Classes of Drugs

Adult Nursing NCLEX Review NCLEX Pharmacology Classes of Drugs

Lithium for Mania in Bipolar Disorder

Lithium Toxicity

Anything that causes hyponatremia can lead to lithium toxicity such as dehydration, Addison’s disease, and kidney disease. The treatment is A: Stop lithium and B: Hemodialysis

Signs and Symptoms of Toxicity. Toxicity occurs at levels > 1.5 mEq/L

L

Level: > 1.5 mEq/L is toxic. Normal 0.6 to 1.2 mEq/L

I

Increased Urine and Thirst (Nephrogenic Diabetes Insipidus).

T

Tremors, Tinnitus, and Tonic-clonic seizures

H

Hypo thyroidism & Hallucinations

I

Impaired Consciousness

U

Upset Stomach (Nausea, vomiting, & diarrhea)

M

Muscle Weakness

Pay attention: At levels of > 3.5 mEq/L, the client experiences seizures, coma, oliguria/anuria, arrhythmias, MI, and cardiovascular collapse. Levels of 2.0 to 3.5 mEq/L, the client will have confusion, tremors, and the polyuria. Mild toxicity (levels of 1.5 to 2.0 mEq/L) symptoms of ataxia, tinnitus, nausea, vomiting, diarrhea and blurred vision.

Important Interventions: Keep hydrated, consume foods with sodium, take on with food to prevent stomach upset, and have levels drawn every 1 to 2 months.

Monoamine Oxidase Inhibitors

Beer & Wine

Bananas &

Figs, papaya, avocados, figs, eggplant & raisins

Aged Cheese

Cheddar, Gruyere, Manchego, & Gouda.

Fermented

Smoked or processed meats, such as hot dogs, bologna, bacon, corned beef or smoked fish. Pickled or fermented foods, such as sauerkraut, kimchi, caviar, tofu or pickles. Sauces, such as soy sauce, shrimp sauce, fish sauce, miso and teriyaki sauce.

Monoamine Oxidase Inhibitors (MAOIs) used for depression when other antidepressants are unsuccessful.

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)

Avoid foods with tyramine to prevent a hypertensive crisis. MAOIs inhibit the breakdown of tyramine. An accumulation of tyramine leads to a hypertensive crisis (sweating, dizziness, tremors, & increased BP).

Avoid these meds: Barbiturates, TCAs, Antihistamines, CNS depressants, OTC cold meds due to the risk of serotonin syndrome with taken together.

Phenytoin (Dilantin)

Normal range

10 to 20 μm/mL. Requires routine blood tests to check levels. Always take at the same time to keep steady levels.

Signs of toxicity

Ataxia (clumsy gait), hand tremors, slurred speech, skin rash (Steven Johnson Syndrome, life-threatening necrosis and detachment of epidermis). Report symptoms to PCP.

Gums

Gingival hyperplasia (good flossing/oral hygiene required).

Vitals and blood dyscracias

Causes hypotension and bradycardia
Thrombocytopenia (low platelets
Leukopenia (low white blood cells)
Monitor CBC levels, bleeding and infection

Education

Never stop abruptly. Good flossing, Reduces effectiveness of oral contraceptives. Use other forms of contraception (condoms, IUD), take calcium and vitamin D (Phenytoin reduces bone density).

Administration

IV form: Mix with normal saline only. Phenytoin will precipitate with D5W. Stop tube feedings at least 1 hour before and after to prevent ↓ absorption. Fosphenytoin is only given IV. Give phenytoin 50 mg/min to prevent hypotension.

Myasthenia Gravis Medications

Acetylcholinesterase inhibitors: Drugs like pyridostigmine (Mestinon) enhance the communication between nerves and muscles by preventing the breakdown of acetylcholine, a neurotransmitter that is reduced in MG.

Cholinergics same as anticholinesterases (work against the enzyme that breaks down. acetylcholine) and cholinesterase inhibitors. We want more acetylcholine.

Cholinergic crisis: Too much medication. Look at the side effects. Lots of secretions. It is a secretion crisis. This happens when a client gets too much medication. Sweating, diarrhea, drooling, muscle cramps. The antidote is Atropine (an anticholinergic)

Medications that increase the available acetylcholine.

Acetylcholinesterase is an enzyme that breaks down acetylcholine. Remember that we want more acetylcholine, so we want to inhibit the acetylcholinesterase.

Neostigmine is IV or subQ & Pyridostigmine is oral. Note the ending.

Lots of secretions, diarrhea, nausea/vomiting, urinary incontinence, salivation (drooling), sweating (diaphoresis), muscle cramps, & pupillary constriction.

Previous Topic

Back to Lesson

Next Quiz

Adult Nursing NCLEX Review