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Pharm > Antipsychotics, Anxiolytics, Antidepressants, & Mood Stabilizers > Flashcards

Antipsychotics, Anxiolytics, Antidepressants, & Mood Stabilizers Flashcards

1
Q

False beliefs about what is taking place or who one is

A

delusions

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2
Q

Seeing or hearing things that aren’t there

A

hallucinations

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3
Q

Psychosis etiologies (causes)

A

Illicit drugs/ alcohol
Certain brain disorders
Brain tumors/cysts
Certain prescription drugs
Schizophrenia
Some with bipolar disorder or severe depression

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4
Q

 Chronic psychotic disorder
 Symptoms characterized as cognitive, positive, and negative symptoms

A

SCHIZOPHRENIA

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5
Q

Positive sx of SCHIZOPHRENIA

Harder to deal with

A

 Delusions
 Hallucinations
 Disorganized speech
 Agitation
 Hyperactivity
 Hostility

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6
Q

Negative sx of SCHIZOPHRENIA

Easier than positive sx

A

 Social withdrawal/isolation
 Lack of enjoyment
 Lack of personal care
 Flat affect
 Difficulty in abstract thinking
 Deterioration of hygiene, job, academic performance

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7
Q

CONVENTIONAL (TYPICAL) ANTIPSYCHOTIC AGENTS

1st generation

A

Phenothiazines
Ex: fluphenazine (Prolixin)

Phenothiazine-like
Ex: haloperidol (Haldol)

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8
Q

Blocks dopamine receptors, controls psychotic symptoms

Manage symptoms of psychosis including schizophrenia

Blocks POSITIVE sx

A

fluphenazine (Prolixin)

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9
Q

Alters effects of dopamine on CNS (downer)

Treat acute psychoses, ADHD, schizophrenia, Tourette syndrome

A

haloperidol (Haldol)

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10
Q

Side effects and adverse effects of conventional antipsychotics

Fluphenazine and haloperidol

A

Side effects: anticholinergic effects (can’t see, pee, shit, spit), sexual dysfunction

Adverse effects: hyper/hypotension, EPS, NMS, agranulocytosis, thrombocytopenia

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11
Q

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

A

NEUROLEPTIC MALIGNANT SYNDROME (NMS)

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12
Q

How is NMS treated?

A

 Immediate withdrawal of antipsychotics,
 hydration, hypothermic blankets, antipyretics, icepacks
 benzodiazepines, muscle relaxants

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13
Q

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)

A

ATYPICAL ANTIPSYCHOTICS (AKA SECOND-GENERATION ANTIPSYCHOTICS (SGAS))

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14
Q

Interferes with binding of dopamine to dopamine and serotonin receptors

Used to manage schizophrenia, bipolar disorder, autism, depression, Tourette syndrome

A

Aripiprazole (Abilify)

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15
Q

Side effects and adverse effects of aripiprazole

A

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

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16
Q

Patient Teaching for antipsychotics

Compliance is difficult

DOT is useful- watch pts take meds

Get family involved

A

-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

17
Q

Antianxiety drugs

Major group is benzodiazepines

A

ANXIOLYTICS

End in *pam

18
Q

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

A

lorazepam (Ativan)

19
Q

Side effects & adverse effects of lorazepam

A

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

20
Q

Lorazepam interactions

A

Increases CNS depression with alcohol, other CNS depressants,
cimetidine increases lorazepam serum levels

Smoking and caffeine decreases antianxiety effects

Oral contraceptives decrease effects

21
Q

-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)

A

Misc. anxiolytic - Buspirone Hydrochloride

22
Q

MAJOR CATEGORIESDRUGS FOR TREATMENT OF DEPRESSION

A
  • Tricyclic Antidepressants (TCAs)
  • Selective Serotonin Reuptake Inhibitors
    (SSRIs)
  • Serotonin and Norepinephrine Reuptake
    Inhibitors (SNRIs)
  • MAO inhibitors
  • Atypical antidepressants
23
Q

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

A

TRICYCLIC ANTIDEPRESSANTS (TCAs)

Downers

Ex: amitriptyline and imipramine

24
Q

Block reuptake of serotonin, enhancing its presence & transmission at the synapse

Treats major depressive disorder & anxiety disorders (OCD, panic disorder, PTSD, & phobias)

A

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

Ex: fluoxetine (Prozac)

25
Q

Side effects/Adverse effects of fluoxetine & other SSRIs

A
  • Headache, nervousness, restlessness
  • Insomnia, tremors, seizures
  • GI distress
  • Sexual dysfunction
  • Suicidal ideation (watch in early stages)
  • Serotonin Syndrome
26
Q

Block reuptake of serotonin AND norepinephrine

Major depressive disorder, generalized anxiety, & socialized anxiety

A

SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)

Ex: venlafaxine (Effexor)

27
Q

Side effects/Adverse effects of venlafaxine & other SNRIs

A

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

28
Q

Serotonin syndrome sx

Within hrs of starting a new drug or increasing dose

STOP THE DRUGS

A

hypertensive, hyperreflexia, clonus, fever, mydriasis, tachycardia, diaphoresis, agitation, tremors

29
Q

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

A

MONOAMINE OXIDASE INHIBITORS (MAO-Is)

30
Q

Risk of hypertensive crisis when taking MAO-Is due to interactions with

A

-foods w/ tyramine
-vasoconstrictors and cold medications

31
Q

General patient teaching for antidepressants

A
  • 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
32
Q

Depressive or mania symptoms?

  • Lack of energy, sleep disturbances, abnormal eating patterns
  • Feelings of despair, guilt, and hopelessness
A

Depressive

33
Q

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
A

Mania

34
Q

Alteration of ion transport in muscle and nerve cells; increased receptor sensitivity to serotonin

Used to treat bipolar disorder, manic episodes

A

Mood stabilizer

Ex: lithium

35
Q

Lithium has a very __________ therapeutic index. It is considered a high-risk drug.

A

narrow

36
Q

__________ in sodium intake may result in higher serum lithium levels, while a sudden __________ in sodium might cause fall in lithium levels.

A

Decrease in sodium intake may result in higher serum lithium levels, while a sudden increase in sodium might cause fall in lithium levels.

37
Q

Ranges of lithium

Therapeutic and toxic

A
  • 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.
38
Q

Patient teaching for lithium

A

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)

Pharm (19 decks)

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