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Pharm Final > Antipsychotics, Anxiolytics, and Antidepressants > Flashcards

Antipsychotics, Anxiolytics, and Antidepressants Flashcards

1
Q

Psychosis

A

Losing contact with reality

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2
Q

Psychosis Sxs (usually has more than one)

A

Difficulty processing information/conclusion
Delusions
Hallucinations
Incoherence
Catatonia (no facial expressions)
Aggressive behavior

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3
Q

Schizophrenia

A

Chronic psychotic disorder, psychosis sxs manifest
Sxs develop in late teens to early adulthood
Results from imbalance of dopamine
Has “positive” and “negative” sxs

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4
Q

Schizophrenia Positive Sxs

A

(Exaggeration of normal function)
Incoherent speech
Hallucinations
Delusions
Paranoia

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5
Q

Schizophrenia Negative Sxs

A

(Decrease/loss of function or motivation)
Loss of speech
Poor self-care
Social withdrawal

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6
Q

General Adverse Reactions to Antipsychotics

A

Acute dystonia (muscle spasms of face, eye rolling, laryngeal spasms that can impair respiration etc.)
Akathisia (restless, can’t sit still)
Tardive dyskinesia (sticking out and rolling tongue, smacking lips, chewing motion, involuntary movement, etc.)

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7
Q

Neuroleptic Malignant Syndrome

A

Rare, potentially fatal condition associated with antipsychotic drugs

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8
Q

Neuroleptic Malignant Syndrome Sxs

A

Muscle rigidity
Acute fever
Altered mental status
Labile BP
Rhabdomyolysis, ARF, RF, coma

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9
Q

Phenothiazine (typical antipsychotic) Prototype

A

Fluphenazine (Prolixin)

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10
Q

Fluphenazine (Prolixin) Pregnancy Category

A

Pregnancy category C

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11
Q

Fluphenazine (Prolixin) Routes

A

PO/IM

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12
Q

Sxs Specific to Fluphenazine (Prolixin)

A

CNS depression (sedation, dizziness)
Anticholinergic sxs (dry mouth, urinary retention)

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13
Q

Adverse Reactions Specific to Fluphenazine (Prolixin)

A

HTN, hypotension (more common than HTN), EPS syndrome, impaired thermal regulations, convulsions

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14
Q

Contraindications Specific to Fluphenazine (Prolixin)

A

Subcortical brain damage, blood dyscrasia, renal/liver damage, coma

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15
Q

Life-threatening Reaction Specific to Fluphenazine (Prolixin)

A

Agranulocytosis

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16
Q

Drug Interactions Specific to Fluphenazine (Prolixin)

A

Increased depression with ETOH/CNS depression (Prolixin is a CNS depressant already)
Kava kava: may increase dystonia

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17
Q

Nonphenothiazine (typical antipsychotic) Prototype

A

Haloperidol (Haldol)

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18
Q

Haloperidol (Haldol) Pregnancy Category

A

Pregnancy Category C

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19
Q

Sxs Specific to Haloperidol (Haldol)

A

CNS depression (sedation), anticholinergic sxs (dry mouth and eyes, blurred vision), orthostatic hypotension

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20
Q

Adverse Reactions Specific to Haloperidol (Haldol)

A

Tachycardia, seizures, anticholinergic sxs (urinary retention)

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21
Q

Life-threatening Reaction Specific to Haloperidol (Haldol)

A

Respiratory depression, laryngospasm, neuromalignant syndrome, agranulocytosis

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22
Q

Atypical Antipsychotic Prototype

A

Risperidone (Risperdal)
Extremely sedating

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23
Q

Risperidone (Risperdal) Pregnancy Category

A

Pregnancy Category C

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24
Q

Risperidone (Risperdal) Route and Onset

A

PO unknown

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25
Q

Atypical Antipsychotic (Non-Phenothiazine) Prototype

A

Aripiprazole (Abilify)

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26
Q

Sxs Specific to Aripiprazole (Abilify)

A

Weight gain, sexual dysfunction, CNS depression (sedation), blurred vision

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27
Q

Adverse Reactions Specific to Aripiprazole (Abilify)

A

Orthostatic hypotension, HTN, bradycardia, tachycardia, convulsions, EPS

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28
Q

Life-threatening Reactions Specific to Aripiprazole (Abilify)

A

Suicidal ideation, neuroleptic malignant syndrome

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29
Q

Contraindications Specific to Aripiprazole (Abilify)

A

Hypersensitivity, dehydration, ETOH intoxication, suicidal ideation

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30
Q

Drug Interactions Specific to Aripiprazole (Abilify)

A

Increases the effects of antihypertensives
Antidiabetic agents can cause hypoglycemia
Other antipsychotics increase risk of NMS and EPS syndrome
CNS depressants
Grapefruit juice may increase blood levels
St. John’s Wort may decrease blood levels

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31
Q

General Nursing Considerations for Antipsychotics

A

Monitor for orthostatic hypotension
Make sure pt has swallowed pill
Observe for EPS
May take 6 weeks or longer for full clinical effect
Do not discontinue abruptly
Avoid CNS depressants, ETOH
May be excreted in breast milk
Wear medi-alert bracelet
Tolerance to sedative effect develops over a few weeks

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32
Q

Anxiety Types

A

Primary and secondary

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33
Q

Primary Anxiety

A

Not caused by medical condition
Treated with anxiolytics

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34
Q

Secondary Anxiety

A

R/T drug use or psychiatric disorders
Treated with anxiolytics only if severe, untreatable, or causes disability

35
Q

Anxiolytics

A

Benzodiazapines and azapirones
For short term use (can cause addiction and death)

36
Q

Benzodiazepine Prototype

A

Lorazepam (Ativan)

37
Q

Lorazepam (Ativan) Pregnancy Category

A

Pregnancy Category D

38
Q

Lorazepam (Ativan) Routes and Onset

A

PO/IM 15-30 minutes, IV 1-5 minutes
PO preferred route

39
Q

Sxs Specific to Lorazepam (Ativan)

A

CNS depression (drowsiness, dizziness, confusion), blurred vision, N/V/A

40
Q

Adverse Reactions Specific to Lorazepam (Ativan)

A

Hypotension (more common), HTN

41
Q

Contraindications Specific to Lorazepam (Ativan)

A

CNS depression, shock, coma, narrow-angle glaucoma, pregnancy, lactation
Caution: hepatic or renal dysfunction, suicidal

42
Q

Drug Interactions Specific to Lorazepam (Ativan)

A

Increased CNS depression when taken with ETOH, CNS depressants, or anticonvulsants
Cimetidine increases lorazepam plasma levels, increases Dilantin levels, smoking decreases antianxiety effects
Kava: may potentiate sedation

43
Q

General Nursing Considerations for Anxiolytics

A

Do not use for more than 2-4 months (dependence/tolerance)
Use lower doses for elderly and children
Monitor for orthostatic hypotension
Avoid activities requiring alertness (driving)
Avoid ETOH and other CNS depressants
May take 1-2 weeks for drug to take effect
Do not stop abruptly

44
Q

Depression

A

Mood changes and loss of interest in normal activities

45
Q

Major Depression Sxs

A

Loss of interest in most activities
Depressed mood
Weight loss or gain
Insomnia/hypersomnia
Loss of energy/fatigue
Feeling of despair
Decreased ability to think/concentrate
Suicidal thoughts

46
Q

Common Causes for Depression

A

Genetics
Social/environmental factors
Biological conditions

47
Q

Common Theory for Depression

A

Insufficient neurotransmitters: serotonin, norepinephrine, dopamine
Low serotonin permits depression to occur
Low norepinephrine causes depression

48
Q

Herbal Supplements for Depression

A

St. John’s wort
Gingko Biloba
Discontinue both 1-2 weeks before surgery due to them causing an increased risk of bleeding

49
Q

General Info for Tricyclic Antidepressants

A

Clinical response 2-4 weeks
Discontinue gradually to avoid withdrawal sxs such as N/V/A

50
Q

Tricyclic Antidepressant Prototype

A

Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)

51
Q

Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil) Pregnancy Category

A

Pregnancy Category C

52
Q

Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil) Route and Onset

A

PO 1-3 weeks

53
Q

Sxs Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)

A

CNS depression (sedation, drowsiness), anticholinergic sxs (dry mouth, urinary retention, constipation)

54
Q

Adverse Reactions Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)

A

Orthostatic hypotension, EPS syndrome

55
Q

Life-threatening Reactions Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)

A

Agranulocytosis, thrombocytopenia, leukopenia, seizures

56
Q

Contraindications Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)

A

Severe depression w/ suicidal tendency (gives pt enough energy to actually commit suicide)
Acute MI
MAOI’s
Cardiac dysthymias

57
Q

Drug Interactions Specific to Amitriptyline HCL (Vanatrip, Apo-Amitriptyline, Elavil)

A

Increased CNS and respiratory depression when taken with other CNS depressants or ETOH
Hypertensive crisis and death may occur with MAOI’s

58
Q

Selective Serotonin Reuptake Inhibitor (SSRI) Prototype

A

Fluoxetine (Prozac)

59
Q

Fluoxetine (Prozac) Pregnancy Category

A

Pregnancy Category C

60
Q

Fluoxetine (Prozac) Route and Onset

A

PO 2-4 weeks

61
Q

Sxs Specific to Fluoxetine (Prozac)

A

HA, nervousness, restlessness, GI distress

62
Q

Adverse Reactions Specific to Fluoxetine (Prozac)

A

Hyponatremia (common with all SSRI’s), seizures, palpations, chest pain

63
Q

Contraindications Specific to Fluoxetine (Prozac)

A

Acute MI
MAOI’s (increased risk of hypertensive crisis and death)
Caution: severe depression w/ suicidal tendency (will have the energy to actually commit suicide), severe liver or kidney disease

64
Q

Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) Prototype

A

Venlafaxine (Effexor)

65
Q

Venlafaxine (Effexor) Sxs

A

Drowsiness, dizziness, nervousness

66
Q

Venlafaxine (Effexor) Adverse Reactions

A

Seizures, hyponatremia

67
Q

Venlafaxine (Effexor) Contraindications

A

Do NOT take with MAOI, wait 14 days after discontinuing MAOI’s before starting (hypertensive crisis and death)

68
Q

MAOI Examples

A

Isocarboxazid (Marplan), phenelzine sulfate (Nardil), tranylycypromine sulfate (Parnate), selegline HcL (Eldepryl)

Prescribed when other antidepressants don’t wok (last resort)

69
Q

MAOI Sxs

A

Agitation, restlessness, insomnia, orthostatic hypotension

70
Q

MAOI Adverse Reactions

A

Many adverse reactions, hypertensive crisis from food and drug interactions

71
Q

MAOI Contraindications/Drug and Food Interactions

A

DO NOT TAKE WITH TCA’s
Do not mix with sympathomimetics or CNS stimulants (vasoconstrictors, cold medicines containing phenylephrine or pseudoephedrine)
Food to avoid: cheese, bananas, raisins, pickled foods, red wine, beer, cream, yogurt, chocolate, coffee, Italian green beans, liver, yeast, soy sauce

72
Q

MAOI Nursing Consideration

A

Monitor BP for hypertensive crisis

73
Q

General Nursing Considerations for Antidepressants

A

Observe for sxs of depression/suicidal ideation
Monitor for orthostatic hypotension
Decreased anticonvulsant effectiveness (monitor for seizures)
Avoid certain foods
Monitor BP for hypertensive crisis
Avoid ETOH
Check with MD/pharmacist before taking herbal drugs
Do not do activities requiring alertness until drug stabilizes (CNS depression)
Do not stop abruptly

74
Q

Mood Stabilizer Prototype

A

Lithium (Eskalith, Lithane, Lithonate, Lithobid)

Used for bipolar disorder

75
Q

Lithium Pregnancy Category

A

Pregnancy category C

76
Q

Lithium Route and Onset

A

PO 5-6 days

77
Q

Lithium Therapeutic Drug Range

A

0.5-1.5 meq/L

78
Q

Lithium Sxs

A

Dizziness, drowsiness, slurred speech, slow reaction time

Patients will adjust after a few weeks

79
Q

Lithium Adverse Reactions

A

Urinary incontinence, hyponatremia, nephrotoxicity

80
Q

Lithium Life-threatening Reactions

A

Cardiac dysrhythmias and circulatory collapse

81
Q

Lithium Contraindications

A

Hyponatremia (main thing), liver and renal dx, pregnancy, lactation, severe dehydration, children under 12

Caution: thyroid dx

82
Q

Lithium Drug Interactions

A

Increased sodium levels with thiazide diuretics, Haldol, NSAID’s, and antidepressants

83
Q

Mood Stabilizer (Lithium) Nursing Considerations

A

Watch for toxicity
Monitor for depression/suicidal tendencies
Check blood levels immediately before next dose or 8-12 hours after last dose
Monitor weight and urine output (could have a lot of fluid loss)
Maintain adequate fluid intake
Take with meals to decrease GI distress
Full effect could take a few weeks (1-2)
Compliance with med is important (pts dislike the slowness feeling)

Pharm Final (5 decks)

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