Chapter 2: Neurobiologic Theories and Psychopharmacology Flashcards
What does the pineal gland influence?
Its an endocrine gland that influences activities of the pituitary gland, islets, parathyroids, adrenals, and gonads
What does the left hemisphere control?
Controls right side of body and is center for logical reasoning and analytic functions like reading, writing, and math
What does the right hemisphere control?
Left side of body. Center for creative thinking, intuition and artistic abilities
Cerebral hemisphere is divided how?
Frontal, parietal, temporal, and occipital
Front lobe conrols what?
Organization of thought, body movement, memories, emotions, and moral behavior
Disorders of the Frontal Lobe is associated with what disease?
Schizophrenia, ADHD, and DEmentia
What does the Parietal Lobe interpret?
Sensations of taste and touch and assist with spacial orientation
What does the Temporal Lobe do?
Centers for senses of smell and hearing and for memory and emotional expression
Occipital Lobes do what?
Assist in coordinating language generation and visual interpretation, such as depth perception
What does the cerebellum do?
Center for coordination of mvoements and postural adjustments . Receives information from all over the body
Lack of Dopamine in Cerebellum associated with what?
Lack of smooth coordinated movemenets in diseases like parkinsons and dementia
Brainstem includes what
midbrain, pons, and medulla oblongata
What does the medulla control?
Contains vital centers for respiration and cardiovascular functions
What does the pons do?
Serves as a primary motor pathway
What does the medulla oblongata do?
Contains retricular activating system (influences motor activity, sleep, consciousness, awareness) and extrapyramidal system (relays information about movement and coordination from brain to spinal nerves)
What does the limbic system include?
Thalamus, Hypothalamus, Hyppocampus, and Amygdala
What does the Thalamus do?
Regulates activity, sensation and emotion
Hypothalamus does what?
Temperature regulation, appetite control, endocrine function, sexual drive, and impulse behavior with anger and rage
What do the Hypocampus and amygdala do?
Involved in emotional arousal and memory
Disturbances in the limbic system are associated with what mental illnesses?
Memory loss with dementia and poorly controlled emotions and impulses seen with psychotic or manic behavior
What is a synapse?
Gap between the cells . Electrochemical messages cross here by way of special chemical messengers
What are neurotransmitters?
Chemical substances manufactured in neuron that aid in transmission of information throughout body
Where do Neurotransmitters fit?
Fit into specific receptor cels embedded in the membrane of the dendrite
Dopamine MOA
Excitatory
Dopamine Physiologic Effects?
Controls complex movements, motivation, cognition: regulates emotional response
Norepinephrine MOA
Excitatory
Norepinephrine Physiologic Effects
Causes change in attention, learning and memory ,sleep and wakefulness, mood
Epinephrine MOA
Excitatory
Epinephrine Physiologic Effects
Controls fight or flight response
Serotonin MOA
Inhibitory
SErotonin Physiologic Effects
Controls food intake, sleep and wakefulness, temp, pain, sexual behaviors, emotions
Histamine MOA
Neuromodulator
Histmaine Physiologic Effects
Controls alertness, gastric secretions, cardiac stimulation, peripheral allergies
Acetylcholine MOA
Excitatory or Inhibitory
Acetylcholine Physiologic Effects
Controls sleep and wakefullness cycle, signals muscles to become alert
Neuropeptides MOA
NEuromodulators
NEuropeptides Physiologic Effects
Enhance, prolong, inhibit, or limit efects of neurotransmitters
GLutamate MOA
Excitatory
Glutamate Physiologic Effects
REsults in neurotoxicity if levels too high
Y-Aminobutyric Acid MOA
Inhibitory
Y-Aminobutyric Acid Physiologic Effects
Modulates other neurotransmitters
What does Dopamine control?
COmplex movements, motivation, cognition, and regulation of emotional responses
Dopamine is implicted in what disorders?
Schizophrennia and movement disorders like Parkinsons
Antipsychotic medications work how?
By blocking dopamine receptors and reducing dopamine activity
What is the mostprevelent neurotransmitter in the nervous sytem?
Norepinephrine
What does Norepinephrine do?
Plays role in attention, leanring and memory, sleep and wakefulness and mood regulation
Excess Norepinephrine associated with
several anxiety disorders
Deficit of Norepinephrine and Epinephrine may contribute to what?
Memory loss, social withdrawal, and depression
How do some antidepressants work with Norepinephrine and Epinephrine?
BLock reuptake of norepinephrine while others inhibit MAO from metabolizing it
What does Epinephrine control?
Fight or lfight response in peripheral nervous sytem
What does Serotonin control?
Control of food intake, sleep and wakefulness temp regulation, pain control, sexual behavior and regulates emotions
SErotonin is associates with what illness?
Anxiety, mood disorders, schizophrenia
SErotonin has been foudnt ocontribute to what seen in schizophrenia?
Delusions, Hallucinations, and Withdrawn behavior
How to Antidepressants affect SErotonin?
Block serotonin reuptake, staying longer in synapse and improving mood
Some psychotropic drugs block histamine, resulting in
weight gain, sedation, and hypotension
Where is Acetylcholine found?
Brain, spinal cord, and peripheral nervous sytem.. Particularly at neuromuscular junction of skeletal muscle
Where can Acetylcholine be synthesized from?
Found in red meat and vegetables and found to affect the sleep-wake cycle and signal muscles to become active
What illness are due to acetylcholine?
Alzhemier and Myasthenia Gravis
When can GLutamate be implicated in the brain?
Stroke, hypoglycemia, sustained hypoxia and Huntington or Alzheimer disease
Drugs that increase GABA are and do what?
Benzodiazepines and treat anxiety and induce sleep
What can a CT diagnose?
Primary tumors, metasteses and effusions and to determine size of ventricles (Thsoe with Schizo have enlarged ones)
What is SORL1?
Its a variation in a gene in those with Alzheimers
What are Twin Studies?
Used to compare rate of certin mental illness or traits in monozygotic (identical) and dizygotic (fraternal) twins
What are adoption studies?
Used to determine a trait among biologic veruss adoptive family members
What are family studies?
Used to ocmpared whether a treat is more common amove first-degree relatives than more distant relatives
What is Psychoimmunology?
Examines effect of psychosocial stressors on the body’s immune system . such as someone with an compromised immune system
What is Efficacy?
Refers to maximal therapeutic effect that a drug can achieve
What is Potency?
Amount of drug needed to achieve maximum effect
What are antipsychotic drugs used to treat?
Symptoms of psychosis, such as delusions and hallucinations seen in schizo, schizoaffective disorders, and manic phaase of bipolar
Antipsychotics: Off lab use includes
treatment of anxiety and insomnia, aggressive behavior, and delusions and hallucinations with alzheimers
Antipsychotics: How do these drugs work?
By blocking receptors of the neurotransmitter dopamine
Antipsychotics: These are the primary medical treamtent for what illness?
Schizophrenia and also used in acute mania, psychotic depression and drug-induced psychosis
Antipsychotics: How does this affect Alzhemiers?
Use a low dose for those with psychotic symptoms
Antipsychotics: Benefit for second-generation?
Can increase mortality rates in elderly clients with dementia-related psychosis
Antipsychotics: Short term therapy may be used for what?
transient psychotic symptoms such as those with borderline personality disorder
Antipsychotics: Major action of this drug?
Block receptors for the neurotransmitter.
Antipsychotics: What are dopamine receptors classified into?
D1, D2, D3, D4, D5
Antipsychotics: Which dopamine receptors are associated with illness?
D2, D3, D4
Antipsychotics: First generation drugs are potent antagonists of what?
D2, D3, and D4 but produce many side effects due to D2
Antipsychotics: Newer, second-generation drugs like Clozapien (Clozaril) are weak blockers of what?
D2, resulting in lower side efects
Antipsychotics: What else do second generation drugs inhibit?
Inhibit the reuptke of serotonin, as do some antidepressants, increasing their effectiveness in treating depressive aspects of schizophrenia
Antipsychotics: What are the newest second gen drugs?
Paliperidone (Invega), Iloperidone (Fanapt), Asenapine (Saphris) and Lurasidone (Latuda)
Antipsychotics: What is the difference between Paliperidone (Invega) and Risperidone (Risperdal)?
Extended relase, meaning you only take one time a day
Antipsychotics: How is Asenapine (Saphris) taken?
Sublingually, avoid food or drink 10-15 minutes after med dissolves
Antipsychotics: What do third generation drugs do?
Dopamine system stabilizers. Thought ot stabilize dopamine output . Increase when low and decrease when high
Antipsychotics: What are the third generation drugs?
Aripiprazole (Abilify)
Cariprazine (Vraylar)
Brexpiprazle (Rexulti)
Antipsychotics: What are the third generation drugs used for?
Schizo, Manic Episodes, and Adjunct Medication in both bipolar and depression
Antipsychotics: SIde effects of third generation drugs?
Weight gain, akathisia, headache, anxiety, and nausea
Antipsychotics: What is Depot injection?
A time release form of intramuscular medication for maintenance therapy
Antipsychotics: Decanoate Fluphenazine (Prolixin) duration?
7-28 days
Antipsychotics: Decanoate Haloperidol (Haldol) duration?
4 weeks
Antipsychotics: Once patient condition is stablized with oral condiiton , administration by depot injection required how often?
2-4 weeks to maintian therapeutic effect
Antipsychotics: How do Risperidone (Riseperdal Consta), Paliperidone (Invega Sustenna) and Olanzapine Pamoate (Zyprexa RElprevv) second gen drugs work?
Encapsulate active medicationinto polymer based microspheres tht degrade slowly in the body
Antipsychotics: How often is Risperdal Consta given?
25 mgevery 2 weeks
Antipsychotics: How often is Invega Sustenna given?
117 mg every 4 weeks
Antipsychotics: How often is Zyprexa Relprevv given?
210 mg every 2 weeks or 405 mg every 4 weeks. May cause postinjection delirium/sedation syndrome
Antipsychotics: Signs of postinjection dlirium/sedation syndrome?
Sedation, confusion, disorientation, agitation and cogntiive impairment that leads to ataxia, convulsions, weakness, and hypertension. Must be observed for 3 hours after injection
Antipsychotics: What are Extrapyramidal symptoms (EPS)?
Serious neurologic symptoms and side effects of antipsychotic drugs
Antipsychotics: EPS of this drug?
Acute Dystonia, Pseudoparkinsonism and Akathisia
Antipsychotics: What is responsible for the development of EPS?
Blockade of D2 reeptors
Antipsychotics: Which drug rarely causes EPS?
Ziprasidone (GEodon)
Antipsychotics: Geodon is contraindicated in those with?
History of QT prolongation
Antipsychotics: How to treat EPS?
lowering the dose, change to a different drug, or administer anticholinergic meds
Antipsychotics: What is Acute Dystonia?
Acute muscular rigidity and cramping, a stiff or thick tongue, and laryngospasm and respiratory difficulties
Antipsychotics: When is Dystonia most likely to occur?
In the first week of treatment, those <40 and in males and those receiving haloperidol and thiothixene
Antipsychotics: Spasms or stiffness is muscle groups can produce what?
Torticollis (twisted head and neck), Opisthotonus (tightness in entire body with the head back and an arched neck) or oculogyric crisis (eyes rolled back in locked position)
Antipsychotics: Treatment for Actue Dystonia includes what?
Anticholinergic drugs like intramuscular benztropine mestylate (Cogentin) or IM/IV Benadryl
Antipsychotics: What is Pseudoparkinsonism?
Drug induced parkinsonism
Antipsychotics: Symptoms of one with Psuedoparkinsonism?
Stiff, stooped posture
Masklike Facies
Decreased Arm Swing
Shuffling, Festinating Gait
Cogwhell Rigidity
Drooling, Tremor, Bradycardia, Pill-Rolling movemenets of thumb
Antipsychotics: How is Pseudoparkinsonism treated?
Changing to an antipsychotic medication that has lower EPS or adding oral anticholinergic agent or amatadine )dopamine agonist)
Antipsychotics: How does a client report Akathisia?
An intense need to move about. Restless or anxious and agitated.
Antipsychotics: How ccan Akathisia be treated?
By a change in antipsychotic meds or by addition of an oral agent such as beta blocker, anticholinergic, or benzodiazepine
Antipsychotics and NMS: What is Neuroleptic Maligant Syndrome (NMS)?
Potentially fatal idiosyncratic reaction to antipsychotic drug.
Antipsychotics and NMS: Symptoms of this?
Rigidity, high fever, autonomic instability such as unstable BP diaphoresis and pallar, delirium, and elevated levels of enzymes
Antipsychotics and NMS: When does this most often occur?
During the first 2 weeks of therapy or after an increase in dosage
Antipsychotics and NMS: What else can increase the risk for this?
Dehydration, poor nutrition and concurrent medical illness
Antipsychotics and NMS: Treatment for this?
Discontinuance of all antipsychotic medsd and institution of supporitive medical care to treat dehydration and hyperthermia
Antipsychotics and TD: What is this?
Tardive Dyskinesia. A syndrome of permanent involuntary movements due to long-term use
Antipsychotics and TD: Symptms of this?
involuntary movements of the tongue, facial and neck muscles, upper and lower extremities. Tongue thrusting and lip smacking are characteristic of this . It is irreversible
Antipsychotics and TD: First drugs to treat TD?
Valbenazine (Ingrezza) and Deutetrabenazine (Austedo, TEVA)
Antipsychotics and TD: How do Valbenazine and Deutetrabenazine work?
VMAT2 Inhibitors. Decrease activity of monoamines like dopamine, serotonin and norepinephrine therefore decreasing abnromal movements associated with this
Antipsychotics and TD: Valbenazine dosage?
40-80 mg daily
Antipsychotics and TD: Deutetrabenazine dosage?
12-48 mg daily.
Antipsychotics and TD: What side effects do Valbenzine and Deutetrabenazine cause?
Somnolence, QT prolongation, Akathisia, and restlessness
Antipsychotics and TD: When specific side effects can Valbenzine cause?
nausea, vomiting, headache, and balance disturbances
Antipsychotics and TD: What specific side effects can deutetrabenazine cause?
NMS and depression and suicidality in patients with huntington
Antipsychotics and TD: How toprevent TD when administering drugs?
Keep maintenance dosage as low as possible, change meds, and monitor the client periodically for inital signs
Antipsychotics and Anticholinergic SE: When does this occur?
With use of antipsychotics
Antipsychotics and Anticholinergic SE: Side effects of this?
Orthostatic Hypotension Dry mouth Constipation Urinary Hesitance Blurred Near Vision Dry Eyes Photophobia Decrease Memory
Antipsychotics and Anticholinergic SE: When do the side effects decrease?
Within 3-4 weeks
Antipsychotics and Anticholinergic SE: Client taking this to treat EPS may have what side effects?
Increase Anticholinergic SE
Antipsychotics and SE: What does this do to prlactin?
Increase it. Cause breast enlaargement and tenderness in men and women, diminished libido, erictile dysfunction and menstural irregulatories
Antipsychotics and SE: Weight gain significant with what drugs?
Clozapine (Clozaril) and Olanzapine (Zyprexa)
Antipsychotics and SE: What is Metabolic syndrome?
When a patient has three or more of the following:
Obesity (Excess Weight)
Increased BP
High Blood Sugar
High Cholesterol
Antipsychotics and SE: Those with Schizo have an increase RF what?
Obesity. Should be involved in education program to control weight and decrease BMI
Antipsychotics and SE: Thioridazine and Mesoridazine are used to treat…
psychosis
Antipsychotics and SE: Droperidol is most often used as an adjunct with
anesthesia or to produce sedation
Antipsychotics and SE: Clozapine produces fewer traditional side effects than do m ost antipsychotics drugs but has potentially fatal side efect of
agranulocytosis
Antipsychotics and SE: What is Agranulocytosis characterized by?
Fever, Malaise, Ulcerative Sore Throat, and Leukopenia
Antipsychotics and SE: When can Agranulocytosis begin?
24 weeks after initation of therapy . Need weekly WBCs drawn for first 6 months
Antipsychotics and SE: What range do you want your WBCs to be in for someone taking Clozapine?
WBC at 3500 and ANC at 2,000. Monitor every 2 weeks for 6 months and then every 4 weeks
Antipsychotics and SE: What can ease dry mouth?
Drinking sugar free fluids and eating sugar-free hard candy
Antipsychotics and SE: What to do if client misses dose?
Can take missed dose if it is 3-4 hours late. If longer, client can omit the forgotten dose.
Antidepressants: Primarily used to treat
major depressive illness, anxiety disorders, depressed phase of bipolar, and psychotic depresion
Antidepressants: off-label uses inlcude
tx of chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, dermatologic disorders, pain disorder, eating disorder
Antidepressants: They interact with whattwo neurotransmitters?
Serotonin and norepinephrine, that regulate mood, arousal, attention, sensory processiving and appetite
Antidepressants: Four groups of antidepressants?
Selective Serotonin Reuptake Inhibitors (SSRI)
MAO Inhibitors (MAOIs)
Tryclic and related Cyclic Antidepreassants
Other Antidepressants
Antidepressants: Problems with first generation drugs?
Varying degrees of sedation, orthostatic hypotension , and anticholinergic side efects
Antidepressants: Problems with MAOIs?
Life-threatening SE, hypertensive crisis may occur if food with tyramine ingested . Cannot be given with other MAOIs or depressants.
Antidepressants: What is the first choice in treating depression?
Fluxetine (Prozac) in 1987. Its an SSRI
Antidepressants: What is effective in treating OCD?
SSRIs and Clomipramine
Antidepressants: What is the only drug that can be given once a week after client stabilized on Fluoxetine?
Prozac Weekly. Contains 90 mg with an enteric coating
Antidepressants: What are the drugs of choice for someone with suicidial idealiations?
SSRIs, Venlafaxine, Nefazodone, and Bupropion. No risk of overdose when compared to cyclic compounds and MAOIs
Antidepressants: SSRIs only effective for what type of depression
mild to moderate
Antidepressants: Major interaction occurs how?
With the monamine neurotransmitter system in the brain: Norepinephrine and Serotonin . Help regulate arousal, vigilance, attention, mood, sensory processing, and appetite.
Antidepressants: What happens to Norepinephrine, SErotonin and Dopamine in the synapse?
Removed from synapse after release by reuptake. After reuptake, these three neurotransmitter are reloaded for subsequent release or metabolize dby enzyme MAO
Antidepressants: What do SSRIs block?
Reuptake of serotonin
Antidepressants: What do cyclic antidepressants and venlafaxine block?
The reuptake of norepinephrine primarily and block serotonin to some degree.
Antidepressants: Cyclic compounds take how long to become effective?
4-6 weeks
Antidepressants: MAOIs tkke how long to become effective?
2-4 weks
Antidepressants: SSRIS take how long to become effective?
2-3 weeks
Antidepressants and SSRI SE: Side effets may lead to
Anxiety, Agitation, Akathisia (Motor Restlessness), Nausea, Insomnia, and Sexual Dysfunction. weight gain too
Antidepressants and SSRI SE: How is Akathisia treated?
With Beta-blocker, such as propranolol (Ideral) or benzodiazepine)
Antidepressants and SSRI SE: Les common SE of this?
Sedation, Sweating, Diarrhea, Hand Tremor, And Headaches
Antidepressants and Cyclic SE: How do these work?
Block cholinergic receptors, resulting in anticholinergic effecs like dry mouth, constipation, urinary retnetion, dry nasal, blurred near vision
Antidepressants and Cyclic SE: More severe SE include
agitation, delirium, and ileus.
Antidepressants and Cyclic SE: Normal SE?
Orthostatic hypotension, Sedation, Weight Gain, Tachycardia
Antidepressants and MAOIs SE: Most common SE include
Daytime sedation, Insomnoia, Weight Gain, Dry Mouth, Orthostatic Hypotension, Adn Sexual dysfunction
Antidepressants and MAOIs SE: Most important concern to watch for is
potential for hypertensive crisis if client ingests food with tyramine.
Antidepressants and MAOIs SE: Hypertensive Crisis SE?
Hypertension, Hyperpyrexia, Tachycardia, Diaphoresis , Cardiac Dysrhythmias
Antidepressants and MAOIs SE: Drugs that may cause fatal interaction with MAOIs include
SSRIs, certain cyclic compounds, buspirone , dextromethorphan, and opiate derivatives
Antidepressants and Other Antidepressants SE: What drugs are included here?
Nefazodone, Trazodone, and Mirtazapine
Antidepressants and Other Antidepressants SE: What do Nefazodone, Trazodone and Mirtazapien cause?
Sedation
Antidepressants and Other Antidepressants SE: What do Nefazodone and Trazodone cause?
Headache
Antidepressants and Other Antidepressants SE: What can Nefazodone cause?
Dry mouth and nausea
Antidepressants and Other Antidepressants SE: What can Bupropion, Venlafaxine and Desvenlafaxine cause?
loss of appetite, nausea, agitation, and insomnia
Antidepressants and Other Antidepressants SE: What can Venlafaxine cause?
Dizziness, sweating or sedation
Antidepressants and Other Antidepressants SE: Nefazodone can cause what life threatening issue?
Liver damage
Antidepressants and Other Antidepressants SE: Bupropion can cause what major issue?
Seizures at a rate 4x other antidepressants
Antidepressants and Drug Interactions: What is Serotonin Syndrome?
Can result from taking an MAOI and a SSRI at the same time
Antidepressants and Drug Interactions: Symptoms of Serotonin Syndrome?
Agitation, Sweating, Fever, Tachycardia, Hypotension, Rigidity, Hyperreflexia and even coma/death
Antidepressants and Client Teaching: Whens hould clients take SSRI
in the morning
Antidepressants and Client Teaching: which drug causes most sedation?
paroxetine
Antidepressants and Client Teaching: What happens if patient forgets SSRI dose?
can take up to 8 hours after missed dose
Antidepressants and Client Teaching: When should client take cyclic compound?
At night .
Antidepressants and Client Teaching: What happens if client misses cyclic dose?
Take within 3 hours or omit dose for that day
Antidepressants and Client Teaching: Those taking MAOI ned to be aware of what?
Hyperadrenergic crisis can ocur if diet restrictions arent observed
Mood-Stabilizing Drugs: Used to treat what?
Bipolar disorder by stabilzing the clients mood, preventing or minimizing the highs and lows a dn treating acute episodes of mania
Mood-Stabilizing Drugs: What is the most established mood stabilizer?
Lithium
Mood-Stabilizing Drugs: What are some effective modo stabilizers?
Carbamazepine (Tegretol) and Valproic ACid (Depakote, DEpakene)
Mood-Stabilizing Drugs: What is occasionaly used to treat acute mania?
Clonazepam (Klonopin)
Mood-Stabilizing Drugs: What is a warning about Lamotrigine?
Can cause serious rashes requiring hospitalization including Stevens-Johnson Syndrome
Mood-Stabilizing Drugs and MOA: How does Lithium work?
Normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine and acetylcholine and dopamine. Also reduces release of norepinephrine through competition with calcium.
Mood-Stabilizing Drugs and MOA: How do Valproic Acid and Topiramate work?
Increases levels of GABA
Mood-Stabilizing Drugs and MOA: How do Valproic Acid and Carbamazepien work?
Stabilize mood by inhibiting kindling process. Is a snowball effect where minor seizures start to build up.
Mood-Stabilizing Drugs and Dosage: Lithium is available in what form
tablet, capsule, liquid, and sustained-release forms
Mood-Stabilizing Drugs and Dosage: How is Lithium dosage determined?
Monitoring serum lithium levels .
Mood-Stabilizing Drugs and Dosage: Lithium dose ranges form what ot what?
900 - 3600 mg.
Mood-Stabilizing Drugs and Dosage: Serum Litium level should be at what level?
1 mEq/L
Mood-Stabilizing Drugs and Dosage: Serum Lithium levels less than 0.5 are rarely
therapeutic
Mood-Stabilizing Drugs and Dosage: Serum Lithium levels more than 1.5 are
considered toxic
Mood-Stabilizing Drugs and Dosage: How is Carbamazepien available?
In liquid, tablet, and chewable tablet forms
Mood-Stabilizing Drugs and Dosage: Carbamazepien dosage range from
800-1200 / day. Extreme dosage is 200-2,000 mg/day
Mood-Stabilizing Drugs and Dosage: How is Vlproic Acid available?
Liquid, tablet, and capsule forms and as prinkles
Mood-Stabilizing Drugs and Dosage: Valproic Acid range”?
1,000 to 1,500 . Extreme dose is 750-300
Mood-Stabilizing Drugs and Side Effects: Common side effects of Lithium include
mild nausea/diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, metallic tase in mouth, and fatigue. Weight gain and acne occur later
Mood-Stabilizing Drugs and Side Effects: Toxic effects of lithium include
diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination. If untreated, lead to renal failure
Mood-Stabilizing Drugs and Side Effects: What does a Lithium level of 3 indicate?
Dialysis may be needed
Mood-Stabilizing Drugs and Side Effects: SE of Carbamazepien and Valproic Acid include
drowsiness, sedation, dry mouth and blurred vision
Mood-Stabilizing Drugs and Side Effects: What may Carbamazepine specifically cause?
Rashes and orthostatic hypotension
Mood-Stabilizing Drugs and Side Effects: What may Valproic Acid specically cause?
Weight gain, alopecia and hand tremor
Mood-Stabilizing Drugs and Side Effects: What may Topiramate cause?
Dizziness, sedation, weight loss, and increase incidence of renal calculi
Mood-Stabilizing Drugs and Side Effects: What dangerous SE can Valproic Acid cause?
Hepatic Failure. Liver function tests should be performed often
Mood-Stabilizing Drugs and Side Effects: What dangerous SE can occur with Carbamazepine?
Aplastic Anemia and Agranulocytosis at a rate 5-8x higher than normal population
Mood-Stabilizing Drugs and Client Teaching: What is important for someone taking Lithium or Anticonvulsants?
Monitor blood levels periodically. Time of last dose must be accurate so labs can be checked 12 hours after lat dose.
Antianxiety Drugs (Anxiolytics) : USed to treat what?
Anxiety, and anxiety disorders, insomnia, OCD , depression, posttraumatic stress disorder and alcohol withdrawal
Antianxiety Drugs (Anxiolytics) : What has been proven to be most effective in relieving anxiety?
Benzodiazepines
Antianxiety Drugs (Anxiolytics) : Why may Benzodiazepines also be prescribed?
Anticonvulsant and Muscle relaxant effects
Antianxiety Drugs (Anxiolytics) : What is Buspirone?
Nonbenzodiazepien and often used for relief of anxiety
Antianxiety Drugs (Anxiolytics) and MOA: How do Benzodiazepines work?
Medicate actions of GABA. Binds to specific site on Gaba
Antianxiety Drugs (Anxiolytics) and MOA: How does Buspirone work?
Acts as a partial agonist at serotonin receptors which decreases serotonin turnover
Antianxiety Drugs (Anxiolytics) and MOA: What is most often prescribed for sleep rather thn releif of anxiety?
Temazepam (Restoril)
Triazolam (Halcion)
Flurazepam (Dalmane)
Antianxiety Drugs (Anxiolytics) and MOA: What is often prescribed to manage alcohol withdrawal and to relieve anxiety?
Diazepam (Valium)
Chlordiazepoxide (Librium)
Antianxiety Drugs (Anxiolytics) and SE: Main problem with Benzodiazepines?
How it causes physical dependence. Buspirone does not cause thi s
Antianxiety Drugs (Anxiolytics) and SE: SE seen with Benzodiazepines include?
CNS depression such as drowsiness, sedation, poor coordination and impaired memory or clouded sensorium
Antianxiety Drugs (Anxiolytics) and SE: Common SE from Buspirone include
Dizziness, sedation, nausea, and headache
Antianxiety Drugs (Anxiolytics) and client Teaching: Clients need to know what?
Are aimed at relieving symptoms such as anxiety or insomnia but do not treat the underlying problem
Antianxiety Drugs (Anxiolytics) and client Teaching: Benzodiazepines strongly potentiate the efects of
alcohol. One drink feels like three.
Antianxiety Drugs (Anxiolytics) and client Teaching: How should they discontinue this?
Withdrawal can be fatal. Never discontinnue abruptly.
Stimulants: What were they first used for?
Amphetamines and other drugs were used to treat psychiatric disorders in the 1930s.
Stimulants: Dextroamphetamine (Dexedrine) has been abused how?
To produce a high or to remain awake for long periods.
Stimulants: The primary use for stimulants today is
for ADHD, residual attention-deficit disorder in adults, and narcolepsy
Stimulants: Primary drugs to treat ADHD?
Methyphenidate (Ritalin)
Amphetamine (Addrerall)
Dextroamphetamine (Dexedrine)
Stimulants: Wh is Pemoline (Cylert) infrequently used?
Because potential for liver problems
Stimulants: What was the first nonstimulation medication specifally designed to treat ADHD?
Atomoxetine (Strettera) a SSRI
Stimulants: What is a Warning about Methyphenidate?
Use in caution with emotionally unstable clients such as those with drug or alcohol dependnce
Stimulants: Warning about Pemoline?
Can cause life-threatening liver failure
Stimulants and MOA: Amphetamines and Methyphenidate work how?
Act by causing release of enurotransmitters (norepinephrine, dopamine, and serotonin) from presynaptic nerve terminals as opposed to having direct agonist effects of postsynaptic receptors. They also block reuptake of these
Stimulants and MOA: How does Pemoline work?
Affects dopamine and therefore has less effects on the sympathetic nervous sytem
Stimulants and MOA: How does Atomoxetine work?
Blocks the reuptake of norepinephrine into neurons, thereby leaving more of the neurotransmitter int he synapse to help convey electrical impulses
Stimulants and Dosage: Dextroamphetamine and MEthylphenidate can be given in what dose?
Dose up to 20-200 mg/day. Higher doses may be needed if Nacrolepsy develops
Stimulants and SE: Most common side effects re
anorexia, weight loss, nausea, and irritability . Should avoid caffeine, sugar and chocolate
Stimulants and SE: Less common SE include
dizziness, dry mouth, blurred vision, and palpitations
Stimulants and SE: Most common long term problems is
growth and weight suppression occurs in some children
Stimulants and SE: What can Atomoxetine cause?
Decreased appetite, nausea, vomiting, fatigue, or upset stomach
Stimulants and Client Teaching: What should be taught?
Take after meals.
Caffeine-Free Beverage important. Avoid chocolate and excessive sugar
Disulfiram (Antabuse): What is this?
It is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body
Disulfiram (Antabuse): Symptoms after someone ingests alcohol?
10 minutes later.. facial and body flushing, throbbing headache, sweating, dry mouth, n/v, dizziness
Disulfiram (Antabuse): How logn do symptoms last?
30 minutes to 2 hours
Disulfiram (Antabuse): What does Disulfiram inhibit?
The enzyme aldehyde dehydrogenase, which is involved in metabolism of ethanol
Disulfiram (Antabuse): What products may contain alcohol?
Shaving cream, aftershave lotion, cologne, deodorant and OTC meds
Disulfiram (Antabuse): Other side effects from this?
Fatigue, drowsiness, halitosis, tremor, and impotence
Disulfiram (Antabuse): This can interfere with other drugs being taken such as
Phenytoin (Dilantin)
Isoniazid
Warfarin (Coumadin)
Barbiturates
Benzodiazepines such as diazepam and chlordidazepoxide
Disulfiram (Antabuse): What is Acamprosate (Campral)
Prescribed for those recovering from alcohol abuse. Reduces physical and emotional discomfort
Disulfiram (Antabuse): Acamprosate (Campral) dosage?
2 tabs 33 mg each 3x per day
Disulfiram (Antabuse): SE of Acamprosate?
Mild and include diarrhea, nausea, flatulence, and pruritus
Cultural Considerations: African American respond quickly to what drugs?
Antipsychotic and tricyclic antidepressants and have a greater risk for developing side effects
Cultural Considerations: How do Asians handle their drugs?
Metabolized antipsychotics and tricyclic antidepressants more slowly than white people
Cultural Considerations: What is St. Johns wort sued for?
To treat depression
Cultural Considerations: What is Kava used for?
Treat anxiety and can potentiate effects of alcohol, benzodiazepines and other sedative-hypnotic agents
Cultural Considerations: What is Valerian used for?
Helps produce sleep and is sometimes used to relieve stress and anxiety
Cultural Considerations: What is Ginkgo Biloba used for
Primairly used to improve memory but is also taken for fatigue, anxiety, and depression
What factors must be considered in the selection of medications to treat mental disorders?
The Efficacy, potency, half-life of drug. Age and Race of Client. Other Meds client taking and side effects of the drugs