverse Effects: hypotension, depression, dependence, liver failure Contraindications: respiratory depression, allergy Interactions: other CNS depressants, alcohol Eval/Monitor/Teach: monitor for signs of depression/ suicidal ideation, monitor renal/ hepatic function, use caution in older adults Zolpidem (Ambien) *** Classification: non-benzodiazepine Uses: insomnia, conscious sedation Side Effects: dizziness, drowsiness, residual sedation, headache, blurred vision Adverse Effects: hypotension, tolerance, phycological and physical dependence Contraindications: allergy to benzodiazepines, respiratory depression, renal/ liver dysfunction Interactions: other CNS depressants, alcohol, food decreases absorption Eval/Monitor/Teach: use caution in children and older adults, monitor for dependency, avoid alcohol NSAIDS in general *** •Prostaglandin inhibitors •pain inhibitor COX 1 and enzyme Needing for prostaglandin inhibitors to work Protects stomach lining Regulates platelets COX 2 enzymes Anti-inflammatory Pain Stiffness in joints Mildly work for fever Preferred drugs for headache and fever (mild) Salicylates *** Aspirin Prostaglandin inhibitor Decreases inflammatory process Antiplatelet Reduces pain by blocking COX 1 and 2 enzyme GI bleeding, ulcers (cox 1) Antiplatelet property (cox 1) Reduces pain/inflammation (cox 2) Side effects N/V Diarrhea Constipation Abdominal pain Take with food or enteric coated Hypersensitivity Tinnitus (ringing of the ear) Vertigo (spinning) Bronchospasm (throat spasm) Not given to children Reye's syndrome (brain/liver damage) Propionic Acid Derivatives *** Ibuprofen Aspirin like Stronger (6-8 hours) Less GI distress Highly protein bound so can interact with other drugs Avoid Warfarin Sulfonamides Cephalosporins Phenytoin Hypoglycemia can happen if taken with diabetic meds Side effects GI upset if taken without food (COX 1) Sodium and water retention Fenamates *** Used for chronic arthritis, watch GI effects Oxicams *** Used for RA, long half life, so once a day dosing COX-2 inhibitors *** •No effect on COX 1 so will not see GI distress or bleeding •Only works on pain and inflammation (COX 2) •Increased risk of heart attack and stroke, so use cautiously Celecoxib *** •Only COX 2 inhibitor and doesn't produce GI bleeding •Affects heart disease patients DMARDS *** •Immunosuppressants •Increased risk of infection Immunomodulators •Antimalarials •Used for RA •Severe psoriasis •Crohn's disease •UC •Must assess risk of infection Antigout *** •High level of uric acid in blood, causes inflammation/severe pain •Increase fluids while taking meds to flush out uric acid Colchicine *** Inflammation related to gout, not for other inflammatory conditions Aspirin *** Classification: salicylate, NSAID Uses: pain, arthritis, inflammation, anticoagulation Action: COX 1/2 inhibitor, prostaglandin inhibitor Side Effects: dizziness, abdominal pain, drowsiness, HA Adverse Effects: tinnitus, hearing loss, GI distress/ bleeding/ ulceration, thrombocytopenia, agranulocytosis, hepatotoxicity, Reye syndrome Contraindications: GI bleeding, sensitivity to NSAIDs, flu or viral illnesses, pregnancy Interactions: anticoagulants, hypoglycemics Eval/Monitor/Teach: monitor for bleeding/ bruising, GI, no alcohol or warfarin, inform dentist before procedure, stop 7 days before surgery, watch liver function, do not give to children Ibuprofen *** Classification: NSAID, propionic acid derivative Uses: arthritis pain, inflammation, mild-moderate pain Action: Inhibits COX 1/2 enzyme, prostaglandin inhibitor Side Effects: GI upset, peripheral edema, dizziness Adverse Effects: hearing loss/ tinnitus, GI bleeding/ulcers, petechiae Contraindications: cross sensitivity to other NSAIDs, hypersensitivity to aspirin, peptic ulcers Interactions: anticoagulants, lithium, herbal products Eval/Monitor/Teach: monitor for GI bleeding (severe stomach pain, black/tarry stools) Celecoxib (Celebrex) *** Classification: COX-2 inhibitor, NSAID Action: Inhibits prostaglandin synthesis in COX 2, decreases inflammation/pain Uses: osteoarthritis, RA, mild-moderate pain, fever Side Effects: GI upset, dizziness, diarrhea Adverse Effects: headaches, peripheral edema, bleeding, HTN, can cause strokes Contraindications: cardiac conditions Interactions: anticoagulants, lithium, herbal products (gingko biloba) Eval/Monitor/Teach: monitor for GI bleeding (severe stomach pain, black/tarry stools), monitor VS, caution with hepatic or renal dysfunction, highly protein bound, dysrhythmias, Allopurinol *** Classification: uric acid inhibitor, anti-gout Action: reduces serum uric acid levels Uses: gout, chronic gout prophylactic Side Effects: GI upset, dizziness, pruritus, HA, flushed skin Adverse Effects: blood dyscrasias, n/v, anemia, metallic taste, pruritus Contraindications: severe kidney disease Interactions: cyclosporine, anticoagulants, diuretics Eval/Monitor/Teach: monitor uric acid, increase fluids, encourage yearly eye exams, take with food, avoid high purine foods (meats, salmon, legumes, gravy, coffee), increase fluids, assess renal/liver function Acetominophen *** •Analgesic, antipyretic •Not an NSAID •no anti-inflammatory properties •Little GI effects, no antiplatelet properties •Short half life - taken q 4 •Watch liver function •no more than 4 g/24 hours •Hepatic toxicity •N/V •Diarrhea •Abdominal pain •Used for mild headache and mild fever antidote is acetylcysteine Opioid Analgesics *** •Moderate to severe pain •Antitussive •Antidiarrheal •Act on PNS and CNS Pain receptor sites Respiratory depression Euphoria Sedation Constipation Orthostatic hypotension (consider safety, falls risk) N/V •In the older adult with high doses Respiratory depression Urinary retention •Morphine Acute pain Watch for constipation RR Hypotension Urinary retention Decreased cough Combination Drugs *** Ibuprofen and hydrocodone PCA pump *** •Loading dose •Lock out prevents overdose •Patient must control transdermal *** •Patch Wear gloves Clean site Opioid Antagonists *** •Naloxone Monitor patient closely Might need to add analgesia afterwards Withdrawal symptoms Tachycardia N/V Sweating Migraine headaches *** •Triptans •Beta blockers •Anticonvulsants •TCA Morphine *** Classification: opioid analgesic Uses: moderate to severe pain, SOB Side Effects: constipation, urinary retention, rash, orthostatic hypotension Adverse Effects: respiratory depression, psychological dependence, miosis (small pupils), sedation, blurred vision, euphoria Contraindications: CNS or respiratory depression, asthma, increased ICP Interactions: CNS depressants, alcohol Eval/Monitor/Teach: avoid alcohol, may decrease respiratory rate, monitor VS, orthostatic hypotension (falls risk), confusion decreased LOC in elderly Sumatriptan (Imitrex) *** Classification: selective serotonin receptor agonist Uses: migraines, cluster headaches Action: vasoconstriction of cranial arteries Side Effects: dizziness, vertigo, drowsiness Adverse Effects: suicidal ideations, hypo/hypertension, bradycardia, dysrhythmias, cardiac arrest Contraindications: cardiovascular disease, uncontrolled HTN, liver failure, pregnancy Interactions: SSRIs, MAOIs Eval/Monitor/Teach: monitor VS, administer before pain escalates, avoid MAOIs and SSRIs, stress management, avoid migraine triggers Naloxone (Narcan) *** Classification: opioid antagonist Uses: opioid overdose Side Effects: sweating, flushing, agitation, dyspnea, elevated PTT, bleeding Adverse Effects: reversal of analgesia, hypo/hypertension, tachycardia Contraindications: use caution in patients with cardiac disease Interactions: opioids, topiramate Eval/Monitor/Teach: monitor VS and respiratory status, if using opioids for pain using naloxone will cause pain to return Amphetamines and amphetamine-like drugs *** •CNS stimulant •Used for ADHD and narcolepsy (excessive daytime sleepiness) •Can produce euphoria (seeing things) and increased alertness •Can also cause insomnia (can't sleep), restlessness, tremors, irritability, weight loss •Can also cause cardiovascular problems (high blood pressure, tachycardia, palpitations) •Other adverse reactions: dry mouth, diarrhea, seizure •Don't take in evening •Nursing process page 200 •High potential for building up tolerance, abuse •Monitoring weight, sleep patterns, anxiety, foods (caffeine) •You can have withdrawal, tapper dosage down when trying to stop taking, make sure you eat in the morning due to not feeling hungry Methylphenidate *** Classification: stimulant Uses: ADHD, narcolepsy Actions: Stimulates release of norepinephrine and dopamine Side Effects: nervousness, anorexia, restlessness, tremors, insomnia, dry mouth Adverse Effects: tachycardia, HTN, growth suppression Contraindications: HTN, hyperthyroidism, CAD, history of seizures Interactions: other stimulants, caffeine, anticoagulants, barbiturates, anticonvulsants, decrease effects of antihypertensive meds Eval/Monitor/Teach: avoid caffeine and other stimulants, monitor for changes in mood, sugarless gum/candy for dry mouth, take in am, before meals, eat good breakfast due to anorexia effects, monitor weight, report palpations (tachy) Phenytoin *** Classification: anticonvulsant Action: reduces motor activity, acts on sodium/calcium channel Uses: epilepsy, seizure prevention Side Effects: HA, dizziness, drowsiness, slurred speech, gingival hyperplasia, harmless urine discoloration Adverse Effects: thrombocytopenia, leukopenia, suicidal ideation, hyperglycemia Contraindications: pregnancy, NSAIDs, anticoagulants Interactions: folic acid, anticoagulants, decrease effectiveness of oral contraceptives, Vit K, diazepam Eval/Monitor/Teach: avoid alcohol, monitor for seizure activity, monitor for bleeding, teach good oral hygiene (gingival hyperplasia), highly protein bound, therapeutic range: 10-20 Phenobarbital *** Classification: barbiturate Uses: seizures Action: Stops status epilepticus Side Effects: dizziness, drowsiness, loss of appetite, nausea Adverse Effects: dependency, respiratory depression, coma Contraindications: pregnancy Interactions: anticoagulants, disulfiram, doxycycline, hormone replacement therapy Eval/Monitor/Teach: monitor therapeutic serum levels, do not stop abruptly, monitor RR Diazepam *** Diazepam IV for status epilepticus along with phenytoin/phenobarbital Valproic Acid *** Classification: antiepileptic, valproate Uses: chronic seizures Side Effects: N/V/D, HA, blurred vision, dizziness, drowsiness, hair loss, weight gain Adverse Effects: signs of infection, chest pain, tachycardia, rapid breathing, loss of consciousness Contraindications: pregnancy Interactions: amitriptyline, carbapenem antibiotics, phenytoin, lamotrigine Eval/Monitor/Teach: take with food, monitor liver enzymes, monitor seizure activity, monitor liver enzymes Pregnancy *** All antiseizure meds can cause fetal abnormalities Antipsychotics *** •typical and atypical •used to treat schizophrenia •Side effects •Parkinsonism or Extrapyramidal syndrome (EPS) •Positive symptoms •Hallucination •Typical •EPS •Tardive dyskinesia (TD) - uncontrollable movements of the mouth •Negative symptoms •Withdrawal/taken away •Atypical •Effective on negative symptoms, unlikely to cause EPS, TD •Fewer severe side effects •Weight gain •Diabetes •Dyslipidemia •Noncompliance a problem, check mouth for swallowing •May take weeks to see full therapeutic effect, don't stop abruptly Aripiprazole *** Classification: atypical antipsychotic Uses: schizophrenia, bipolar disorder, Tourette syndrome, Autism, psychotic disorders Action: Interferes with dopamine and serotonin receptors Side Effects: sedation, photosensitivity, orthostatic hypotension, blurred vision, constipation, urinary retention, sexual dysfunction Adverse Effects: EPS, NMS, blood dyscrasias, tachycardia, tardive dyskinesia, suicide ideation Contraindications: renal/ liver impairment, Parkinson's disease, CNS depression Interactions: alcohol, hypnotics, CNS depressants, antiseizure meds, antacids, herbal products, grapefruit products, DM meds Eval/Monitor/Teach: avoid alcohol/ CNS depressants, no grapefruit products, monitor for EPS/ NMS symptoms, do not stop abruptly, monitor BG levels in diabetics, can increase anxiolytics (antianxiety) *** •Treats anxiety and insomnia •Benzodiazepines and Tranquilizers •Benzodiazepines •Lorazepam •Treats anxiety •Status epilepticus •Sedation induction •Insomnia •Side effects •Sedation •Dizziness •Headache •Dry mouth •Don't stop abruptly - will see withdrawal symptoms, no alcohol Benzodiazepine antagonist *** Flumazenil Lorazepam *** Classification: benzodiazepine Uses: anxiety, pre-op sedation, sleep disorders Action: Alters dopamine Side Effects: lethargy, drowsiness, dizziness, blurred vision, headache, dry mouth Adverse Effects: hypotension, depression, dependence, liver failure Contraindications: respiratory depression, allergy Interactions: other CNS depressants, alcohol, tobacco Eval/Monitor/Teach: monitor for signs of depression/ suicidal ideation, monitor renal/ hepatic function, use caution in older adults. do not drive Haloperidol *** Classification: non-phenothiazine antipsychotic Uses: schizophrenia, bipolar disorder, Tourette syndrome, Autism, psychotic disorders Action: Alters dopamine Side Effects: sedation, photosensitivity, orthostatic hypotension, blurred vision, constipation, urinary retention, sexual dysfunction Adverse Effects: EPS, NMS, blood dyscrasias, tachycardia, tardive dyskinesia Contraindications: renal/ liver impairment, Parkinson's disease, CNS depression Interactions: alcohol, hypnotics, CNS depressants, antiseizure meds, antacids, herbal products, grapefruit products, DM meds Eval/Monitor/Teach: avoid alcohol/ CNS depressants, no grapefruit products, monitor for EPS/ NMS symptoms, do not stop abruptly, monitor WBC for agranulocytosis Antidepressants/mood stabilizers *** •Used for depression, hopelessness, helplessness •5 classes •TCA - tricyclic antidepressant (major depression) •SSRI - selective serotonin reuptake inhibitors (most common) •SNRI - serotonin norepinephrine reuptake inhibitors •Atypical antidepressants •MAOI - monoamine oxidase inhibitors (last choice) •Types of depression •Reactive depression •Job/divorce •Major •Interferes with daily life •Bipolar •Really high euphoric •Really low depression TCAs (tricyclic antidepressants) *** •Major depression •Blocks the uptake of norepinephrine and serotonin in brain •Takes 2-4 weeks to see improvement •Should see •Increased mood •Increased interest in daily life •Decreased insomnia •Given at night - sedating •Gradually reduce drug to reduce side effects related to withdrawal •Side effects •Orthostatic hypotension •Sedation •Anticholinergic effect •Cardiotoxicity, seizures •Don't take with any CNS depressant Amitriptyline *** Classification: tricyclic antidepressant Uses: depression, OCD, childhood enuresis, trigeminal neuralgia Action: Blocks uptake of norepinephrine and serotonin Side Effects: sedation, dizziness, memory impairment, impotence, anticholinergic effects, weight loss, orthostatic hypotension, can lead to EPS Adverse Effects: blood dyscrasias, cardio toxicity, tachycardia Contraindications: older adults should not take tricyclic's, severe cardiovascular disease Interactions: alcohol, CNS depressants, MAOIs Eval/Monitor/Teach: avoid alcohol/ CNS depressants, use caution in patients with cardiac disease/disorders, takes 3-4 weeks for effectiveness, monitor blood count SSRIs *** •Most common class of antidepressants used •Can also treat •OCD •PTSD •Eating disorders •Interact with grapefruit juice •Takes 3-4 weeks to work •Side effects •Dry mouth •Blurred vision •Insomnia •Headache •Suicide ideation •Sexual dysfunction •Do not take with other CNS depressants Fluoxetine *** Classification: selective serotonin reuptake inhibitor (SSRI) Uses: depression, anxiety, OCD, bulimia, premenstrual dysphoric disorder Action: blocks reuptake of serotonin Side Effects: weight loss, sexual dysfunction, insomnia, drowsiness, orthostatic hypotension, dry mouth, blurred vision, anorexia, not given with glaucoma Adverse Effects: suicidal ideation, bleeding, hepatic dysfunction Contraindications: caution with anticoagulants Interactions: St. John's Wort, grapefruit products, NSAIDs, anticoagulants, MAOIs Eval/Monitor/Teach: avoid grapefruit products, monitor for bleeding, avoid alcohol/ CNS depressants, takes 3-4 weeks for effectiveness, take at bedtime, SNRIs *** •Used for •Major depression •Anxiety •Social anxiety •Panic disorder •Side effects •Drowsiness •Dizziness •Insomnia •Headache •Blurred vision •Amnesia •Hypertension •Tachycardia •Suicide ideation •Angioedema •Seizures MAOIs *** •Not first drug of choice, many side effects, will give only if TCA doesn't work •Side effects •Drug interactions •CNS stimulants such as pseudoephedrine can cause hypertensive crisis, cannot take with TCA •Food interactions •Tyramine •Aged cheese, yogurt, coffee, chocolate, raisins, bananas, liver, pickled foods, yeast, wine, beer •Can cause hypertensive crisis Venlafaxine *** Classification: serotonin norepinephrine reuptake inhibitor (SNRI) Uses: depression, anxiety, panic disorder Action: serotonin and norepinephrine increased in nerve cells Side Effects: drowsiness, dizziness, insomnia, blurred vision, ejaculation dysfunction, weight loss, Steven Johnson syndrome, agitation Adverse Effects: hypertension, tachycardia, seizures, suicidal ideations, renal failure Contraindications: caution with renal impairment Interactions: St. John's Wort Eval/Monitor/Teach: avoid alcohol/ CNS depressants, monitor for suicidal ideations, takes 3-4 weeks for effectiveness phenelzine sulfate *** Classification: monoamine oxidase inhibitor (MAOI) Uses: depression, anxiety, panic disorders Action: inactivates norepinephrine and serotonin Side Effects: agitation, restlessness, insomnia, orthostatic hypotension, anticholinergic effects, weight gain Adverse Effects: hypertensive crisis, suicidal ideations Contraindications: caution with hypertension Interactions: TCAs, foods containing tyramine Eval/Monitor/Teach: monitor VS, avoid foods with tyramine (aged cheese, wine, yogurt, cream, chocolate, beer) can cause hypertensive crisis, last resort class of medication, assess depression Lithium *** Classification: mood stabilizer Uses: bipolar disorder, mania Action: increased sensitivity to serotonin Side Effects: increased urination, loss or water and sodium, dehydration, edema in hands/ankles, weight gain, thirst, dry mouth, hypotension, memory impairment, metallic taste, Adverse Effects: severe hyponatremia, hyperglycemia, dysrhythmias, seizures Contraindications: pregnancy Interactions: NSAIDs, caffeine Eval/Monitor/Teach: avoid alcohol, monitor lithium levels closely/ signs of toxicity (small therapeutic range), monitor sodium intake, monitor suicidal ideations. BUN/creatinine, I&O's, weight, above 1.5=toxicity, assess mood (suicide ideation).