Acetylocysteine (Mucomyst) ! M - monitor q4h, mix w/ juice, mucolytic ! U - used as antidote for acetominophen O.D. ! C - Contraindications: GI hemorrhage; Chronic/acute pulmonary disease ! U - unpleasant oder! S - STOP use of med if aspiration or bronchospasm occurs

Acetaminophen (Tylenol) ! L - look for diaphoresis, tachycardia & malaise! I - inhibits prostoglandins = decrease pain and fever ! V - via nebulizer, administer Mucomyst ! E - Errors = liver damage ! R - Renal disease (toxic), alcohol abuse, and hepatic disease = use CAUTION

Pancuronium (Pavulon) ! - Raggedy Anne just got out of surgery. She is not unconscious but her arms and legs are falling off the operating table due to SKELETAL MUSCLE RELAXANT. She can’t breath (respiratory depression) without the help of a ventilator. She has received a neuromuscular blocking agent. She needs to be cautious in case she has cardiac disease or history of malignant hyperthermia.

Phenobarbital (Luminal) ! B - Barbiturate; bad with liver/kidney/respiratory DOs & CNS depression ! A - anticonvulsants = control seizures (tonic-clonic & partial) & status epilepticus! D - Don’t take with MAOIs; AE: depression, drowsiness, delirium, resp. ! ! ! depression! S - Sedative; S/S of angioedema

Temazepam (Restoril) = Benzo ! S - short term management of insomnia; sedative/hypnotic ! L - lack REM sleep! E - effects: hangover, decrease insomnia, hallucinations! E - emphasize mental status, sleeping pattern, drowsiness, dizziness, physical ! ! dependency ! P - Pregnancy X, hypersensitivity, CNS depression, uncontrolled pain, impaired ! ! respiratory, glaucoma (undesirable changes)

Flurazepam (Dalmane) = Benzo ! S - short term management of insomnia; sedative/hypnotic ! P - Pregnancy X (UE) ! L - Lifestyle changes encouraged ! E - effects CNS depression ! N - Nursing implications: assess anxiety and mental status , monitor BP, CBC, ! ! bilirubin, creatinine! D - drowsiness, daytime sedation, dependence (physical or psychological) = UE! A - ABILITY TO SLEEP, anticonvulsant action

Ramelteon (Rozerem) ! I - Indication: Insomnia characterized by difficult sleep onset! N - Not given if client has sever hepatic disease! S - syncope, fatigue, headache, insomnia may worsen, abnormal thinking, ! ! behavioral changes (undesirable changes) ! O - Other CNS depressant may interact and result in increased CNS depression ! M - Measures to promote rest ! N - NO driving after taking Rozerem due to causing lethargy ! I - instruct to not take after a high fat meal; take on empty stomach ! A - Administer 30 minutes prior to bed

Cyclobenzaprine (Flexeril) ! R - reduces stiffness, spasms, pain in muscles (SMR)! E - elevate liver function tests ! L - limit driving, operating machinery because of drowsiness, dizziness! A - avoid taking relaxants with antidepressants!! X - out alcohol

Kava ! K - Kava interacts with CNS depressants (decrease anxiety & increase sleep) ! A - Anti-anxiety medication; advise to take with food; acts as diuretic ! V - Visual and mild GI disturbances (undesired effect) ! A - Advise to NOT take with wine or other sleeping pills = cause liver ! ! damage or coma

- Kava-kava has been restless due to pain and muscle spasms, stressed, anxious, and unable to sleep, but she is now floating on her cloud of calm.

Caffeine! Chemical CNS stimulant = stay awake and alert ! Cause: sleep deprivation = NODOS! Caution w/ ulcers and cardiac dysrhythmias

Orlistat (Xenical) !! F - flatus with discharge; anal leakage (UE) ! A - Absorb dietary fat by inhibiting lipase! T - taken for weight loss

Methylphenidate (Ritalin) ! A - ADHD & narcolepsy; assess weight and height in children (prescription) ! A - Administer 4-6 hours before bed or mornings ! D - Dopamine & NE in cerebral cortex is increased ! S - Suicidal/homicidal tendencies = DO NOT TAKE WITH = ^ chances

Phenytoin (Dilatin)! G -gingival hyperplasia! U - Use alternate birth control ! M - Mouth care = preventative dental check up ! S - Soft tooth brush; don’t stop abruptly; SERUM levels = 10-20 mcg/ML

What would you worry if a patient was taking Ergot alkaloids for migraines? ! - If they had a CAD - as Ergot causes vasoconstriction

What is the contraindications for Triptans (SSRAs) for migraines? ! - Any serious Cardiovascular disease

AED (antiepileptic drugs) = prevent seizures

Black box on Drug = WARNING in regards to ^ risk of suicidal thoughts and behaviors

Gabapentin (Neurontin) ! C - CNS: dizziness, insomnia & GI symptoms - UE ! A - Antacids decrease; assess seizure & neuropathic pain ! E - Eat food with drug ! S - support group for epileptics (mental status) ! A - Alert tag indicating specific drug ! R - Report UE

What does it mean if a patient is perscribed >10mg of Selegiline (Eldepryl) per day? ! - Selegiline becomes an MAOI == avoid TYRAMINE

Antiparkinson meds! Looking for: sense of well-being, mental status ! ! ! - increased appetite! ! ! - ability to perform ADL’s to concentrate and think clearly ! ! ! - lessen Parkinson’s symptoms

Tolcapone (Tasmar) = Anitparkinsonian drug! Contraindications: Liver failure

Entacapone (Comtan) ! = urine discoloration is normal ! ! ASSESS: quality of life (mental status & complete suicidal assessment) & ! ! ! involuntary movement

Dyskinesia = difficulty performing voluntary movements

Benzodiazepine ! A - avoid abrupt discontinuation after prolonged use ! N - Not give if ^ BP, renal/hepatic dysfunction or hx of drug abuse! X - Xanax, Aticvan, Serax - a few examples! I - Increase in 3D’s = drowsiness, dizziness, decreased BP ! E - Enhances action of GABA ! T - Teach to rise slowly from supine (orthostatic hypotension) ! Y - Yes! Alcohol should be avoided

Bupirone (Buspar) ! - Get on the Buspar Bus to decrease anxiety, as it interacts with seritonin and dopamine in the CNS. The seats recline for the undesirable effect of dizziness, and drowsiness. Smiles can be seen after taking the drug for a week, with a trip that may take ~ 4wks.

What class of meds should we assess for in SSRIs? = WARFORIN

Why are SSRIs more widely perscribed than tricyclics? = less or no effect on cardio ! ! ! system

Antipsychotics = Risperdone (Risperdal) & Chlorpromazine (Thorazine) ! S - sedation; sunlight sensitivity ! T - tardive dyskinesia; tacyhcardia, tremors! A - anticholinergic, Agranulocytisosis, Addiction ! N - Neuroleptic malignant syndrome ! C - Cardiac arrhythmias (orthostatic hypotension) ! E - Extrapyramidal (akathesia); endocrine (change in libido) !Risperdone: decrease hallucinations and suicidal thoughts

Thorazine: schizophrenia and psychoses after failure with atypical antipsychotics!

Lithium Therapeutic level ! acute mania = 0.5 - 1.5 mEq/mL ! chronic mania = 0.6 - 1.2 mEq/mL

What type of medications cause Extrapyramidal Reactions? ! - antipsychotics ! ! = tarditive dyskinesia, chorea, muscle tremors

Goal of patients who are on antischizophrenic drugs? ! = reduce delusions and paranoia

Phenelzine (Nardil) = MAOI ! = AVOID TYRAMINE

Phenothiazines ! Adverse Reactions: stiff muscles, fever, trouble sleeping, tachypenia, seizures, ! ! fast heartbeat, increased sweating, unusually pale skin, unusual tiredness

Ginseng ! = improves stamina, concentration and stress-resistance ! Adverse: high doses can cause jitters, headaches, and hypertension. Vaginal ! ! bleeding, skin eruption and pruritus have also been noted.

Naltrexone (ReVia) = blocks opioid receptors (antagonist) = suppresses effect of ! alcohol ! ! - opioid withdrawal

“Roofie” = Flunitrazpam (Rohypnol) = sedative “Date-rape Drug”

Conditions associated w/ Chronic Alcohol Use ! - electrolyte imbalance ! - acts as diuretics ! - increases in gastric acidity ! - Cardiomyopathy ! - peripheral vasodilation

Disulfiram (Antabuse) = NO drinking for at least 3-4 days ! ! - prevent acetaldehyde syndrome