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Mental Health > 1.3 Psychopharmacology > Flashcards

1.3 Psychopharmacology Flashcards

1
Q

Psychotropic Medications

A
  • DOES NOT ELIMINATE MENTAL DISORDER
  • Relieves physical and behavioral symptoms
  • Used as a supplement with psychotherapy
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2
Q

Role of a Nurse

A

Legal/Ethical Issues - Patients have the right to refuse medications unless in emergency situations where client may harm themselves. Patients with history of violence can be court-ordered to take medications.

Assessment - Baseline assessment always done before beginning medications. These include history, physical, ethnocultural assessment and comprehensive medication assessment.

Medication administration/evaluation - Nurses are the key person in contact with individuals receiving medications. We monitor for side/adverse effects and evaluate therapeutic effectiveness

Patient Education - Education on medication

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3
Q

Psychotropic Medications

A
  • Effects neuronal synapse and change neurotransmitter release/receptors.
  • Antidepressants block re-uptake of neurotransmitters (serotonin and norepinephrine)
    REUPTAKE - Inactivation of neurotransmitters by reabsorption into the presynaptic neuron where it came from.
  • Blocking re-uptake of neurotransmitters allows more of it to be available for neuronal transmission.
  • Antipsychotic medications block dopamine, muscarinic cholinergic, histaminergic, and a-adrenergic receptors. Most block serotonin receptors.
  • Benzodiazepines facilitate transmission of inhibitory neurotransmitter GABA
  • Psychostimulants increase norepinephrine, serotonin, and dopamine release.
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4
Q

Anxiolytics

A
  • Antianxiety medications (tranquilizers)
  • Most appropriate for acute anxiety attacks, not long term treatment.
  • Used for anxiety, alcohol withdrawal, muscle spasms, convulsive disorders, epilepticus, pre-operation sedation.
  • Depresses subcortical levels in the CNS (limbic system and reticular formation)
  • May potentiate GABA in the brain causing a calming effect.
  • Most common is benzodiazepine (clonazepam (Klonopin), diazepam (Valium), alprozolam (Xanax)

INCREASED EFFECTS WHEN TAKEN WITH
- Alcohol, Barbiturates, Narcotics, Antipsychotics, Antidepressants, Antihistamines, Neuromuscular Blocking Agents, Cimetidine, Disulfiram
INCREASED EFFECTS WHEN TAKEN WITH HERBAL SUPPLEMENTS
- Kava, Valerian, Lemon Verbena, L-tryptophan, Melatonin, Chamomile

DECREASED EFFECTS WHEN TAKEN WITH
- Cigarettes and Caffeine

BLACK BOX WARNING
- Combining benzodiazepines with opioids or cough medicines.

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5
Q

Nursing Diagnosis

A

Risk of injury related to seizure, panic anxiety, agitation from alcohol withdrawal, abrupt withdrawal of long term medication, medication intoxication

Anxiety related to threat to physical integrity or self-concept

Activity Intolerance due to side effect of sedation, confusion, lethargy

Disturbed sleep pattern due to situational crises, physical condition, severe level of anxiety.

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6
Q

Evaluation of Anti-Anxiety Medication

A
  • Reduction in anxiety, tension, restlessness
  • No seizures or physical injury
  • No evidence of confusion
  • Tolerate usual activity without excessive sedation
  • Tolerates medication without GI distress
  • Understanding of side effects and self-administration
  • Verbalizes possible side effects of withdrawal
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7
Q

Antidepressants

A
  • Used for major depressive and dysthymic (low mood) disorders
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8
Q

SSRI’s

A
  • Selective Serotonin Reuptake Inhibitors

Used to treat

  • Anxiety disorders
  • Bulimia Nervosa
  • Premenstrual Dysphoric Disorder
  • Borderline personality disorder
  • Obesity
  • Smoking Cessation

OTHER INDICATIONS

  • Alcoholism
  • Schizophrenia
  • Intellectual disability
  • Bipolar Disorder
  • Depression with Anxiety
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9
Q

Antidepressant Action

A
  • Increase concentration of norepinephrine, serotonin, dopamine
    By..
  • Blocking reuptake of these neurotransmitters
    Or
  • Inhibiting release of monoamine oxidase
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10
Q

Antidepressant Drug Groups

A

MAOIs (Monoamine Oxidase Inhibitors)
- Inhibit release of Monoamine Oxidase

TCAs (Tricyclic Antidepressants)
- Block reuptake of norepinephrine and serotonin

SSRI’s (Serotonin Reuptake Inhibitor)
- Block reuptake of serotonin

SNRI’s (Serotonin/Norepinephrine Reuptake Inhibitor)
- Block reuptake of serotonin and norepinephrine

Atypical Antidepressant
- Dual mechanism antidepressants effecting both norepinephrine and serotonin

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11
Q

Antidepressant Medication Interactions

A
  • Buspirone, TCA’s Selegiline Hydrochloride, St John’s Wort can cause SEROTONIN SYNDROME (fatal overstimulation of serotonin)
  • Can also cause high fever, convulsions, severe hypertension, and psychosis
  • TCA’s were developed due to MAOIs being potentially deadly due to interactions with drugs/food. TCA’s were found to cause urine retention and dry mouth and postural hypotension.
  • Then SSRIs and SNRIs were developed which led to atypical antidepressants for those who did not respond well to SSRIs and SNRIs
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12
Q

SSRI Interactions

A

Buspirone, TCA, Selegiline, St Johns Wort - SEROTONIN SYNDROME

MAOIs - Hypertensive Crisis

Warfarin/NSAIDs - Risk of bleeding

Alcohol/Benzodiazepines - Increased sedation

Antiepileptics - Lowered seizure threshold

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13
Q

TCA Interactions

A

MAOIs - High fever, convulsion, death
St John Wort - Seizure, Serotonin Syndrome
Clonidine, Epinephrine - Severe Hypertension
Acetylcholine Blocker - Paralytic Ileus (Bowel Impairment)
Alcohol/Carbamazepine - Blocks antidepressant action and increases sedation
Cimetidine, Bupropion - Increased TSA blood levels and increased side effects

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14
Q

MAOIs Interactions

A

SSRI, TCA, atomoxetine, duloxetine, dextromethorphan (cough syrup), venlafaxine, St John Wort, ginkgo - Serotonin Syndrome

Morphine/Narcotic Pain Relievers - Hypotension

Antidepressants (pseudoephedrine, amphetamines, cocaine cyclobenzaprine, dopamine, methyldopa, levodopa, epinephrine, buspirone - Hypertensive Crisis (even if taken within 2 weeks of stopping MAOIs)

Buspirone - Psychosis, agitation, seizures

Antidiabetics - Hypoglycemia

Tegretol - Fever, Hypertension, Seizures

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15
Q

Medication Diagnosis (Antidepressants)

A
  • Risk of suicide due to depression
  • Risk of injury due to side effects
  • Social isolation due to depressive mood
  • Risk of constipation due to medication
  • Risk of insomnia due to depressive mood
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16
Q

Outcome Criteria/Evaluation Antidepressants

A
  • Patient has not harmed themselves
  • Patient has not had injury from side effects
  • Patients vitals are normal
  • Patient has better mood (brighter mood, interaction with others, improved hygiene, clear thought, hopeful, ability to decision-make)
  • Willing participation in activities and interaction with others
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17
Q

Mood Stabilizing Agents

A
  • Used for bi-polar disorder
  • Action is unclear
  • May interact with lithium (salt). Decreased sodium allows more receptor sites for lithium and increases risk of toxicity. Patients should maintain normal sodium intake to reduce lithium level fluctuation. Increase in sodium decreases lithium and Decrease in sodium increases lithium.
  • Those who respond well to lithium will be placed on it forever. Monitor for therapeutic range to prevent toxicity
    Acute Mania - 1.0 - 1.5 mEq/L
    Maintenance - 0.6 - 1.2 mEq/L
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18
Q

Nursing Diagnosis Mood Stabalizers

A
  • Risk of injury due to manic activity
  • Risk of violence due to unresolved anger
  • Risk of lithium toxicity
  • Risk of injury from adverse effects
  • Risk of activity intolerance due to drowsiness/dizziness
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19
Q

Outcome of Mood Stabilizers

A
  • Maintenance of mood stability
  • Does not harm anyone or themselves
  • No injury from hyperactivity
  • Able to participate in activities without dizziness or sedation
  • Maintain appropriate weight
  • No signs of lithium toxicity
  • Verbalizes importance of taking medication regularly with blood tests.
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20
Q

Antipsychotics

A
  • Treatment of schizophrenia and other psychotic disorders
    Antiemetics - chlorpromazine, perphenazine, prochlorperazine
    Intractable Hiccups - Chlorpromazine
    Tourette’s Disorder - Haloperidol, Pimozide
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21
Q

Typical Antipsychotic Contraindications

A
  • Do not use when in coma or CNS depression
  • Blood dyscarias (disease)
  • Parkinson’s or Narrow-Angle Glaucoma
  • Liver/Renal/Cardiac insufficiency
  • Poorly controlled seizure disorders
  • Dementia related psychosis
22
Q

Atypical Antipsychotic Contraindications

A
  • Do not use in coma/dementia/lactation
  • -done and -pine contraindications
  • History of prolonged QT intervals
  • MI
  • Uncompensated heart failure
  • Concurrent use with other drugs that prolong QT interval

Clozapine Contraindications

  • Myeloproliferative disorders
  • Uncontrolled epilepsy
23
Q

Typical Antipsychotic Action

A
  • Blocks dopamine receptors in basal ganglia, hypothalamus, limbic system, brainstem, medulla
  • Alter affinity for cholinergic, alpha-1, and histamine receptors
  • Inhibits dopamine-mediated transmission of neural impulses
  • Be careful when administering to elderly due to metabolic disturbances such as weight
    (Caution with elderly who are ill, diabetic, respiratory insufficiency, prostatic hypertrophy, intestinal obstruction)
24
Q

Atypical Antipsychotic Action

A
  • Weak dopamine receptor antagonist but strong serotonin antagonist
25
Q

Antipsychotic Interactions

A
  • Severe hypotension with hypertensive drugs
  • Reduces effects of oral anticoagulants
  • Additive effects with medications that increase QT interval
26
Q

Anti-Psychotic Nursing Diagnosis

A
  • Risk of violence related to panic anxiety
  • Risk of injury related to medication side effects
  • Risk if inactivity due to medication side effects
  • Non-compliance of medication due to mis-trust of others
27
Q

Antipsychotic Education

A
  • Smoking decreases effectiveness (increases metabolism)
  • Temperature is hard to maintain with these medications (dress appropriately)
  • Alcohol potentiates anti-psychotics
28
Q

Clozapine

A
  • Agranulocytosis (low neutrophil count less than 500 uL) is a major risk (Neutropenia)
  • Must be monitored
29
Q

EXTRAPYRAMIDAL SIDE EFFECTS OF ANTI-PSYCHOTICS

A
30
Q

Pseudoparkinsonism

A
  • Symptoms occur 1-5 days after starting medication. Mostly in women, elderly, and dehydrated patients
  • Tremor, shuffling, gait, drooling, rigidity
31
Q

Akinesia

A
  • Muscular Weakness
32
Q

Akathisia

A
  • Frequent in women 50-60 days after beginning therapy

- Restlessness and fidgeting

33
Q

Dystonia

A
  • Involuntary muscle spasms of the face, arms, legs, neck
  • Common in men under 25
  • EMERGENCY
  • TREATED WITH IM/IV Benztropine (Cogentin)
34
Q

Oculogyric Crisis

A
  • Uncontrolled rolling of eyes
  • Happens with dystonia
  • MEDICAL EMERGENCY
35
Q

Tardive Dyskinesia

A
  • Bizarre face/tongue movements, stiff neck, difficulty swallowing
  • Most common with 1st gen anti-psychotics
36
Q

Sexual Side Effects

A
  • Decreased libido
  • Retrograde ejaculation (semen ejected into bladder instead of urethra)
  • Gynecomastia
  • Amenorrhea
37
Q

Outcome of Anti-psychotics

A
  • No harm to self or others
  • No injury from medication side effects of lowered seizure threshold and photosensitivity
  • Maintain normal ANC (Absolute Neutrophil Count)
  • No extrapyramidal side effects
  • Maintain normal weight
  • Tolerate activity
38
Q

Sedative Hypnotics

A
  • Short term management for anxiety and insomnia
  • Reduces symptoms of alcohol withdrawal
  • Anticonvulsant for pre-op
  • Causes CNS depression and promotes sleep by agonist on melatonin receptors
  • Can cause dependence except Ramelteon (Rozerem)
39
Q

Sedative Hypnotics Contraindications

A
  • Pregnancy
  • Hepatic/Cardiac/Respiratory/Renal Disease
  • Caution with suicidal patients
40
Q

Barbiturate Interactions

A
  • Effects are increased with alcohol, CNS depressants, MAOIs and Valproic Acid
  • Effects decreased with rifampin

Decreases Effects Of
- Anticoagulants, beta blockers, contraceptives, corticosteroids, digitoxin,

41
Q

Benzodiazepine Interactions

A
  • Effects increased with CNS depressants, alcohol, oral contraceptives, isoniazid,
  • Decreased with rifampin, st john wort, cigarettes
  • Increases effects of digoxin, phenytoin
42
Q

Eszopiclone

A
  • Additive effects with alcohol and CNS depressants

- Decreased effects with rifampin, lorazepam, and HIGH FAT MEALS

43
Q

Zaleplon

A
  • Additive effects with other CNS depressants
44
Q

Zolpidem

A
  • Life threatening cardiac dysrhythmias with amiodarone
45
Q

Sedative Hypnotic Diagnosis

A
  • Injury due to withdrawal or mental alertness from residual sedation
  • Disturbed sleep pattern
  • Activity Intolerance
  • Confusion due to affect on CNS
46
Q

Outcome Sedative Hypnotics

A
  • Reduced anxiety
  • Asleep within 30 minutes for 6-8 hours
  • Participation in usual activity without residual sedation
  • No injuries or confusion
  • Understanding that this is a short term treatment plan and prolonged use can cause dependence
47
Q

ADHD Agents

A
  • Amphetamines can also be used to treat narcolepsy (daytime drowsiness) and exogenous obesity.
  • Bupropion is used for major depression and smoking cessation (Zyban)
  • Clonidine and Guanfacine used to treat hypertension

ACTION
Atomoxetine - Inhibits reuptake of norepinephrine
Bupropion - Blocks uptake of serotonin, norepinephrine and dopamine
Clonidine and Guanfacine - Stimulates alpha-adrenergic receptors that reduces sympathetic flow to CNS

CNS Stimulants - Increases level of neurotransmitters in CNS
- WORKS BY ACTIVATING DOPAMINE RECEPTORS WHICH DEPRESS MOTOR ACTIVITY

48
Q

CNS Stimulant Contraindications

A
  • Arteriosclerosis
  • CVD
  • Hypertension
  • Hyperthyroidism
  • Glaucoma
  • Drug abuse
  • Within 14 days of MAOIs
  • Young children and pregnancy
49
Q

ADHD Medication Precautions

A
  • CAUTION in children with psychosis, Tourette’s Disorder, anorexia/insomnia, elderly, history of suicidal thoughts, can cause dependence
  • Atomoxetine and Bupropion caution with urinary retention patients, hypertension, hepatic/renal/cardiac disease patients, suicidal clients, elderly
  • Alpha agonist use caution in patients with coronary insufficiency, recent MI, stroke, chronic renal/hepatic failure, elderly, pregnancy and lactation.
50
Q

Nursing Diagnosis ADHD Medications

A
  • Injury from overstimulation, hyperactivity in CNS, and seizures
  • Risk of suicide from withdrawal (adults)
  • BLACK BOX WARNING RISK OF SUICIDE IN ADOLESCENTS OF ATOMEXETINE AND BUPROPION
  • Risk of anorexia and weight loss from CNS Stimulants
  • Insomnia from over stimulation
  • Risk of abdominal pain and headaches
  • Activity Intolerance
51
Q

Education for ADHD Medications

A
  • Caution Driving
  • Don’t stop taking abruptly
  • Avoid taking late day to prevent insomnia
  • Monitor blood sugar in diabetics due to change in diet and weight
  • Avoid caffeine
  • Carry Medication Card

Mental Health (57 decks)

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