Ch. 10: Mental Health and Behavioral Problems Flashcards
Antianxiety agents/anxiolytics
BNZs, BNZ agonists, certain antidepressants including SSRIs/SNRIs
Action and uses of antianxiety drugs
act with GABA receptors to chance GABA effects (inhibitory), recommended for short term use, can cause anxiety with too high blood drug levels
Buspirone
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
Expected Side Effects/Adverse Reactions of antianxiety drugs
BNZs and BNZ agonists cause drowsiness and memory loss, dizziness, headaches, or hypotension
confusion, apnea, and seizures
Drug Interactions of antianxiety drugs
Sodium oxybate (for narcolepsy), respiratory depression and coma Avoid opioids or any drug that results in CNS depression
Do not give buspirone
with MAOIs, opioids, or drugs for TB
grapefruit juice increases blood levels
Assessment of antianxiety drugs
Check vitals, BP, HR, respiratory rate, and assess patient’s alertness before giving the drug
Assess mental status
before giving the drug
Assess patient for any history of
alcohol or chemical dependency
Planning and Implementation of antianxiety drugs
monitor patient for side effects of drowsiness, dizziness, increased risk for falls
report mental status changes
Flumazenil (Romazicon)
can quickly reverse effects of respiratory depression
Evaluation of antianxiety drugs
ask the patient about relief from anxiety
do not use if pregnant/breastfeeding
Psychosis
loss of control with reality
also called delirium
Acute vs Chronic psychosis
delirium vs schizophernia/bipolar
Dementia patients can have an increased risk for
stroke, cognitive impairment, and mortality
Positive and Negative psychosis with Schizophrenia
Those that add to normal behaviors, those that subtract from the normal behavior
Positive psychosis examples
hallucinations, delusions, disorganized thoughts, and speech
Negative psychosis examples
poor hygiene, difficulty with social relationships, lack of interest in activities, lack of motivation
Typical antipsychotics
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
Schizophrenia
disease of overstimulation of dopamine
Which drug can cause pseudoparkinsonism and other extrapyrimidal symptoms?
typical antipsychotics
Phenothiazines
block transmission of dopamine at the dopamine receptors
also blocks ACh and alpha-adrenergic receptors
Nonphenothiazines
similar action but are chemically different from phenothiazines
side effects/adverse reactions are basically the same
Side effects/adverse reactions of antipsychotics
headache, drowsiness, nausea, constipation, and dry mouth
Main adverse effects of antipsychotics
ESPs related to decrease of dopamine, pseudoparkinsonism, acute dystonia, akathisia, and tardive dyskinesia
Acute dystonia is managed with
anticholingeric drugs and BNZs, exhibits facial grimacing, involuntary upward eye movement, muscle spasms of face, neck, back, laryngeal spasms
Examples of antipsychotics
chlorpromazine (Thorazine), fluphenazine (Prolixin), halperidal (Haldol), risperidone (Risperidal), ziprasidone (Geodon), quetapine (Seroquel), aripiprazole (Abilify)
Akathisia
restless, trouble standing still, paces the floor, feet in constant motion
Tardive Dyskinesia
protrusion and rolling of the tongue, sucking and smacking of the lips, chewing motions, involuntary movements
increase risk in patients with bipolar disorder
These drugs affect the body’s ability to regulate core body temperature
can cause hypothermia in rare cases
increases risk of hypothyroidism, brain injury, or cold environmental temperature
Neuroleptic malignant syndrome (NMS)
hyperpyrexia, confusion changes in BP, and ESPs
can lead to coma and death
more often in men
Drug Interactions
acetaminophen, diuretics such as furosemide or hydrochlorothiazide, certain calcium channel blockers, and several antidiabetic agents
Assessment of antipsychotics
determine baseline level of consciousness
components of the mental status exam
include factors as patient’s appearance, behavior, mood, affect, and thought processes
Monitor vital signs carefully
for significant changes: increase in temperature or severe changes in blood pressure can indicate the severe adverse effects of NMS
Changes in motor function such as
muscle tone, gait, or fine motor movement (ESPs)
contact healthcare provider right away
Most antipsychotics can be taken with food to avoid
GI upset
Antipsychotics can interact with
prescription drugs and herbal supplements
Atypical Antipsychotics (2nd generation)
many block dopamine type 2 receptors in the brain or other subtypes (serotonin)
Atypical Antipsychotics have a lower risk for
ESPs
Atypical Antipsychotics treats
negative and positive symptoms of psychosis
Dopamine System Stabilizers (DSS)
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
Side Effects/Adverse Reactions to DSS
Insomnia and drowsiness, dizziness, orthostatic hypotension, constipation and dry mouth
decreased rates of ESPs
Risks with DSS
weight gain, hypertriglyceridemia, risk for insulin resistance, type 2 diabetes
increased risk of cardiovascular disease and death
Dopamine System Stabilizers affects the heart by
prolonging the QT interval, can cause severe dysrhythmias
Clozapine can cause
agranulocytosis, decrease in WBCs
Drug Interactions of Dopamine System Stabilizers
Drugs that decrease dopamine, or typical antipsychotics, use with SSRIs or SNRIs, alcohol/other CNS depressants
With DSS drugs detemine
baseline level of consciousness, assess for history of hypertension, diabetes, cardiovascular disease, or dysrhytmias
Suddenly stopping antipsychotics can result in
nausea, dizziness, tremors
Antidepressants are used with
dysthymic disorder, major depressive disorder, bipolar disorder
MAOIs
tricyclic antidepressants are 1st generation, became available in the 60s
Atypical antidepressants
work slightly different but affect same neurotransmitters
screen for thoughts of self-harm or suicide
should not be stopped suddenly
SSRIs
inhibiting the reuptake of serotonin, increase concentration of serotonin
safer than TCAs and better tolerated
Side Effects/Adverse Reactions of atypical antidepressants
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
Risks of atypical antidepressants
bleeding, hyponatremia, and bone fracture
skin reactions
cause changes in the electrical conduction of the heart
Antidepressants should be avoided in
pregnancy, due to neonatal abstinence syndrome (withdrawal)
Knowledge of patient’s drug use can prevent
serotonin syndrome
SNRIs
inhibit the reuptake of both serotonin and norepinephrine, increase concentration
SNRIs are also used in
depression, hot flushes, premenstrual dysphoric disorder, fibro, and chronic pain, diabetic neuropathy
Side effects and adverse reactions of SNRIs
nausea, dry mouth, loss of appetite, fatigue and drowsiness
Hyperhidrosis
increased sweating
SNRIs are avoided
during late pregnancy
Drug Interactions of tricyclic antidepressants
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
Side Effects/Adverse Reactions of Tricyclic Antidepressants
dry mouth, drowsiness, constipation, nausea, and orthostatic hypotension
weight gain/weight loss
mild to severe vision problems
Cardiac dysrhythmias are a contraindication for
antidepressants
Tricyclic antidepressants can trigger a
manic episode, cause delirium in older patients with cognitive impairment, and should not be used in patients with glaucoma
Drug interactions with Tricyclic Antidepressants
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
MAOIs
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
Serious interactions with MAOIs can occur
with certain foods and drink (high tyramine)
MAOIs can also be used for
certain anxiety disorders and treating Parkinson’s
Drug Interactions of MAOIs
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
Tyramine
amino acid involved in the release of norepinephrine, broken down by monoamine oxidase
Function of MAOIs
increase norepinephrine, thus significantly increases BP
-avoid caffeine products
Mood Stabilizers
Drugs used mainly to treat patients with bipolar illness. Extreme changes in mood
Bipolar characteristics
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
Actions and uses of Lithium
inhibits the synthesis, storage, release, and reuptake of monoamine neurotransmitters
Lithium does not cause
sedation, depression, or euphoria
Onset of action for mania
1 week, but may take 2 to 3 weeks for the patient to experience the full benefit
Lithium has a very narrow
therapeutic range, monitor blood levels regularly( 4 days after 1st day of drug therapy)
adjust the pts dose accordingly
Side Effects/Adverse Reactions of Lithium
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
While taking Lithium, maintain
fluid balance to prevent drop in sodium levels
decrease caused by reduced salt intake, intensive exercise, very hot enviroments
Drug Interactions of Lithium
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
Contraindications of Lithium
pregnant women
Desired level for acute mania
0.8 to 1.2
Maintenance level
0.8 to 1.0
More than 1.5 of Lithium
toxicity
More than 3
organ failure or death
Blood levels of Lithium are measured every
6 to 12 weeks
