Chapter 18 &22 & 23 : Psychotherapeutic Drugs Flashcards
1
Q
We are going to need to know the chart in this PowerPoint to the tea.
So the following flashcards are regarding that chart
A
2
Q
What are the 5 neurotransmitter we are going to be talking about?
A
Dopamine
Norepinephrine
Serotonin
Aminobutyric acid ( GABA )
Acetylcholine
3
Q
What is the function of dopamine? (4)
A
Muscle movement
Integration of emotion and thoughts
Decision making
Hormone releasing
4
Q
When you have too much dopamine what syndrome do you have ?
A
Schizophrenia mania
5
Q
When you have too little dopamine what syndrome do you have? (2)
A
Parkison disease
Depression
6
Q
What is the function of norepinephrine? (4)
A
Mood
Attention
Arousal
Stimulates fight or flight response
7
Q
When you have too much norepinephrine what 3 syndromes do you have?
A
Mania
Anxiety
Schizophrenia
8
Q
When you have too little norepinephrine what syndrome do you have?
A
Depression
9
Q
What is the function of serotonin? (6)
A
Sleep regulation
Hunger
Mood
Pain perception
Aggression
Sexual behavior
10
Q
What syndrome do you have when you have too much serotonin?
A
Nothing !
11
Q
What syndrome do you have when you have too little serotonin?
A
Depression
12
Q
What is the function of aminobutyric acid? (GABA) (3)
A
Inhibition
Reduces aggression, excitation and anxiety
13
Q
What syndrome do you have when you have too much GABA?
A
Decreased anxiety
14
Q
What syndrome do you have when you have too little GABA? (3)
A
Anxiety
Mania
Schizophrenia
15
Q
What is the function of acetylcholine? (4)
A
Learning
Memory
Mood regulation
Affects sexual & aggressive behavior
16
Q
What do syndrome do you have when you have too much acetylcholine?
A
Depression
17
Q
What do syndrome do you have when you have too little acetylcholine? (3)
A
Alzheimer disease
Huntington disease
Parkinson disease
18
Q
What does schizophrenia mean?
A
Too many thoughts!!!
So when you’re treating schizophrenia, typically we are gonna use medications to lower the dopamine !
19
Q
How would you asssociate GABA neurotransmitter?
A
Like mom
Have a bad day, you go to mom and she calms you down !
When you’re stressed out it’s important to have mom around !
20
Q
Psychotherapeutic drugs
A
21
Q
Psychotherapeutic drugs function?
What are they used for?
A
Used in the treatment of emotional and mental disorders
22
Q
Psychotherapeutic drugs are used in the treatment of emotional and mental disorders
What ability does it give patients?
A
Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress
23
Q
When are psychotherapeutic drugs indicated for patients?
A
When emotions significantly affect an individuals ability to carry out normal daily functions, treatment with a psychotherapeutic drug is a possible option
24
Q
What are the 3 main emotional and mental disorders?
A
Anxiety
Affective disorders
Psychoses
25
What are the 5 psychotherapeutic drugs we are going to talk about?
Anxiolytic drugs
Cns depressants
Mood-stabilizing drugs
Antidepressant drugs
Antipsychotic drugs
26
We are gonna start with anxiety first
Anxiety!
27
What does anxiety mean?
Unpleasant state of mind, characterized by a sense of dread and fear
28
Anxiety may be based on what? (2)
May be Actual anticipated experiences or past experience
Maybe be exaggerated responses to imaginary negative situations
29
It’s important to note that a little bit anxiety is good? Why?
Because it heighten your senses
And focuses you
30
When do you treat anxiety?
When it’s interfered with daily activities or routines
31
Does there have to be a reason for you to be anxious or even depressed?
NO!!
Don’t say that. It’s so insensitive.
32
What is the anxiety drug name?
Anxiolytic drugs
33
What is the anxiolytic drug medication we are gonna talk about? (2)
Benzodiazepines & miscellaneous
34
What is the function of anxiolytic drugs?
Reduce anxiety by reducing over activity in CNS
35
What is the function or action of benzodiazepines?
Promotes GABA release
36
Benzodiazepines depress activity in the brainstem and limbic system
What are the 3 medications under this that does that ^
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
37
Do benzodiazepines have a risk of addiction in patients? And if so, what do we do?
Yes there is dependence
Giving them cautiously & controlled
38
Should you take benzodiazepines everyday?
Not really, if so, you take it in small doses everyday ( usually at night for sleep )
39
Benzodiazepines work best for what type of anxiety?
Intermittent
Like if you’re anxious on getting on a plane, take it
Public speaking? Take it
Just like a in moment thing
40
Benzodiazepines depress what activity?
CNS
41
Benzodiazepines increase what neurotransmitter?
GABA
( relaxes your body )
42
Benzodiazepines does not suppress your what?
REM sleep
( you can still wake up with that hangover feeling but not as much as other medication )
43
Benzodiazepines and drug interactions, what are their relationship?
They don’t really interact with much
Do not increase metabolism of other drugs
44
What are the 4 drug effects of benzodiazepines?
Calming effect on the CNS
Useful in controlling agitation and anxiety
Reduce excessive sensory stimulation, inducing sleep
Induce skeletal muscle relaxations
45
What are the indications of benzodiazepines? (8)
Sedation
Sleep induction
Skeletal muscle relaxations
Anxiety relief- anxiety related depression
Acute seizure disorders
ETOH withdrawal
Agitation
Balanced anesthesia:moderate/conscious sedation
46
What’s the anagram for the indication for benzodiazepines for anxiety medication? (8)
Sedation
Sleeps
Scaley
Anna
And
Alcohol
Agitates
Bri
47
What is the scale we use for alcohol withdrawal symptoms?
What medication usually is given
C1 scale
Ativan
48
What are the side effects of benzodiazepines? (10)
Headache
Drowsiness
Dizziness
Cognitive impairment
Vertigo
Lethargy
Fall hazard for elderly people
( give low dose )
Hangover effect/ daytime sleepy
Monitor for abuse
Alcohol use intensifies side effects
49
Since benzodiazepines usually cause hypotension, we are most worried about falling, mainly old people. What do we tell them??
Walk slowly
Get up slowly
Wear good shoes
Night light in bathroom
Empty bladder before going to bed
Make sure you have clear pathway
Call for help
No driving
Hazardous activity
50
No matter what type of medication
If it causes CNS depressants we don’t want to what?
Mix CNS depressants
Like alcohol is cns depressants
Don’t mix it
51
Can you overdose of benzodiazepines?
Yes
52
What is the antidoate benzodiazepines?
Flumazenil
53
What is the benzodiazepine overdose effects? (4)
Somnolence - excessive sleep
Confusion
Coma
Diminished reflexes
54
Typically people who overdose on benzodiazepines usually don’t die from the benzodiazepine alone because they go into hypotensive states and respiratory depression
Instead usually they can die from what?
Another CNS depressant or alcohol
55
What are the medication that benzodiazepines interact with? (5)
And what do these do?
Azole antifungals (PO)
Verapamil
Diltizam
Protease inhibitors
Macrolide antibodies
Prolonged the effectiveness of benzo
56
What type of juice do we tell these patients to avoid with benzodiazepines because they increase the effectiveness of it?
Grapefruit juice
57
What are some CNS depressants we want patients to avoid when on benzodiazepines? (3)
And why?
Alcohol
Opioids
Muscle relaxants
Because it causes increase CNS depression
58
What is the medication that decreases benzodiazepines effectiveness?
Rifampin ( TB orange drug )
59
What are the 2 contraindication to not give benzodiazepines to patients?
Glaucoma
Pregnancy
60
If you have a patient who is anxious and also being treated for TB ( rifampin ), would benzodiazepines be the best medication to treat them?
No
Rifampin decrease effectiveness of benzodiazepines
61
Miscellaneous anxiolytic
62
What is the medication we are gonna talk about with miscellaneous anxiolytic?
Buspirone ( BuSpar )
63
What is so great about buspirone (BuSpar)?
Non sedating
Non addicting
64
How long does buspirone (BuSpar) last for?
Take twice a day and long effectivness
Every day!!
65
Buspirone (BuSpar)
What are the drug interactions?
What do you get with this?
SSRI
Serotonin syndrome
66
What medication do we not want to be mixed or administered with Buspirone (BuSpar)
MAOIS
67
What are the 3 adverse effects of Buspirone (BuSpar)?
Paradoxical anxiety
Blurred vision
Headaches
68
Usually Buspirone (BuSpar) are for those we are what type of anxious?
Chronically anxious
69
CNS depressants
70
What is CNS depressants, medication name?
Nonbenzodiazepines hypnotics
71
What do we use CNS depressants : Nonbenzodiazepine hypnotics?
Like treat what?
Insomnia
72
What are the nonbenzodiazepine hypnotics medications? (4)
Zaleplon (Sonata)
Zolpidem (ambien)
Eszoplicone (lunesta)
Ramelteon (Rozerem)
73
Ramelteon (Rozerm) does not cause what? (3)
CNS depression
No potential abuse
No withdrawal symptoms
74
Lunesta and extended release zolpidem (ambien) approved for what?
Long term therapy
75
Should we use nonbenzodiazepine hypnotics everyday?
NO!!
76
What are the important things for nonbenzodiazepine hypnotics ?
1. Crazy things
2. Works on for 6-8 hours
77
When do we tell patients about nonbenzodiazepine hypnotics about their sleep?
Take their medication when they are 100% sure are gonna sleep 8 hours of sleep !!!
78
What if they don’t get enough sleep when taking nonbenzodiazepine hypnotics?
Very very tired
Risk for injury
79
What time do we tell patients to take their nonbenzodiazepine hypnotics?
1 hour before sleep time
80
Affective disorders
Mood disorder
81
What does mood disorders mean?
Changes in mood that range from mania
( abnormally pronounced emotions to depression, abnormally reduced emotions )
82
Some patients are famous for exhibiting both mania and depression, famously known as what disorder?
Bipolar disorder
83
What is the mood disorder medication class called?
Mood-stabilizing drugs
84
What is the two medication we use for mood-stabling drugs?
Lithium carbonate
Lithium citrate
85
Can other drugs like, benzodiazepines, antipsychotic drugs, antieplieptic drugs and dopamine rectors agonist be used with mood stabilizers?
Yes
86
Does lithium have a narrow therapeutic window?
Yes!!
87
What is the range of lithium?
0.6-1.2mEq/L
88
Since lithium has a narrow theruaptic range, what do we usually do before giving this medication to patients?
Baseline of liver & kidney test
89
We also usually have to do a what type of work and how many days at the start of treatment of lithium?
And why?
Blood work
1-3 days
Because we don’t want a toxic level
90
Lithium is a what?
A salt!
Acts the same way as sodium
91
Since lithium is a salt, lithium toxicity can occur with what 2 things?
Dehydration
Hypernatremia
92
So patients should do what to help about dehydration and what activity when taking lithium ?
Stay hydrated
Avoid strenuous activity during high heat
93
What are the 5 common side effects of lithium?
Metallic taste
Tremors
Nausea
Polyuria
Weight gain
94
Antidepressants
95
What are antidepressants used for?
To treat many mental health disorders
Migraines
Chronic pain syndrome
Sleep disorders
96
What are the 4 categories of antidepressants we are going to discuss about?
Tricyclic antidepressants (TCA)
Monoamine oxidase inhibitors ( MAOIS)
seconds generation antidepressants
- Selective serotonin reuptake inhibitors ( SSRIS)
- serotonin norepinephrine reuptake inhibitors (SNRIS)
- miscellaneous
97
Second generation antidepressants have 3 things under them, which are?
- Selective serotonin reuptake inhibitors ( SSRIS)
- serotonin norepinephrine reuptake inhibitors (SNRIS)
- miscellaneous
98
What is tricyclic antidepressants? (TCA)
Have been replaced by what ?
And are known as ?
Have largely been replaced by SSRI as first-line antidepressant drugs
Second line treatment
99
SSRI&SNRIS came out 30 years ago
And have changed the world so much
Why?
Because they don’t have many side effects like TCA and MAOIs
100
Back in the day, many providers never put patients on TCA or MAOI why?
Because the treatment was worsen than having depression
101
What are the 2 considerations to start treatment on TCA?
Patients who fail the usage of SSRI
Adjunct therapy with newer generation
102
TCA should not be given with how many days and with what drug?
14 days
MAOI’s
103
Why do we have to wait 14 days of MAOIS for another anti depressants?
Because toxic effects
104
What is the medication example of TCA?
Amitriptyline (Elavil)
105
What is the mechanism of action of tricyclic antidepressants (TCA)?
Inhibits presynaptic re-uptake of norepinephrine and serotonin
106
It is thought that increasing concentration of ______ will correct the abnormally low levels that lead to depression for TCA
Neurotransmitter
Norepinephrine and serotonin
107
Can you cold turkey TCA?
So how is the process with switching over to MAOIS
No
Taper off slowly with TCA
then wait 14 days (2 weeks)
Then take MAOIS
108
How do we administer TCA?
What is the peak?
What is the half life ?
Orally
1-2 hours
8-16 hours
109
Tricyclic antidepressants are metabolized where?
Excreted where?
Liver
Kidneys
110
Is Tricyclic antidepressants safer than MAOIS ?
Yes
111
What is TCA usually used for, like what type of patients? (4)
Major depression
Enuresis (bed wetting)
OCD
Adjunct medication for chronic pain
112
When we are treating something else other than depression when using TCA, what is usually the dose?
Usually lower
113
Usually a lower dose for TCA when treating other illness other than depression like migraines and such.
We are the positive?
Not that many side effects
114
What are the 2 massive side effects of TCA?
Orthostatic hypotension
Cardiac dysrhythmias
115
So the big two side effects of TCA are the
Orthostatic hypotension &
Cardiac dysthrymjas
What about the other side effects?
Anticholinergic side effects
- sedation
Dry mouth
Constipation
Urinary retention
Excessive perspiration
116
TCA are something that cause orthostatic hypotension, what do we usually tell patients?
Get up slowly
Ask for help
Our biggest worry is them falling, especially elderly patients
117
When you immediate stop taking TCA, what effect can you have?
Cholinergic rebound
118
What is cholinergic rebound ?
Hyper salivation
Diarrhea
Urinary urgency
Sweating
119
Patients, mainly elderly patients who are on tricyclic antidepressants, our biggest worry is them falling because TCA medications will cause them what side effects? (6)
Dizziness
Postural hypotension
Constipation
Delayed micturetion ( urinary retention )
Edema
Muscle tremors
120
What do we educate patients on dry mouth?
Sugar free candy
Ice chips
Water- fluid
121
Can you overdose on tricyclic antidepressants?
Sadly yes
122
When do symptoms of overdose occur ? Like what is the time frame of TCA ?
1-4 hours
123
What are the overdose symptoms of TCA? (5)
Nystagmus - rapid involuntary eye movement
Tremor
Seizures
Hypotension
Dysrhythmias
124
Tricyclic antidepressants overdose
70-80% of people don’t what?
Don’t make it to the hospital,
It’s so lethal
125
Is there an antidoate to reverse the tricyclic antidepressant?
No
126
What is the main death cause from overdosing on tricyclic antidepressants?
Cns and cardiovascular system are mainly effect
Seizure or dysrhythmias
127
Since there isn’t an antidote of tricyclic antidepressants, what are we gonna do?
Decrease drug absorption with ___
Speed elimation by __
Manage ___(2)
Basic ___
Activated charcoal
Alkalinizing urine
Seizures & dysthymias
Basic life support
128
We usually like putting patients on a lot of fluids on overdose because of what for TCA?
Because their hypotensive
129
Making the urine alkalinizing to help with overdose will do what for TCA?
Speed elimination by peeing it out
130
How long are these patients on TCA for?
And what are we doing for these patients?
Usually a month
Keeping them in contact because we don’t want to give them something they can use to harm themselves
Frequent follow ups
How many pills they can get
131
MAOI inhibitors
132
What is the action of MAO inhibitors?
Binds to MAO enzyme system in the CNS, increase epinephrine, norepinephrine, serotionin and dopamine
133
MAO inhibitors are as effective as TCA and SSRI, however they are what?
Not as safe as
134
How long does it take for MAOI to start showing effectiveness?
2-8 weeks
135
What are the indications for MAOI ? (2)
Notes
They also can be used for Parkinson’s disease in a very very low dose!
Depression, especially type characterized by vegetative symptoms such as increased sleep & appetite
( reversed depression )
Depression that does not respond to other drugs such as tricycles
136
Usually MAOI are the last what ?
Last choice medication
137
What are the 2 most serious side effects of MAOIS?
Hypertension
- precipitated by eating foods containing tyramine
138
What other side effects of MAOIS? (5)
Think of the 3Ds and O!!
Dysthrymjas
Dizziness
Drowsiness
Sexual dysfunction
Orthostatic hypotension
139
What medications are we gonna tell patients to avoid when taking MAOIS and why? (3) meds
(2) reason why
OTC cold & allergies
- because it causing vasoconstriction
SSRI
- serotonin syndrome
140
What is a hypertensive crisis with serious side effects of MAOIS?
High blood pressure where it’s like Vasoconstriction and your not getting enough perfusion in your body vital organs
So heart attack, stroke and death easily
141
Can you overdose on an MAOI?
Yes
142
How long does it take for overdose symptoms to start showing for MAOI?
12 hours after ingestion
143
What are the 4 overdose symptoms of MAOIS?
Tachycardia
Circulator collapse
Seizures
Coma
144
The treatment of overdose of an MAOI
Really is to protect the brain & heart and to help eliminate the toxin
So what are the 2 ways we are gonna do this?
Urine acidification
Hemodialysis
145
So MAOI is what urine
TCA is what urine?
Maoi is acidification
TCA is alkaline
146
Ingestion of foods or drink with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma or death
When patients take what medication?
MAOI
147
What are some examples of food that patients should avoid when taking MAOIS that contain tyramine?
Aged, mature cheese
( cheddar, blue, Swiss)
Smoked/pickled or aged meats
Fish poultry
( herring, sausage; corned beef, salami, pepperoni, pâté)
Yeast extracts
Red wine
( chianti, burgundy, sherry, vermouth )
Italian broad beans ( fava beans )
148
Second generation antidepressants
149
What are the 3 second generation antidepressants categories we are gonna talk about?
SSRI
Selective serotonin re uptake inhibitor
SNRI
Selective norepinephrine re uptake inhibitor
Miscellaneous
150
Second generation antidepressants usually are better than TCA and MAOI why?
Fewer adverse effects
151
Second generation antidepressants
Are now considered to be what?
First line drug for depression
152
How long does it take for second generation antidepressants to reach maximum clinical effectiveness?
4-6 weeks
153
Second generation antidepressants have very very few what with food and drugs?
Interactions
154
What are your side effects of your second generation antidepressants? (3)
Sexual dysfunction
Tired vs energy
Weight gain vs weight loss
155
Do we have to taper off second generation antidepressants ?
Yes, slowly taper off
Like if patients have sexual dysfunction, we can change it but typically slowly taper off
156
Notes
Second generation antidepressants indications
Depression
Bi-polar
Obesity ; eating disorders
OCD
panic attack or disorders
Social anxiety disorder
PTSD
Treatment of various substance abuse problems
( bupropion is used for smoking cessation treatment )
157
What is the miscellaneous second generation antidepressant medication? (4)
Trazodone( desyrel, oleptro)
Bupropion (Wellbutrin)
Nefazodone (serzone)
Mirtazapine (remeron)
158
Trazodone (desyrel,oleptro)
- often used for what?
Bupropion (Wellbutrin)
Used for what?
Sleep
Smoking cessation
159
Bupropion (Wellbutrin) puts patient at what risk?
Seizures
160
SSRI mechanism of action?
Selectively inhibit serotonin reuptake
Little or no effect on norepinephrine or dopamine reuptake
Result in increased serotonin concentrations at nerve endings
161
SNRI mechanism of action?
Inhibit reuptake of both serotonin and Norepinephrine
162
SSRI and SNRI have a black box warning
Why and what is this warning?
Increases risk of actual suicide
So when the patient usually starts to get better, their idea of suicide is increased
163
When working with anyone who has any mental illness you always wanna open the conversation with what?
Are they having any thoughts of harming themselves or killing themselves
164
What is serotonin syndrome?
A serious and fatal syndrome
In which occurs when two medications affecting reuptake of serotonin are taken at the same time
165
How long does it take for serotonin syndrome to start?
2 hours of taking first dose
166
To avoid serotonin syndrome
What do we tell patients ?
Do not take SSRI and MAOI within 5 weeks of each other
167
What are the symptoms serotonin syndrome?
Delirium
Tachycardia
Hyperreflexia
Shivering
Agitation
Sweating
Muscle spasms
Coarse tremors
168
What are the severe symptoms of serotonin syndrome? (7)
Hyperthermia
Seizures
Renal failure
Rhabdomyloysis
Dysthrymjas
Disseminated Intravascular coagulation ( DIC)
( complication that occurs where you are bleeding & clotting at the same time ^^
Bleeding everywhere and using micro clots, so your body doesn’t have the ability to stop bleeding, most cause of death is really bleeding of death. Most happens in pregnancy & cancer patients )
169
Neuroleptic syndrome and serotonin syndrome symptoms are like literally the same
What are the difference tho?
Neuroleptic is caused by antipsychotic medications
Serotioin is caused by antidepressant
170
There will be a test question of a serotonin/neurloleptic syndrome
The symptoms are the same
We have to differentiate due to the medication
171
How do we treat the DIC in serotonin syndrome?
Heparin and blood products
172
Psychosis !!!
173
What is psychosis ?
Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living
174
What are 2 examples of psychosis?
Schizophrenia
Depressive and drugs induced psychoses
175
What is the hallmark of psychosis?
Loss of contact with reality
176
What is the drug class we used for psychosis?
Antipsychotics
177
Antipsychotics also have been known as two other names?
Tranquilizers
Neuroleptics
178
Antipsychotics are here to treat what?
Behavior problem
Psychotic disorders
179
What are the two types of antipsychotics?
Typical antipsychotics
Atypical antipsychotics
180
What is the mechanism of action of antipsychotics?
Block dopamine repertoire in the brain ( limbic system, basal ganglia) areas associated with emotion, cognitive function and motor function
181
What is the result of antipsychotics?
Tranquilizing effect in psychotic patiejtsb
182
In antipsychotics, dopamine levels and CNS levels are what?
Decreased
183
What is atypical antipsychotic mechanism of action? (2)
Block specific dopamine receptors
Dopamine 2-rectors
Block specific serotonin receptors
Serotonin 2 (5-HT2h receptors )
( this is responsible for their improved efficacy and safety profiles )
184
What is the adverse effects of antipsychotics? (14)
Photosensitive
Pruritus
Orthostatic hypotension
Sedation
Delirium
Dizziness
ECG changes
Anti-cholinergic effects
Urinary hesistancy or erection
Leukopenia & agranulocytosis
Galactorrhea
( producing milk but not pregnant )
Irregular menses
( mess up menstrual cycle )
Increase appetite
Polydipsia
185
What is An anagram to help remember antipsychotic? (14)
Photoshoot
Praises
Olivia
Sexy
Delirious
Dances
Exactly
As
Uranus
Lover
George
Iggy
Is
Pretty
186
What are the 2 big adverse effects to remember tho for antipsychotics?
EPS/ extrapyramidal symptoms
Pseudoparkinsonism
( tremors, rigidity, stopped posture )
Tardive dyskinesia
187
What is tardive dyskinesia? (3)
Lip smacking
Worm like movements of the tongue
Uncontrolled chewing & grimacing
188
Patients may also experience
Acute dystonias which is?
Akathisia?
Usually is treated with benztropine ( cogenin ) and trihexypgenidyl (artsne)
Symptoms can be reversible if caught early but if not can be permanent
Painful muscle spasms of face, tongue, neck or back
Inability to rest and relax ; pacing
189
What is neuroleptic malignant syndrome?
Client suffers a toxic fatal reaction to therapeutic disease of antipsychotic drug
190
What are the symptoms of neuroleptic malignant syndrome ( NMS)?
Same as serotonin syndrome
Elevated temperature
Unstable blood pressure
Profuse sweating
Dyspnea
Muscle rigidity
Incontinence
191
What is the main difference once again between neuroleptic malignant syndrome and serotonin syndrome?
NMS
- antipsychotic
Serotonin
- antidepressant
192
Herbal products !!
193
What’s the the two herbal products ?
St. John wort
Ginseng
194
St.john wort is used for what?
Depression
Anxiety
Sleep disorders
Nervousness
195
St. John wart may cause what symptoms? (6)
Gi upset
Fatigue
Dizziness
Confusion
Dry mouth
Photosensitive
196
St. John wort has a severe interaction if taken with what two drugs?
MAOIS & SSRI
197
St. John sort also has a food interaction with what?
Tyramine
198
St. John wort also decreases what for females?
Birth control pills
199
What is ginseng used for?
Stress reduction
Improvement of physical endurance and concentration
200
Ginseng may cause what?
Elevated blood pressure
Chest pain
Palpitations
Anxiety
Insomnia
Headache
Gi symptoms
201
Ginseng interactions with what 4 drugs?
Anticoagulants - bleeding
Immunosuppressants
Anticonvulsants
Antidiabetics
202
Psychotherapeutic drugs
Nursing implications
203
Psychotherapeutic drugs
Nursing implications
Before beginning therapy, assess physical and emotional status of patients
Obtain baseline vital signs, including postural BP readings
Obtain liver and renal functions test
Assess for level of consciousness, mental alertness, potential for injury to self and others
Check the patients mouth to make sure oral doses are swallowed
Advise patients to avoid abrupt withdrawal
Advise patients to change position slowly to avoid postural hypotension and possible injury
The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquired more effective coping skills
Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts
Simultaneous use of these drugs with alcohol or other CNS depressants can be fetal
204
Antidepressants nursing implications
Inform patients that it may take several weeks to see therapeutic effects
Monitor patients closely during this times, assess for suicidal tendencies and provide support
Assist elderly or weakened patients with ambulation and other activities because calls may occur because of drowsiness or postural hypotension
Tricycle may need to be weaned and discontinue before undergoing surgery to avoid interactions with anesthetic drugs
Encourage patients to wear medication ID badges naming the drugs being taken
Caffeine and cigarettes smoking may decrease effectiveness of medication therapy
With MAOIS, instruct patients and family regarding tyramine- containing foods and signs and symptoms of hypertensive crisis
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Antipsychotics- phenothizaines
Nursing implications
Instruct patient to wear sunscreen because of photosensitivity
Tell patients to avoid taking antacids or antidiarrheal preparation within 1 hour of a dose
Inform patients to avoid alcohol or other CNS depressants with these medications
Long term haliperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups; report these symptoms to the physician
Oral form may be taken with meals to decrease GI upset
These drug may cause drowsiness, dizziness, or fainting, instruct patients to change position slowly
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Monitor for therapeutic effects
Monitor mental alertness, cognition, affect, mood, ability to carry out activity of daily living, appetite and sleep patterns
Monitor for potential self injury during the delay between the start of therapy and symptomatic improvement
