Question

Drug Cards for the following medications that describe the Drug class, Prototype Name, MOA, Major Adverse Effects, Drug Interactions and Contraindications, and Nursing Implications.

Buproprion

Lithium

Valproic Acid

Benzodiazepines

Barbiturates

Buspirone

Answer 1

1. BUPROPRION

Other Names : Alpenzin, Budeprion SR, Budeprion XL, Buproban

Functional class: Antidepressant miscellaneous smoking deterrent

Chemical class: Aminoketone

Action: Inhibits reuptake of DOPamine.

Contraindications: Hypersensitivity, Eating disorders, seizure disorders

Adverse Effects: CNS - Seizures, suicidal ideation, CV - complete AV block, QRS prolongation, EENT - blurred vision, auditory disturbance, INTEG - Steven Johnson Syndrome

Interactions: increase- adverse reactions, seizures(levodopa), MAOIs, phenothiazines, antidepressants, benzodiazipines, increase - buPROPion toxicity(ritonavir), decrease effect of tamoxifen

Nursing consideration:

Assess,

• Hepatic/renal gfunctio in patients with hepatic, kidney impairment
• For increased risk of seizures
• For smoking cessation after 7-12wk
• Provide assistance with ambulation during beginning therapy because sedation occurs

​​​​​​​2. LITHIUM

Other names: Apo-Lithium Carbonate, Carbolith, Duralith

Functional class: Antimanic, Antipsychotics

Chemical class: Alkali metal ion salt

Action: may alter sodium, potassium ion transport across cell membrane in nerve, muscle cells; may balance biogenic amines of norepinephrine, serotonin in CNS areas involved in emotional responses.

Contraindications: pregnancy, breastfeeding, children <12yrs, hepatic disease brain trauma, organic brain syndrome, schizophrenia, severe cardiac/renal disease, severe dehydration

Adverse effects:

CNS: seizure, headache

CV: dysrhythmias, circulatory collapse

GU: polyuria, glycosuria, proteinuria, albuminuria

HEMA: leukocytosis

Interactions: Neurotoxicity with haloperidol, thioridazine, increase hypothyroid effects with antithyroid agents, calcium iodide, increase effects of neuromuscular blocking agents

Nursing consideration:

Assess,

• Mental status: manic symptoms, mood, behaviour before, during treatment
• Lithium toxicity: Diarrhea, vomiting, tremor, twitching
• Weight daily, report edema in legs
• Sodium intake
• ​​​​​​​Neurologic status: LOC, gait, motor reflexes, hand tremors

3. VALPROIC ACID

Other names: Valproate, divalproex sodium

Functional class: Anticoagulant, vascular heafahea suppressants

Chemical class: Carboxylic acid derivatives

Action: increases levels of gamma amino butyric acid in the brain, which decreases seizure activity

Contraindications: hypersensitivity, urea cycle disorders

Adverse effects:

CNS: coma, suicidal ideation

GI: hepatic failure, Pancreatitis, toxic hepatitis

HEMA: thrombocytopenia, leukopenia, lymphocytosis

Interactions: increase VALPROIC acid levels (erythromycin,felbamate), increase CNS depression (alcohol, opioids, barbiturates, antihistamines), increase toxicity of VALPROIC acid(salicylates)

Nursing considerations:

Assess,

• seizure disorder: location, aura, activity, duration
• Mental status: bipolar disorder;mood activity, sleeping/eating behaviour; suicidal thoughts
• Migraines: frequency, intensity, alleviating factors
• Blood studies: Hct, Hgb, RBC, serum folate, PT/PTT, serum ammonia, platelet, bit D
• Respiratory dysfunction: respiratory depression, character, rate, rhythm
• ​​​​​​​Blood levels: therapeutic level 50-100mcg/ml, during seizures