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Exam 1 Drug List - Practice this drug this for pharm.
Pharmacology (Rasmussen University)
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Module 1:
There are a lot of terms and de昀椀nitions to know in pharmacology. The items below are
important to know.
Drug (Also known as: Medication)
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Full De昀椀nition: Any chemical that can a昀昀ect living processes within the human
body (Burchum & Rosenthal, 2019).Note: The term drug and medication can and
will be used interchangeably throughout this course.
Simple De昀椀nition: Any substance that has a physiological e昀昀ect on the body
Pharmacology
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Full De昀椀nition: The study of drugs and their origin, nature, properties, and
e昀昀ects on living organisms (Venes, 2013).
Simple De昀椀nition: The study of drugs and their e昀昀ects on the body
Therapeutics (Also known as: Pharmacotherapeutics)

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Full De昀椀nition: The use of drugs to diagnose, prevent, or treat disease.Note:
The phrase "therapeutic e昀昀ect" refers to the drug's e昀昀ect on the body to
diagnose, prevent, or treat disease (Burchum & Rosenthal, 2019).
Simple De昀椀nition: Bene昀椀cial or useful e昀昀ects of a drug
Side e昀昀ect
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Full De昀椀nition: Responses in the body where the drug's e昀昀ects are neither
needed nor wanted that cause problematic, but not harmful, symptoms (Smith,
2016).
Simple De昀椀nition: Undesirable e昀昀ects that are bothersome, but not harmful to
the client
Adverse e昀昀ect


Full De昀椀nition: Responses in the body where the drug's e昀昀ects are both
undesirable and harmful (Smith, 2016).
Simple De昀椀nition: Harmful undesirable e昀昀ects
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Pharmacokinetics
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
Full De昀椀nition: The study of the metabolism and action of drugs with particular
emphasis on the time required for absorption, duration of action, distribution in
the body, and method of excretion (Venes, 2013).
Simple De昀椀nition: What the body does to drugs
Pharmacodynamics

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Full De昀椀nition: The molecular interactions of a drug with speci昀椀c biological
receptors on or in the body's cells, which lead to a desired therapeutic response
(Smith, 2016).
Simple De昀椀nition: What drugs do to the body
The Original 5 Rights
For much of nursing's history, nursing medication administration focused on
the "5 rights". These 5 rights are almost as old as the profession of nursing,
and are often referred to colloquially as "The Rights".
1. Give the right drug
2. ...to the right client
3. ...in the right dose
4. ...by the right route
5. ...at the right time.
In recent years however, the original 5 rights have been expanded upon;
some textbooks refer to 6, 7, 8 or even 10 unique rights. Common examples
of additional rights include:
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Right assessment
Right documentation
Right evaluation
The client's right to education
The client's right of refusal
Limitations of the rights
While The Rights are an essential and critical element to safe and e昀昀ective medication
administration, they fail to encompass the totality of the nurse's responsibilities around
medication administration.
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
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The Rights only ensure that the medication will be administered as prescribed. As
future professional nurses, it is imperative that you practice to the fullest extent
of your education and training. This means you will need to begin thinking of
medication administration as much more than simply The Rights.
You must recognize that important additional interventions are required both
before and after a medication is given to ensure it will do the most good with the
least harm.
An in-depth understanding of pharmacology is therefore required of the modern
professional nurse in order to ensure the overall therapeutic goals are
accomplished for your client.
Checks and Balances
Remember that The Rights only ensure that the medication is given as
prescribed. But what if a mistake was made by the pharmacist or the
prescribing clinician.
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Strict adherence to The Rights is important, but it is not going to prevent a
mistake from reaching the client.
Does that mean the nurse has no responsibility in preventing mistakes? The
answer is NO - nurses indeed, have a responsibility to detect and prevent
upstream errors from reaching the client.
Nurses spend the most time directly with the client, and therefore often
know the client's health status best. The closeness of this nurse-client
relationship allows the nurse to:

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observe how the medication is a昀昀ecting the client and intervene if needed.
anticipate how a particular medication and or dosage will a昀昀ect the client if
given.
The nurse is the last line of defense against medication errors.
Applying your Pharmacology Knowledge
A good way to break down the responsibilities of the nurse as it pertains to
pharmacology is to think about it in the two primary spheres of in昀氀uence the
nurse has related to medications:
1. Pharmacology knowledge as it pertains to the direct client care you provide
2. Pharmacology knowledge as it pertains to client education
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Pharmacology Knowledge: Direct Client Care
The use of pharmacology in client care focuses on the following eight
aspects of medication therapy:
1. Preadministration assessment - Collecting data and analyzing that data
2. Dosage and administration - The Rights
3. Promoting therapeutic e昀昀ects - Examples, using an analgesic with nonpharm
comfort measures; using asthma meds with breathing exercises
4. Minimizing adverse e昀昀ects - This requires knowledge of what to look for and
how to intervene
5. Minimizing adverse interactions - This requires knowledge of how di昀昀erent
drugs interact with each other when given concurrently to the same client
6. Making “as needed” or PRN decisions - This requires good nursing judgement
7. Evaluating responses to medications - Is the drug doing what it was supposed
to, is not e昀昀ective, or is causing having harmful adverse e昀昀ects
8. Managing toxicity - This requires knowledge
The common thread throughout all these aspects is "you could never know
too much about the medications you are giving your clients".
Pharmacology Knowledge: Client Education
Nurses play an important role in educating clients about their medications. When
educating clients, it is important to give the client the following information:
1.
2.
3.
4.
The name of the drug and what it is for in simple terms
Dosage - how much to take with each dose
Dosing schedule - how often to take it
Route and technique of administration - PO versus sublingual versus
subcutaneous
5. What the expected response should be an when they should expect it
6. Nondrug measures to enhance their response (e.g. exercise for hypertension)
7. Duration of the treatment
8. How to store it
9. Symptoms of major adverse e昀昀ect and how to cope with them
10. Major drug-drug and drug-food interactions
11. Who to call with issues
Module TWO:
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Levodopa - Dopaminergic Drugs
Carbidopa - Dopaminergic Drugs
Donepezil- Cholinesterase Inhibitors
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Memantine - NMDA Receptor Antagonists
Interferon beta - Immunomodulators
Phenytoin - Traditional Antiepileptic Agents
Oxcarbazepine - Newer Antiepileptic Agents
Baclofen - Centrally Acting Muscle Relaxer for Spasticity
Cyclobenzaprine - Centrally Acting Muscle Relaxer for Localized Muscle
Spasm
Amphetamine sulfate - Amphetamines
Methylphenidate - Amphetamine-like Drugs
Strategies for Learning These Medications
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Make charts to compare and contrast the di昀昀erent drug classes.
Make charts to compare and contrast the di昀昀erent drugs.
Write out drug 昀氀ash cards.
Use time and repetition to space learning.
Levodopa, Carbidopa
3,345 views
Summary
Levodopa and carbidopa are medications given in combination to
treat Parkinson’s disease. Levodopa can cross the blood brain
barrier to enter the brain, where it is converted into dopamine.
Carbidopa on the other hand, is given along with levodopa to help
more levodopa reach the brain. This drug combination is very
e昀昀ective in treating the symptoms of Parkinson's disease. Side
e昀昀ects include psychiatric disturbances and orthostatic hypotension.
Levodopa and carbidopa must not be stopped suddenly, or a
paralysis known as akinetic crisis can occur. Instead, the patient
should taper o昀昀 the drug slowly.
Key Points
o
Levodopa, Carbidopa
o Mechanism
o Dopaminergic drug combination
o Levodopa is converted to dopamine in the brain, and
carbidopa is added to increase the amount of
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o
o
dopamine that reaches the brain. Without carbidopa,
99% of levodopa gets converted into
dopamine before it reaches the brain and requires a
really large dose to be e昀昀ective, causing severe side
e昀昀ects. Carbidopa allows for a smaller dose of
levodopa with higher e昀昀ectiveness.
o Has a short half-life and must be taken 3-4 times per
day
Clinical Use
o Parkinson Disease
o Helps with bradykinesia and tremors
o Full therapeutic e昀昀ect may take up to 6 months
Side E昀昀ects and Adverse Reactions
o Orthostatic hypotension
o Expected side e昀昀ect
o Instruct patient to rise slowly
o Akinetic crisis if stopped suddenly
o Complete loss of movement
o Can present if levodopa/carbidopa is stopped
suddenly. The drug must be tapered o昀昀 to
prevent akinetic crisis.
o Psychiatric disturbances
o Psychosis, confusion, hallucinations, delusions,
agitation
o Carbidopa decreases peripheral side e昀昀ects,
but can actually worsen central side e昀昀ects like
anxiety or agitation
o Agranulocytosis
o Decreased white blood cell count
o Dark colored urine and sweat
o Angioedema
o Heart palpitations
o Nausea and vomiting
Donepezil
1,345 views
Summary
Donepezil and Rivastigmine are medications that treat Alzheimer
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Disease by increasing the acetylcholine levels in the body. Although
they are not a cure or prevention for Alzheimer disease, they can
slow the progression of the disease.
Key Points
o
Donepezil (Aricept), Rivastigmine (Exelon)
o Mechanism
o Acetylcholinesterase inhibitor
o Inhibits the enzyme that breaks down
acetylcholine, increasing the amount of
acetylcholine available at the receptor site
and improving memory
o Clinical Uses
o Alzheimer Disease
o E昀昀ective in mild to moderate Alzheimer’s
o Does not cure or prevent Alzheimer’s, but can
slow progression of the disease
o Side E昀昀ects and Adverse Reactions
o Gastrointestinal distress
o Nausea, vomiting, diarrhea (frequent bowel
movements)
o Due to increases parasympathetic (rest and
digest response)
o Bradycardia
o In patients with pre-existing heart conditions
o Frequent Urination
o Due to increased parasympathetic (rest and
digest response)
o
Memantine
876 views
Summary
Memantine is a medication that is used to treat Alzheimer Disease.
This medication o昀昀ers a symptomatic bene昀椀t by improving the
cognition of patients, but cannot cure nor reverse the course of
disease.
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Key Points
o
Memantine (Namenda)
o Mechanism
o NMDA receptor antagonist
o Binds to NMDA receptors, blocking the
neurotransmitter glutamate which then
prevents calcium from building up in the brain
cells.
o Clinical Uses
o Alzheimer Disease
o Memantine is not a cure, but slows the
progression of the disease
o Side E昀昀ects and Adverse Reactions
o Stevens Johnson Syndrome
o Report symptoms of a rash immediately
o Sedation, drowsiness
o Dizziness
o Constipation
o Headaches
Phenytoin
2,240 views
Summary
Phenytoin is an anticonvulsant drug used to treat seizures.
Phenytoin has a narrow therapeutic range of 10-20 mcg/mL. High
doses of phenytoin above this cuto昀昀 can lead to symptoms of acute
toxicity. These symptoms include ataxia, slurred speech, and
nystagmus. The provider should be noti昀椀ed immediately if these
symptoms are seen. Another expected side e昀昀ect of phenytoin is
gingival hyperplasia, so encourage your patients to practice good
oral hygiene and visit the dentist regularly.
Key Points
o
Phenytoin (Dilantin)
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o
o
o
Mechanism
o Anticonvulsants/antiseizure
o Inhibits sodium in昀氀ux and reduces repetitive
neuron 昀椀ring to limit seizures
Clinical Use
o Seizures
o E昀昀ective in treating tonic-clonic and partial
seizures, but not absence seizures
o Arrhythmias
o Has been shown to be e昀昀ective in treating
ventricular tachycardia
Side E昀昀ects and Adverse Reactions
o Acute toxicity/overdose
o Narrow therapeutic range of 10-20 mcg/mL
o Below this range, seizures may not be
controlled. Above this range is considered
phenytoin toxicity
o Ataxia, nystagmus, slurred speech,
decreased LOC
o If these symptoms are noticed, the dose should
be held and the provider contacted
o Gingival hyperplasia
o An expected side e昀昀ect that can often be
limited with good oral hygiene and regular
dentist appointments
o This is NOT a reason to stop the drug
o Drug-drug interactions
o Be careful when taking concurrently with
anticoagulants, antipsychotics, sulfonamides,
barbiturates, sucralfate, rifampin, antacids,
warfarin, and antineoplastic medications
o Note that drug interactions may be the reason
for drug overdose/toxicity
o Injection site reactions
o Phenytoin is a vesicant, meaning that if it leaks
from the vein into the surrounding tissue it can
cause a burning sensation and tissue/skin
damage
o Blood Dyscrasias
o Thrombocytopenia (low platelets)
o Leukopenia (low white blood cells)
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o
Monitor CBC levels
Muscle Relaxants
1,467 views
Summary
Muscle relaxants are a drug class that are used to treat muscle
spasms associated with several skeletal muscle conditions like
multiple sclerosis and cerebral palsy. Drugs to know in this class
include baclofen, carisoprodol, methocarbamol, and
cyclobenzaprine. Muscle relaxants can cause orthostatic
hypotension and sedation, both of which are expected side e昀昀ects.
Patients taking muscle relaxants should avoid alcohol.
Key Points
o
Key Drugs
o Baclofen (Lioresal)
o Methocarbamol (Robaxin)
o Carisoprodol (Soma)
o Cyclobenzaprine (Flexeril)
o Mechanism
o Act on the brain/spinal cord to interfere with nerve pathways
and decrease spasticity
o Clinical Use
o Muscle spasms
o Spinal cord injuries
o Cerebral palsy
o Multiple sclerosis
o Stroke
o Post-surgery on open fractures
o Tetanus
o Intractable hiccups
o Side E昀昀ects and Adverse Reactions
o Orthostatic hypotension
o An expected side e昀昀ect
o Sedation / Drowsiness
o An expected side e昀昀ect, and not a reason to stop taking
the medication
o Avoid alcohol
o Dependence
o Taper o昀昀 medication, do not stop abruptly
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Withdrawal symptoms include anxiety, restlessness,
seizures, and hallucinations
Anticholinergic e昀昀ects (cyclobenzaprine)
o Constipation
o Increase 昀氀uid and 昀椀ber intake
o Contraindicated in glaucoma
o
o
Amphetamines
1,617 views
Summary
Amphetamines are a class of mental health drugs that include all
drugs ending in -amphetamine, like methamphetamine and
dextroamphetamine. The exception to this rule is methylphenidate,
which is an amphetamine-like drug that works similarly, but has a
lower abuse potential. Amphetamines are CNS stimulants clinically
used to treat ADHD and narcolepsy. Amphetamines can cause
insomnia, so be sure to give the last dose before 6:00 pm to avoid
interfering with nighttime sleep. Amphetamines can also cause
hypertension and tachycardia, so the patient’s vital signs should be
monitored closely. Other side e昀昀ects of amphetamines include
appetite suppression, leading to weight loss and growth
suppression. As the nurse, be sure to closely monitor the patient’s
height and weight, especially in children. And lastly, keep in mind
that amphetamines can cause tolerance and dependence, leading to
a high abuse potential.
Key Points
o
Key Drugs
o End in “-amphetamine”
o Amphetamine
o Dextroamphetamine
o Methamphetamine
o Methylphenidate (Ritalin, Concerta)
o Is an amphetamine-like drug, meaning it acts in a
similar mechanism but has a lower potential for
abuse and tolerance than amphetamines
o Mechanism
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CNS Stimulant
o Increases neurotransmitters dopamine and
norepinephrine in the brain by inhibiting their
reuptake
Clinical Use
o Attention De昀椀cit Hyperactivity Disorder
(ADHD)
o First line agent for treating ADHD
o Increases attention span, decreases
distractibility
o Narcolepsy
o Corrects abnormal sleep patterns
Side E昀昀ects and Adverse Reactions
o Side e昀昀ects may be more severe if taken with other
stimulants like ca昀昀eine
o Hypertension
o Related to stimulant e昀昀ect of increasing
norepinephrine and dopamine signalling
o Closely monitor patient’s blood pressure
o Use with caution in patients with hypertension
o Taking with MAOIs can result in a hypertensive
crisis
o Tachycardia
o Increased HR is a stimulant e昀昀ect
o Dysrhythmias and angina may be seen
o Insomnia
o Related to stimulant (amphetamine-like)
e昀昀ects
o Administer the last dose before 6:00 pm to
avoid interference with sleep
o Decreased appetite & weight loss, growth
suppression
o Closely monitor height and weight, especially
in children
o Methylphenidate is usually given 2-3 times a
day before meals, but timing may be adjusted
after consulting with provider if the child isn’t
eating enough
o Abuse potential
o Tolerance / dependence
o
o
o
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Module THREE:
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Chlorpromazine - Traditional Antipsychotics (low-potency)
Haloperidol - Traditional Antipsychotics (high-potency)
Clozapine - Atypical Antipsychotics
Fluoxetine - Selective Serotonin Reuptake Inhibitors
Venlafaxine - Serotonin/Norepinephrine Reuptake Inhibitors
Imipramine - Tricyclic Antidepressants
Phenelzine - Monoamine Oxidase Inhibitors
Bupropion - Atypical Antidepressants
Lithium - Mood Stabilizers
Valproic acid - Mood Stabilizers
Carbamazepine - Mood Stabilizers
Triazolam - Benzodiazepines
Zolpidem - Benzodiazepine-like Drugs
Buspirone - Nonbenzodiazepine-Nonbarbiturates
Typical Antipsychotics
3,004 views
Summary
Typical antipsychotics are a class of drugs that include haloperidol
and 昀氀uphenazine. As their name suggests, the typical antipsychotics
are used to treat psychosis and psychotic disorders like
schizophrenia, as well as dangerous agitation and aggression. Side
e昀昀ects include extrapyramidal symptoms, abbreviated EPS,
neuroleptic malignant syndrome, abbreviated NMS, drowsiness or
sedation, anticholinergic e昀昀ects, and a prolonged QT interval that
puts the patient at risk for torsade de pointes.
Key Points
o
Typical Antipsychotics
o Also known as 昀椀rst-generation antipsychotics
o Key Drugs
o Haloperidol
o Fluphenazine
o Thioridazine
o Chlorpromazine
o Loxapine
o Mechanism
o Blocks D2 dopamine receptors and alters the e昀昀ect of dopamine
on the CNS
o When administered intramuscularly:
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o
o
o
o
Administered via a large bore needle due to the viscosity
of the medication
Should be administered via z-track, rotate injection sites
Clinical Use
o Psychotic states
o Schizophrenia
o Typical antipsychotics are not considered 昀椀rst-line
treatment
o Targets the positive symptoms
(hallucinations, delusions, thought disorders)
but has minimal e昀昀ect on negative
symptoms (昀氀at a昀昀ect, apathy, antisocial
behavior, etc.)
o Mania with Psychotic Symptoms
o Bipolar Type 1
o Postpartum psychosis
o Acute Agitation
o Used intramuscularly as a pharmacological restraint
o Tourette Syndrome
Side E昀昀ects and Adverse Reactions
o Extrapyramidal Symptoms (EPS)
o Drug-induced movement disorders
o Dystonia
o Muscle contraction, spasm, sti昀昀ness
o Pseudoparkinsonism
o Mimics Parkinson’s disease with a shu昀툀ing
gait, bradykinesia, tremor, rigidity
o Akathisia
o Restlessness
o Tardive Dyskinesia (TD)
o Involuntary repetitive movements, often of
the mouth, face, and neck (e.g. lip smacking,
sticking out tongue, grimacing)
o Appears with long-term use
o Can be treated with the drug benztropine
o EPS is common, but still an adverse e昀昀ect that should
receive medical attention. Notify the provider if EPS is
noticed.
o Neuroleptic Malignant Syndrome (NMS)
o Life threatening, a medical emergency
o Manifests with a fever, muscle rigidity, altered mental
status, and unstable vital signs
o All antipsychotics should be held and provider noti昀椀ed
immediately
o Sedation / Drowsiness
o This is an expected side e昀昀ect
o Avoid alcohol and other CNS depressants to prevent
oversedation
o Anticholinergic e昀昀ects
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Dry mouth, dry eyes, urinary retention, tachycardia,
constipation, etc.
o This is an expected side e昀昀ect
QT prolongation
o Can lead to an ventricular arrhythmia known as torsades
de pointes
Photosensitivity
Orthostatic hypotension
o Move positions slowly to avoid sudden drop in blood
pressure
o
o
o
o
Atypical Antipsychotics
2,888 views
Summary
Atypical antipsychotics are a drug class used to treat psychosis in
schizophrenia and other psychotic conditions, and are also used as
mood stabilizers for bipolar disorder. Drugs in this category include
clozapine, olanzapine, aripiprazole, risperidone, quetiapine, and
ziprasidone. Side e昀昀ects of these drugs include extrapyramidal
symptoms, abbreviated EPS, which refers to a constellation of
movement problems, like tremors, muscle spasms, and
restlessness. Atypical antipsychotics are also well known for causing
metabolic syndrome and weight gain. Other side e昀昀ects include
sedation, anticholinergic e昀昀ects, and neuroleptic malignant
syndrome, abbreviated NMS. NMS is a medical emergency
characterized by muscle rigidity, fever, confusion, and unstable
vitals. Clozapine can cause agranulocytosis, or a rapid fall in white
blood cells, and ziprasidone can cause QT prolongation and the
abnormal heart rhythm of torsades de pointes.
Key Points
o
Atypical Antipsychotics
o Also called second-generation antipsychotics
o Key Drugs
o Clozapine
o Risperidone
o Olanzapine
o Quetiapine
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Aripiprazole
o Ziprasidone
Mechanism
o Blocks serotonin and dopamine receptors
Clinical Use
o Schizophrenia
o First line treatment
o Treats both positive AND negative symptoms
o Clozapine is only used to treat schizophrenia
that has not responded to traditional
antipsychotics. This is because it has some
serious adverse e昀昀ects (e.g. agranulocytosis)
o Psychosis
o Atypical antipsychotics like quetiapine and
aripiprazole may be used to treat acute
psychosis and delusions, especially in the
context of dementia
o Bipolar Disorder
o Has mood-stabilizing e昀昀ects
Side E昀昀ects and Adverse Reactions
o Neuroleptic Malignant Syndrome (NMS)
o Life threatening, a medical emergency
o Manifests with high fever, muscle rigidity,
altered mental status, and unstable vital signs
o All antipsychotics should be held and provider
noti昀椀ed immediately
o Extrapyramidal Symptoms (EPS)
o More commonly seen in typical antipsychotics
than atypical
o Drug-induced movement disorders
o Dystonia
o Muscle contraction, spasm, sti昀昀ness
o Pseudoparkinsonism
o Mimics Parkinson’s disease with a
shu昀툀ing gait, bradykinesia, tremor,
rigidity
o Akathisia
o Restlessness
o Tardive Dyskinesia (TD)
o Involuntary repetitive movements,
often of the mouth, face, and neck
o
o
o
o
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o
o
o
o
o
o
o
o
(e.g. lip smacking, sticking out
tongue, grimacing)
o Appears with long-term use
o Can be treated with the drug benztropine
o EPS is common, but still an adverse e昀昀ect that
should receive medical attention. Notify the
provider if EPS is noticed.
Agranulocytosis (clozapine)
o Drop in granulocyte (e.g. neutrophil) count
after starting clozapine can lead to severe
infections
o Call the provider immediately if sore throat or
fever develop
o Closely monitor WBC
QT prolongation (ziprasidone)
o Patients taking ziprasidone are at risk of
developing Torsades de Pointes and should be
monitored for cardiac e昀昀ects
Sedation / Drowsiness
o This is a normal and expected side e昀昀ect
o Avoid alcohol and other CNS depressants to
prevent oversedation
Anticholinergic e昀昀ects
o Urinary retention, constipation, dry mouth,
blurred vision, tachycardia
o Patients should be advised that they may
experience side e昀昀ects like dry mouth
Metabolic Syndrome
o Weight gain
o Hyperglycemia
o May turn into diabetes mellitus
o Monitor blood glucose levels
o High cholesterol
Headaches
o This is a normal and expected side e昀昀ect
Orthostatic Hypotension
Seizures (clozapine)
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SSRIs
5,058 views
Summary
Serotonin-selective reuptake inhibitors, abbreviated as SSRIs, are
antidepressant drugs used to treat both depression and anxiety.
Drug names of the SSRIs to know include citalopram, escitalopram,
sertraline, paroxetine, and 昀氀uoxetine. Common side e昀昀ects include
sexual dysfunction and weight gain. Another important adverse
e昀昀ect is serotonin syndrome, which is a medical emergency
resulting from an overload of serotonin in the body, manifesting as
hypertension, tachycardia, muscle rigidity, and diarrhea. The risk for
Serotonin syndrome can be reduced by teaching the patient to avoid
other serotonin-altering substances like MAOIs, St. John’s Wort, as
well as avoiding any and all grapefruit products.
Key Points
o
Key drugs
o Citalopram
o Sertraline
o Paroxetine
o Fluoxetine
o Escitalopram
o Fluvoxamine
o Mechanism
o Antidepressant
o Increases serotonin in the CNS by blocking its reuptake
at the neuron ends
o Therapeutic e昀昀ects may take up to 4 weeks
o Clinical Use
o Depressive Disorders
o Increased serotonin is thought to improve mood states
o First-line treatment
o Generally preferred over other antidepressants
(MAOIs, TCAs, etc.) because of fewer side e昀昀ects
o Anxiety Disorders
o Generalized anxiety disorder
o Post-traumatic stress disorder (PTSD)
o Phobias
o Panic disorders
o Obsessive-Compulsive Disorder (OCD)
o Low serotonin levels is thought to play a role in
OCD
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o
Side E昀昀ects and Adverse Reactions
o Increased risk of side e昀昀ects with (avoid!)
o MAOIs
o Discontinue 14 days before starting an SSRI and
vice versa
o St John’s Wort
o Grapefruit
o Serotonin Syndrome (think overactive everything)
o Hyperthermia, Sweating
o Tachycardia, hypertension
o Muscle rigidity, loss of muscle coordination
o Dilated pupils
o Diarrhea
o Agitation or restlessness
o Confusion
o Headache
o Shivering
o Goosebumps
o If patient experiences serotonin syndrome symptoms, the
SSRI should be stopped and provider noti昀椀ed
o Increased risk of suicidal thoughts or behavior
o Priority!
o Seen at the beginning of therapy but should diminish over
time
o The patient will receive an increase in energy before they
experience an increase in mood. Patients, especially
young adults, need to be monitored for increased suicidal
ideation, as they may now have the energy to follow
through with the suicide plan
o Sexual Dysfunction
o Common side e昀昀ect, experienced in over 50% of patients
o If patient is still experiencing sexual dysfunction after 2-4
weeks of treatment initiation, they should be encouraged
to report this to the provider for a possible change in
medication
o Noncompliance is common with SSRIs due to side e昀昀ects
of sexual dysfunction and weight gain.
o Weight gain
o Common side e昀昀ect of taking SSRIs
o A healthy diet and regular exercise should be encouraged
to combat weight gain
o Other drug interactions
o Use caution with concurrent use of digoxin, warfarin,
diazepam, NSAIDS, aspirin, alcohol, and other CNS
depressants
o GI Distress
o Nausea, vomiting, diarrhea, anorexia
o Insomnia
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SNRIs
2,341 views
Summary
Serotonin-norepinephrine reuptake inhibitors, abbreviated SNRIs,
are a class of medications that increase serotonin and
norepinephrine levels in the brain. SNRIs are useful in treating
depression, anxiety, and chronic pain. Notably, SNRIs have the
potential to cause serotonin syndrome, a life-threatening medical
emergency. As a reminder, with serotonin syndrome the body is
experiencing overactive everything - tachycardia, hypertension,
hyperactive re昀氀exes, diarrhea, and so on. This risk for serotonin
syndrome is increased if SNRIs are combined with any other
serotonin-altering substances, like St. John’s Wort or MAOIs. SNRIs
can also cause sexual dysfunction.
Key Points
o
Key Drugs
o Duloxetine
o Venlafaxine
o Levomilnacipran
o Desvenlafaxine
o Mechanism
o Antidepressant
o Increases serotonin and norepinephrine in
the synapses by inhibiting their reuptake.
o Clinical Use
o Depressive Disorders
o Anxiety Disorders
o Generalized anxiety disorder (GAD)
o Social anxiety disorder
o Panic disorder
o Post-traumatic Stress Disorder (PTSD)
o Chronic pain
o Diabetic neuropathy
o Fibromyalgia
o Chronic back pain/osteoarthritis
o Side E昀昀ects and Adverse Reactions
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o
o
o
o
o
o
Risk of Side E昀昀ects Increased with (avoid!)
o St. John's Wort
o MAOIs
o Both the above can increase risk for serotonin
syndrome
Serotonin Syndrome (think overactive everything)
o Hyperthermia, Sweating
o Tachycardia, hypertension
o Muscle rigidity, loss of muscle coordination
o Dilated pupils
o Diarrhea
o Agitation or restlessness
o Confusion
o Headache
o Shivering
o Goosebumps
o Do not take concurrently with other serotonin
altering medications
o SSRIs
o MAOIs
o St John’s Wort
Increased risk of suicidal thoughts or behavior
o Priority!
o Seen at the beginning of therapy but should
diminish over time
o The patient will receive an increase in energy
before they experience an increase in mood.
Patients, especially young adults, need to be
monitored for increased suicidal ideation, as
they may now have the energy to follow
through with the suicide plan
Sexual dysfunction
o If patient is still experiencing sexual
dysfunction after 2-4 weeks of treatment
initiation, they should be encouraged to report
this to the provider for a possible change in
medication
Hepatotoxicity
o Teach the patient to avoid alcohol
Withdrawal syndrome
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o
o
Headache, nausea, visual disturbances,
anxiety, dizziness, tremors
Withdraw from medication gradually
Tricyclic Antidepressants
7,528 views
Summary
Tricyclic antidepressants are a class of mental health drugs
recognizable by their endings of -triptyline: like amitriptyline and
nortriptyline, as well as -pramine: like clomipramine, imipramine,
and desipramine. The only exception to these 2 endings is doxepin.
As a class, all the TCAs are used to treat depression, as well as
nerve pain from causes like diabetic neuropathy or 昀椀bromyalgia.
Important side e昀昀ects include orthostatic hypotension which can
result in dizziness and falls, and anticholinergic e昀昀ects like dry
mouth, urinary retention, tachycardia, and so on. Finally, tricyclic
antidepressants are lethal in overdose.
Key Points
o
Key Drugs
o Amitriptyline
o Nortriptyline
o Imipramine
o Clomipramine
o Desipramine
o Doxepin
o Mechanism of Action
o Antidepressant
o Increases the amount of serotonin (strong SSRI),
norepinephrine (moderate SNRI), in the CNS by blocking
their reuptake by the presynaptic neurons
o Desired e昀昀ect may take up to 4 weeks
o Clinical Indications
o Depression
o SSRIs are generally preferred over TCAs because TCAs
are lethal in overdose and have a higher risk of suicide
attempt. TCAs also have more side e昀昀ects.
o Nerve Pain
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Diabetic Neuropathy
Fibromyalgia
o Insomnia
Side E昀昀ects and Adverse Reactions (mictlan, wolters kluwer)
o Orthostatic hypotension
o Safety concern = priority!
o Leads to fall risk in the elderly and other susceptible
patients
o Advise patients to rise slowly from sitting/supine positions
to avoid sudden drop in blood pressure and dizziness
o Anticholinergic e昀昀ects
o Tachycardia
o Urinary retention (this is extremely common!)
o Constipation
o Dry mouth
o Blurred vision
o Overdose risk
o Lethal in overdose due to cardiac arrhythmias
o Sedation
o Best if given at night
o Avoid giving with other sedating substances (alcohol,
sedatives, barbiturates, etc.)
o Serotonin syndrome
o Avoid taking concurrently with other serotonin modulating
drugs
o Increase in suicidal thoughts and actions
o May occur at the beginning of treatment due to an
increase in energy before an increase in mood
o Withdrawal symptoms
o Drug should be tapered gradually; no sudden
discontinuation
o Sexual dysfunction
o Seizures
o Extrapyramidal symptoms (EPS)
o Photosensitivity
o
o
o
MAOIs
2,330 views
Summary
MAOIs are a class of antidepressants and include the drugs
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isocarboxazid, phenelzine, and tranylcypromine. These drugs are
used to treat depression, although they are not 昀椀rst-line treatments
due to their side e昀昀ects and dangerous food and drug interactions.
Notably, MAOIs can cause a hypertensive crisis, especially if patients
consume foods containing tyramine, like wine, cheese, and
processed meats. MAOIs can also cause serotonin syndrome, a lifethreatening condition resulting from overload of serotonin signaling.
As such, MAOIs should not be given within 14 days of taking any
other serotonin-altering drug.
Key Points
o
Key Drugs
o Isocarboxazid
o Phenelzine
o Tranylcypromine
o Selegiline
o Rasagiline
o Mechanism
o Antidepressant
o Inhibits the enzyme monoamine oxidase, thus increasing
norepinephrine, serotonin, dopamine, and epinephrine
levels in the brain.
o Clinical Use
o Depression
o Because of severe adverse reactions of drug/food
interactions, MAOIs are generally only used if other
medications have been proved ine昀昀ective in treatment
o Parkinson’s Disease
o Selegiline and Rasagiline only (MAO-B inhibitors)
o Side E昀昀ects and Adverse Reactions
o Hypertensive Crisis
o Extremely high blood pressure that can lead to stroke,
often accompanied by symptoms such as headache,
tachycardia, neck sti昀昀ness, etc.
o Avoid foods containing tyramine as eating them can
lead to a hypertensive crisis
o Found in aged cheese, processed meats, wine,
yogurt, pickled foods, avocados, chocolate, etc.
o Hypertensive crisis may also occur with concurrent use of
vasoconstrictors and cold medications that contain
phenylephrine and pseudoephedrine
o Closely monitor blood pressure and tell patient to report
any signs of a hypertensive crisis
o Educate patient to consult with provider before taking
over the counter medications, as MAOIs have several drug
interactions
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o
o
o
o
Serotonin Syndrome
o Symptoms include agitation, restlessness, confusion,
tachycardia, hypertension, muscle rigidity
o MAOIs should be withdrawn 14 days before starting
an SSRI or TCA (and vice versa)
o Concurrent use with other serotonin altering
medications increases risk for serotonin syndrome
Hypoglycemia
o MAOIs can increase the hypoglycemic e昀昀ect of insulin and
oral diabetic medications
Orthostatic hypotension
Anticholinergic e昀昀ects
Lithium
2,405 views
Summary
Lithium is a mood stabilizing drug used to treat bipolar disorder. It
has a narrow therapeutic range, and toxicity symptoms start to
show up above a blood level of 1.5. Things that can cause lithium
toxicity include 昀氀uid loss like dehydration and diuretics, low sodium
levels, decreased kidney function, or the speci昀椀c use of NSAIDs or
thiazide diuretics. Early signs of lithium toxicity include GI distress,
which includes nausea, vomiting, and diarrhea. Late signs of toxicity
are neurological problems, like loss of coordination, sedation,
confusion, or seizures. Lithium is also teratogenic and should not be
given during pregnancy.
Key Points
o
Mechanism
o Mood stabilizer
o Alteration of ion transport in muscle and nerve cells
o Increased receptor sensitivity to serotonin
o Excreted through the kidneys
o Clinical Use
o Bipolar disorder
o E昀昀ective in controlling the manic phase (昀氀ight of ideas,
hyperactivity
o Desired e昀昀ect may take up to 3 weeks
o Side E昀昀ects and Adverse Reactions
o Narrow therapeutic range of 0.6-1.2 mEq/L
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Toxicity symptoms generally start above 1.5 mEq/L
Patient will require regular blood work to monitor lithium
levels
o Twice weekly during initial treatment, and then
every 2 months during maintenance
Toxicity caused by
o Fluid loss
o Dehydration
o Diuretics
o Diarrhea/vomiting
o Make sure patient has adequate 昀氀uid intake of 12 L/day
o Hyponatremia
o Make sure patient has adequate sodium intake
o Drug-drug interactions
o NSAIDS and Thiazide Diuretics
o Should not be taken with lithium
o Use acetaminophen for pain relief
o Decreased renal function
o Lithium is excreted through the kidneys, so with
kidney damage, more drug stays in the body
Early/acute signs
o GI Distress
o Nausea, vomiting, diarrhea, loss of appetite
o If patient is experiencing these symptoms hold
lithium, notify provider, and anticipate an order for
a stat serum lithium level
Late/chronic signs
o Neurological Symptoms
o Confusion
o Ataxia
o Muscle tremors/twitching
o Sedation
o Seizures
o Diabetes Insipidus (polyuria, polydipsia)
o Blurred vision
o Severe hypotension
o Cardiac dysrhythmias
Levels above 3.5 will often result in coma and/or death
Teratogenic
o Pregnancy Category D
Ca昀昀eine can lower lithium levels and induce a manic state
Weight gain
Drowsiness
Dry mouth
o
o
o
o
o
o
o
o
o
o
o
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Valproic Acid
1,709 views
Summary
Valproic acid, also called valproate, is an antiepileptic used to treat
both seizures and bipolar disease. Valproic acid can cause
hepatotoxicity, so monitor the patient’s liver enzymes. It is also
teratogenic and should not be given to pregnant women.
Key Points
o
Valproic Acid / Valproate (Depakote)
o Mechanism
o Anticonvulsant/antiseizure
o Clinical Use
o Seizures
o Tonic-clonic, absence, and partial seizures
o Bipolar Disorder
o Mood stabilizing e昀昀ect
o Side E昀昀ects and Adverse Reactions
o Teratogenic
o Can cause fetal birth defects (cleft lip and
palate, spina bi昀椀da, etc.)
o Hepatotoxicity
o Monitor liver enzymes
o Pancreatitis
o Notify provider with symptoms of anorexia,
nausea, vomiting, and abdominal pain
Benzodiazepines
3,479 views
Summary
Benzodiazepines, or benzos for short, are a large class of drugs with
drug names that end in -pam, like clonazepam and lorazepam,
names that end in -lam, like midazolam and alprazolam, as well as
chlordiazepoxide. Benzodiazepines are central nervous system
depressants, meaning they slow the brain down and reduce brain
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activity. This is helpful in treating anxiety, treating seizures, as well
as treating the symptoms of alcohol withdrawal. Benzodiazepines
cause sedation, to the point where some benzodiazepines may even
be used to treat insomnia. Benzodiazepines can also cause
respiratory depression, if taken in excess or if taken with other CNS
depressants like alcohol or opioids. Benzodiazepines can cause
tolerance and dependence, and if possible, the drug should be
tapered down slowly to avoid withdrawal symptoms. If respiratory
depression or other toxic e昀昀ects of benzodiazepines do occur,
昀氀umazenil is the antidote used and can reverse the e昀昀ects of
benzodiazepines.
Key Points
o
Key drugs
o -pam Ending
o Clonazepam
o Lorazepam
o Diazepam
o -lam Ending
o Midazolam
o Alprazolam
o Chlordiazepoxide
o Clorazepate
o Mechanism
o CNS Depressant / Anxiolytic
o Potentiates the e昀昀ects of GABA to depress the CNS
o Stabilizes neuronal membranes and suppresses the the
spread of seizure activity
o Acts on limbic, thalamic, and hypothalamic levels of the
CNS
o Clinical Use
o Anxiety Disorders
o Generalized Anxiety Disorder
o Panic disorder
o Post-traumatic stress disorder (PTSD)
o End of life anxiety
o Seizure (Status Epilepticus)
o CNS depression can suppress the spread of seizure
activity
o IV lorazepam or diazepam are used
o Alcohol withdrawal
o Helps prevent autonomic dysregulation (Delirium
Tremens)
o Note that benzodiazepine withdrawal may also be treated
with lorazepam
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Insomnia/Sedative
o May be used in setting of anesthesia
o Antiemetic
o Muscle spasm
Side E昀昀ects and Adverse Reactions
o Sedation
o Anterograde amnesia and sedation may be used in setting
of anesthesia
o If possible, give at bedtime to reduce daytime sleepiness
o Elderly patients should avoid due to fall risk and potential
to cause delirium
o Caution patients against driving while taking
benzodiazepines
o Respiratory depression
o Use with caution in combination with opioids, avoid
alcohol
o Contraindicated in sleep apnea, COPD, and respiratory
depression
o Withdrawal symptoms
o Drug should not be abruptly stopped; taper if possible
o Anxiety, insomnia, diaphoresis, tremors, hypertension,
muscle twitching, seizures, headache, nausea/vomiting
(same mechanism as alcohol withdrawal)
o Tolerance / Dependence
o High abuse potential
o Schedule IV on Controlled substance act
o Hypotension
o Hepatotoxicity
o Patient should receive baseline liver function tests
o Sexual dysfunction
Antidote
o Flumazenil
o
o
o
Zolpidem
1,147 views
Summary
Zolpidem is a sedative-hypnotic drug that is used to treat insomnia.
It is a short-term treatment, and should not be used for longer than
10 days. Zolpidem is a preferred treatment for insomnia over
benzodiazepines because it does not have as high of a risk for
dependence or abuse compared to the benzodiazepine drugs.
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Key Points
o
Mechanism
o Sedative-hypnotic
o Is considered a nonbenzodiazepine, but has a similar
mechanism of action as benzodiazepines
o Binds to GABA receptors, enhancing GABA
action
o Clinical Use
o Insomnia (Sedative)
o Short-term treatment (less than 10 days)
o Can assist in helping fall asleep, but its short
half life does not generally help to stay asleep
o Preferred treatment over barbiturates and
benzodiazepines, as it has a much lower risk of
dependency and abuse
o Rapid onset
o Should be taken immediately prior to
sleep
o Do not drive after taking zolpidem
o Does not have other e昀昀ects of benzodiazepines
like antianxiety, anticonvulsant, and muscle
relaxing
o Side E昀昀ects and Adverse Reactions
o Drowsiness, lethargy, hangover (residual sedation)
o Avoid other CNS depressants like alcohol,
narcotics, and antipsychotics
o Headache
Buspirone
1,457 views
Summary
Buspirone is a mental health drug that is primarily prescribed to
treat anxiety. Importantly, buspirone has a delayed onset of about 2
weeks, so it is not e昀昀ective for treating acute panic attacks.
Buspirone is a great option for chronic treatment of anxiety because
it has minimal side e昀昀ects compared to other anti-anxiety
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medications.
Key Points
o
Mechanism
o Anxiolytic
o Binds to serotonin and dopamine receptors
o Does not act on GABA receptors like benzodiazepines do,
meaning it has less sedative e昀昀ects and a lower risk of
dependence
o Slow onset of action (1-2 weeks)
o Not appropriate for panic attacks or PRN use
o Another anxiolytic may be prescribed initially until
buspirone has time to take e昀昀ect
o Instruct patient starting buspirone to take the medication
as prescribed, even if they don’t notice a di昀昀erence at
昀椀rst
o Clinical Use
o Anxiety
o Generalized Anxiety Disorder (GAD)
o Anxiety-related depression
o Not useful for acute anxiety or panic disorder
o Side E昀昀ects and Adverse Reactions
o Drug Interactions/Toxicity
o Avoid use with grapefruit juice
o Do not take concurrently with MAOIs
o Dizziness, headache
o Restlessness, nervousness, agitation
o GI distress
o Nausea, vomiting, diarrhea
o Patient can take with food to minimize GI upset
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