Antipsychotics, Anxiolytics, Antidepressants, & Mood Stabilizers Flashcards
False beliefs about what is taking place or who one is
delusions
Seeing or hearing things that aren’t there
hallucinations
Psychosis etiologies (causes)
Illicit drugs/ alcohol
Certain brain disorders
Brain tumors/cysts
Certain prescription drugs
Schizophrenia
Some with bipolar disorder or severe depression
Chronic psychotic disorder
Symptoms characterized as cognitive, positive, and negative symptoms
SCHIZOPHRENIA
Positive sx of SCHIZOPHRENIA
Harder to deal with
Delusions
Hallucinations
Disorganized speech
Agitation
Hyperactivity
Hostility
Negative sx of SCHIZOPHRENIA
Easier than positive sx
Social withdrawal/isolation
Lack of enjoyment
Lack of personal care
Flat affect
Difficulty in abstract thinking
Deterioration of hygiene, job, academic performance
CONVENTIONAL (TYPICAL) ANTIPSYCHOTIC AGENTS
1st generation
Phenothiazines
Ex: fluphenazine (Prolixin)
Phenothiazine-like
Ex: haloperidol (Haldol)
Blocks dopamine receptors, controls psychotic symptoms
Manage symptoms of psychosis including schizophrenia
Blocks POSITIVE sx
fluphenazine (Prolixin)
Alters effects of dopamine on CNS (downer)
Treat acute psychoses, ADHD, schizophrenia, Tourette syndrome
haloperidol (Haldol)
Side effects and adverse effects of conventional antipsychotics
Fluphenazine and haloperidol
Side effects: anticholinergic effects (can’t see, pee, shit, spit), sexual dysfunction
Adverse effects: hyper/hypotension, EPS, NMS, agranulocytosis, thrombocytopenia
Rare, potentially fatal condition
Symptoms:
Altered mental status, seizures
Muscle rigidity, sudden high fever, profuse sweating
BP fluctuations, tachycardia, dysrhythmias
Rhabdomyolysis, acute renal failure
Respiratory failure, coma
NEUROLEPTIC MALIGNANT SYNDROME (NMS)
How is NMS treated?
Immediate withdrawal of antipsychotics,
hydration, hypothermic blankets, antipyretics, icepacks
benzodiazepines, muscle relaxants
Effective in treating both positive and negative symptoms of schizophrenia
Unlikely to cause symptoms of EPS (including tardive dyskinesia)- but still causes side effects that make it difficult for patients to stay on their medications
Have negative metabolic effects (weight gain, dyslipidemia, DM)
ATYPICAL ANTIPSYCHOTICS (AKA SECOND-GENERATION ANTIPSYCHOTICS (SGAS))
Interferes with binding of dopamine to dopamine and serotonin receptors
Used to manage schizophrenia, bipolar disorder, autism, depression, Tourette syndrome
Aripiprazole (Abilify)
Side effects and adverse effects of aripiprazole
Side effects: fewer than those of phenothiazines and nonphenothiazines, but similar anticholinergic side effects; weight
loss/ gain
Adverse effects: Although less likely, can cause EPS, DM, sexual dysfunction, tachy/bradycardia, dysrhythmias, dyslipidemia, suicidal ideation, NMS, agranulocytosis, neutropenia
Patient Teaching for antipsychotics
Compliance is difficult
DOT is useful- watch pts take meds
Get family involved
-Take exactly as prescribed, do not discontinue
-Take even when symptom free
-Avoid antacids for at least 2 hrs
-Avoid alcohol, other CNS depressants
-Smoking may reduce effectiveness
-Drug may take 3-6 weeks for full effectiveness
-Mental health follow up is really important
-Increase activity, fluid intake, and increased fiber to prevent constipation
Antianxiety drugs
Major group is benzodiazepines
ANXIOLYTICS
End in *pam
Anxiolytic that potentiates GABA effects by binding to specific benzodiazepine receptors and inhibiting GABA neurotransmission
Used to control anxiety, treat status epilepticus, sedation induction, insomnia
Benzo
lorazepam (Ativan)
Side effects & adverse effects of lorazepam
Side effects: Drowsiness, dizziness, headache, confusion, euphoria, blurred vision, constipation, restlessness, sexual dysfunction
Adverse effects: hyper/hypotension, brady/tachycardia, tolerance, dependence, seizure, suicidal ideation, NMS, agranulocytosis, thrombocytopenia, pancytopenia, respiratory depression
Lorazepam interactions
Increases CNS depression with alcohol, other CNS depressants,
cimetidine increases lorazepam serum levels
Smoking and caffeine decreases antianxiety effects
Oral contraceptives decrease effects
-Binds to serotonin and dopamine receptors
-May not be effective 1-2 weeks after continuous use
-Fewer side effects of sedation and physical and psychological dependency associated with benzos/safer than benzos
-Side effects: drowsiness, dizziness, headache, nausea, nervousness, excitement
-Interaction with grapefruit juice (can lead to toxicity)
Misc. anxiolytic - Buspirone Hydrochloride
MAJOR CATEGORIESDRUGS FOR TREATMENT OF DEPRESSION
- Tricyclic Antidepressants (TCAs)
- Selective Serotonin Reuptake Inhibitors
(SSRIs) - Serotonin and Norepinephrine Reuptake
Inhibitors (SNRIs) - MAO inhibitors
- Atypical antidepressants
Block reuptake of neurotransmitters norepinephrine and serotonin in brain; Block histamine receptors
Treats major depression, elevates mood, increases interest in ADL’s, decreased insomnia
Increased CNS depression w/ alcohol , sedatives, hypnotics, and barbituates
TRICYCLIC ANTIDEPRESSANTS (TCAs)
Downers
Ex: amitriptyline and imipramine
Block reuptake of serotonin, enhancing its presence & transmission at the synapse
Treats major depressive disorder & anxiety disorders (OCD, panic disorder, PTSD, & phobias)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Ex: fluoxetine (Prozac)
Side effects/Adverse effects of fluoxetine & other SSRIs
- Headache, nervousness, restlessness
- Insomnia, tremors, seizures
- GI distress
- Sexual dysfunction
- Suicidal ideation (watch in early stages)
- Serotonin Syndrome
Block reuptake of serotonin AND norepinephrine
Major depressive disorder, generalized anxiety, & socialized anxiety
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)
Ex: venlafaxine (Effexor)
Side effects/Adverse effects of venlafaxine & other SNRIs
Side effects: drowsiness, dizziness, insomnia, headache, euphoria,
amnesia, blurred vision, photosensitivity, and ejaculation dysfunction
Adverse effects: orthostatic hypotension, hypertension, angioedema, blood dyscrasias, suicidal ideation, and Stevens Johnson syndrome
Serotonin syndrome sx
Within hrs of starting a new drug or increasing dose
STOP THE DRUGS
hypertensive, hyperreflexia, clonus, fever, mydriasis, tachycardia, diaphoresis, agitation, tremors
Decrease effectiveness of monoamine oxidase (an enzyme that inactivates norepinephrine, dopamine, epinephrine, and serotonin); levels of those neurotransmitters will increase.
Not 1st line of treatment for depression
MONOAMINE OXIDASE INHIBITORS (MAO-Is)
Risk of hypertensive crisis when taking MAO-Is due to interactions with
-foods w/ tyramine
-vasoconstrictors and cold medications
General patient teaching for antidepressants
- Take exactly as prescribed; do not double-dose
- Medical follow-up
- Report suicidal thinking
- May take up to 8 weeks for symptoms to improve
- Take even when symptom-free
- Do not use SSRIs, TCAs, and other antidepressants for at least 14 days after discontinuing MAOI drugs
because of the risk of serotonin syndrome. - Avoid alcohol
- Patients taking TCAs should not smoke because it may decrease the effectiveness of these drugs
- May cause dizziness
- Do not discontinue suddenly
Depressive or mania symptoms?
- Lack of energy, sleep disturbances, abnormal eating patterns
- Feelings of despair, guilt, and hopelessness
Depressive
Depressive or mania symptoms?
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased talkativeness
- Flight of ideas; subjective feeling that thoughts are racing
- Distractibility
- Increased goal-directed activity
- Excessive involvement in pleasurable activities that have high potential for painful consequences
Mania
Alteration of ion transport in muscle and nerve cells; increased receptor sensitivity to serotonin
Used to treat bipolar disorder, manic episodes
Mood stabilizer
Ex: lithium
Lithium has a very __________ therapeutic index. It is considered a high-risk drug.
narrow
__________ in sodium intake may result in higher serum lithium levels, while a sudden __________ in sodium might cause fall in lithium levels.
Decrease in sodium intake may result in higher serum lithium levels, while a sudden increase in sodium might cause fall in lithium levels.
Ranges of lithium
Therapeutic and toxic
- Therapeutic serum range: 0.5 to 1.2 mEq/L (may see 1.5 in acute mania)
- Serum lithium levels greater than 1.5 to 2 mEq/L are toxic.
Patient teaching for lithium
Teach patient to wear medical alert identification.
Teach patient to take drug as prescribed and keep medical appointments.
Warn against driving motor vehicles or operating dangerous equipment until drug effect is known.
Advise patient that drug effect may take 1 to 2 weeks.
Encourage patient to avoid caffeine, crash diets, NSAIDs, diuretics.
Advise patient against getting pregnant because of teratogenic effects.
Avoid activities that can cause sodium loss (e.g. heavy exertion, exercise in hot weather, saunas)
