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Pharmacology > Ch. 10: Mental Health and Behavioral Problems > Flashcards

Ch. 10: Mental Health and Behavioral Problems Flashcards

1
Q

Antianxiety agents/anxiolytics

A

BNZs, BNZ agonists, certain antidepressants including SSRIs/SNRIs

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2
Q

Action and uses of antianxiety drugs

A

act with GABA receptors to chance GABA effects (inhibitory), recommended for short term use, can cause anxiety with too high blood drug levels

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3
Q

Buspirone

A

reduces anxiety by affecting the serotonin and dopamine
can take 1 to 2 weeks for full effect, 3 to 6 for maximal effects
reduces the risk of dependence and sedation

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4
Q

Expected Side Effects/Adverse Reactions of antianxiety drugs

A

BNZs and BNZ agonists cause drowsiness and memory loss, dizziness, headaches, or hypotension
confusion, apnea, and seizures

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5
Q

Drug Interactions of antianxiety drugs

A 
Sodium oxybate (for narcolepsy), respiratory depression and coma
Avoid opioids or any drug that results in CNS depression
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6
Q

Do not give buspirone

A

with MAOIs, opioids, or drugs for TB

grapefruit juice increases blood levels

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7
Q

Assessment of antianxiety drugs

A

Check vitals, BP, HR, respiratory rate, and assess patient’s alertness before giving the drug

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8
Q

Assess mental status

A

before giving the drug

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9
Q

Assess patient for any history of

A

alcohol or chemical dependency

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10
Q

Planning and Implementation of antianxiety drugs

A

monitor patient for side effects of drowsiness, dizziness, increased risk for falls
report mental status changes

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11
Q

Flumazenil (Romazicon)

A

can quickly reverse effects of respiratory depression

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12
Q

Evaluation of antianxiety drugs

A

ask the patient about relief from anxiety

do not use if pregnant/breastfeeding

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13
Q

Psychosis

A

loss of control with reality

also called delirium

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14
Q

Acute vs Chronic psychosis

A

delirium vs schizophernia/bipolar

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15
Q

Dementia patients can have an increased risk for

A

stroke, cognitive impairment, and mortality

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16
Q

Positive and Negative psychosis with Schizophrenia

A

Those that add to normal behaviors, those that subtract from the normal behavior

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17
Q

Positive psychosis examples

A

hallucinations, delusions, disorganized thoughts, and speech

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18
Q

Negative psychosis examples

A

poor hygiene, difficulty with social relationships, lack of interest in activities, lack of motivation

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19
Q

Typical antipsychotics

A

1st generation, treats positive symptoms
blocks dopamine 2 D2 receptors
blocking of dopamine receptors helps treat positive symptoms of psychosis, does not affect negative symptoms

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20
Q

Schizophrenia

A

disease of overstimulation of dopamine

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21
Q

Which drug can cause pseudoparkinsonism and other extrapyrimidal symptoms?

A

typical antipsychotics

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22
Q

Phenothiazines

A

block transmission of dopamine at the dopamine receptors

also blocks ACh and alpha-adrenergic receptors

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23
Q

Nonphenothiazines

A

similar action but are chemically different from phenothiazines
side effects/adverse reactions are basically the same

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24
Q

Side effects/adverse reactions of antipsychotics

A

headache, drowsiness, nausea, constipation, and dry mouth

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25
Q

Main adverse effects of antipsychotics

A

ESPs related to decrease of dopamine, pseudoparkinsonism, acute dystonia, akathisia, and tardive dyskinesia

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26
Q

Acute dystonia is managed with

A

anticholingeric drugs and BNZs, exhibits facial grimacing, involuntary upward eye movement, muscle spasms of face, neck, back, laryngeal spasms

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27
Q

Examples of antipsychotics

A

chlorpromazine (Thorazine), fluphenazine (Prolixin), halperidal (Haldol), risperidone (Risperidal), ziprasidone (Geodon), quetapine (Seroquel), aripiprazole (Abilify)

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28
Q

Akathisia

A

restless, trouble standing still, paces the floor, feet in constant motion

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29
Q

Tardive Dyskinesia

A

protrusion and rolling of the tongue, sucking and smacking of the lips, chewing motions, involuntary movements
increase risk in patients with bipolar disorder

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30
Q

These drugs affect the body’s ability to regulate core body temperature

A

can cause hypothermia in rare cases

increases risk of hypothyroidism, brain injury, or cold environmental temperature

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31
Q

Neuroleptic malignant syndrome (NMS)

A

hyperpyrexia, confusion changes in BP, and ESPs
can lead to coma and death
more often in men

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32
Q

Drug Interactions

A

acetaminophen, diuretics such as furosemide or hydrochlorothiazide, certain calcium channel blockers, and several antidiabetic agents

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33
Q

Assessment of antipsychotics

A

determine baseline level of consciousness
components of the mental status exam
include factors as patient’s appearance, behavior, mood, affect, and thought processes

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34
Q

Monitor vital signs carefully

A

for significant changes: increase in temperature or severe changes in blood pressure can indicate the severe adverse effects of NMS

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35
Q

Changes in motor function such as

A

muscle tone, gait, or fine motor movement (ESPs)

contact healthcare provider right away

36
Q

Most antipsychotics can be taken with food to avoid

A

GI upset

37
Q

Antipsychotics can interact with

A

prescription drugs and herbal supplements

38
Q

Atypical Antipsychotics (2nd generation)

A

many block dopamine type 2 receptors in the brain or other subtypes (serotonin)

39
Q

Atypical Antipsychotics have a lower risk for

A

ESPs

40
Q

Atypical Antipsychotics treats

A

negative and positive symptoms of psychosis

41
Q

Dopamine System Stabilizers (DSS)

A

affect dopamine and serotonin receptors slightly differently, partial dopamine 2 agoinsts and partial 5-HT1A agonists and 5-HT2A antagonists
also treats autism and tourettes

42
Q

Side Effects/Adverse Reactions to DSS

A

Insomnia and drowsiness, dizziness, orthostatic hypotension, constipation and dry mouth
decreased rates of ESPs

43
Q

Risks with DSS

A

weight gain, hypertriglyceridemia, risk for insulin resistance, type 2 diabetes
increased risk of cardiovascular disease and death

44
Q

Dopamine System Stabilizers affects the heart by

A

prolonging the QT interval, can cause severe dysrhythmias

45
Q

Clozapine can cause

A

agranulocytosis, decrease in WBCs

46
Q

Drug Interactions of Dopamine System Stabilizers

A

Drugs that decrease dopamine, or typical antipsychotics, use with SSRIs or SNRIs, alcohol/other CNS depressants

47
Q

With DSS drugs detemine

A

baseline level of consciousness, assess for history of hypertension, diabetes, cardiovascular disease, or dysrhytmias

48
Q

Suddenly stopping antipsychotics can result in

A

nausea, dizziness, tremors

49
Q

Antidepressants are used with

A

dysthymic disorder, major depressive disorder, bipolar disorder

50
Q

MAOIs

A

tricyclic antidepressants are 1st generation, became available in the 60s

51
Q

Atypical antidepressants

A

work slightly different but affect same neurotransmitters
screen for thoughts of self-harm or suicide
should not be stopped suddenly

52
Q

SSRIs

A

inhibiting the reuptake of serotonin, increase concentration of serotonin
safer than TCAs and better tolerated

53
Q

Side Effects/Adverse Reactions of atypical antidepressants

A

nausea, drowsiness, insomnia, dry mouth, decreased appetite, increased sweating, and constipation
decreased sex drive, decrease ability to orgasm and erectile dysfunction, increased risk for suicide

54
Q

Risks of atypical antidepressants

A

bleeding, hyponatremia, and bone fracture
skin reactions
cause changes in the electrical conduction of the heart

55
Q

Antidepressants should be avoided in

A

pregnancy, due to neonatal abstinence syndrome (withdrawal)

56
Q

Knowledge of patient’s drug use can prevent

A

serotonin syndrome

57
Q

SNRIs

A

inhibit the reuptake of both serotonin and norepinephrine, increase concentration

58
Q

SNRIs are also used in

A

depression, hot flushes, premenstrual dysphoric disorder, fibro, and chronic pain, diabetic neuropathy

59
Q

Side effects and adverse reactions of SNRIs

A

nausea, dry mouth, loss of appetite, fatigue and drowsiness

60
Q

Hyperhidrosis

A

increased sweating

61
Q

SNRIs are avoided

A

during late pregnancy

62
Q

Drug Interactions of tricyclic antidepressants

A

any drug that affects serotonin or norepinephrine and other antidepressants
increase the risk for serotonin syndrome or neuroleptic malignant syndrome
anticoagulants, antiplatelet drugs, and NSAIDs

63
Q

Side Effects/Adverse Reactions of Tricyclic Antidepressants

A

dry mouth, drowsiness, constipation, nausea, and orthostatic hypotension
weight gain/weight loss
mild to severe vision problems

64
Q

Cardiac dysrhythmias are a contraindication for

A

antidepressants

65
Q

Tricyclic antidepressants can trigger a

A

manic episode, cause delirium in older patients with cognitive impairment, and should not be used in patients with glaucoma

66
Q

Drug interactions with Tricyclic Antidepressants

A

drugs that depress the CNS, increased risk for respiratory depression, sedation, and severe hypotension
interacts with a wide variety of antidysrhythmic drugs, causing serious cardiac problems
use of marijuana can cause cardiac problems
use of tobacco products can decrease the effectiveness of TCAs

67
Q

MAOIs

A

enzymes in cells in your body
break down neurotransmitters, increase the available neurotransmitters, decrease in depressive episodes
used to treat severe depression that does not respond to other medications

68
Q

Serious interactions with MAOIs can occur

A

with certain foods and drink (high tyramine)

69
Q

MAOIs can also be used for

A

certain anxiety disorders and treating Parkinson’s

70
Q

Drug Interactions of MAOIs

A

severe high blood pressure from SSRIs, SNRIs, St. John’s wort, and any drug with stimulant qualities
Drugs that reduce BP can increase hypotensive side effects
Drugs that depress the CNS
Patients who are taking insulin or oral hypoglycemic drugs at risk for hypoglycemic reactions

71
Q

Tyramine

A

amino acid involved in the release of norepinephrine, broken down by monoamine oxidase

72
Q

Function of MAOIs

A

increase norepinephrine, thus significantly increases BP

-avoid caffeine products

73
Q

Mood Stabilizers

A

Drugs used mainly to treat patients with bipolar illness. Extreme changes in mood

74
Q

Bipolar characteristics

A

inability to live life, mania, rapid speech, flight of ideas, excessive activity, staying awake for hours, feelings of elation or superiority
spend money recklessly or sex with multiple partners
extreme depression, lose interest, sad, hopeless, suicidal

75
Q

Actions and uses of Lithium

A

inhibits the synthesis, storage, release, and reuptake of monoamine neurotransmitters

76
Q

Lithium does not cause

A

sedation, depression, or euphoria

77
Q

Onset of action for mania

A

1 week, but may take 2 to 3 weeks for the patient to experience the full benefit

78
Q

Lithium has a very narrow

A

therapeutic range, monitor blood levels regularly( 4 days after 1st day of drug therapy)
adjust the pts dose accordingly

79
Q

Side Effects/Adverse Reactions of Lithium

A

Mild weight gain, increased thirst, increased urine output, dry skin, mild drowsiness, nausea, vomiting, diarrhea; these can also indicate drug toxicity
Hypothyroidism, renal failure, diabetes insipidus, neuroleptic malignant syndrome, serotonin syndrome

80
Q

While taking Lithium, maintain

A

fluid balance to prevent drop in sodium levels

decrease caused by reduced salt intake, intensive exercise, very hot enviroments

81
Q

Drug Interactions of Lithium

A

Diuretics, NSAIDs, antidepressants and antipsychotic drugs, drugs that affect the electrical conduction of the heart. Drugs that affect sodium intake or fluid balance, increased risk for toxicity

82
Q

Contraindications of Lithium

A

pregnant women

83
Q

Desired level for acute mania

A

0.8 to 1.2

84
Q

Maintenance level

A

0.8 to 1.0

85
Q

More than 1.5 of Lithium

A

toxicity

86
Q

More than 3

A

organ failure or death

87
Q

Blood levels of Lithium are measured every

A

6 to 12 weeks

Pharmacology (10 decks)

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