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NRSG 331 > Chapter 4: Pharm: Anti-Anxiety & Antidepressants > Flashcards

Chapter 4: Pharm: Anti-Anxiety & Antidepressants Flashcards

1
Q

Historical perspectives

A

Psychotropic drugs are meant to be an adjunct to individual or group psychotherapy

Meds aren’t everything, they’re a useful tool

As a nurse, don’t always jump to meds first

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2
Q

Extra notes from class relating to mental health treatments

A

Electrical therapy is a thing. It works well. Safe.

Ice baths : Helpful for manic states

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3
Q

Role of the nurse

A

Must understand legal ethical implications

Right to refuse (EXCEPT IN EMERGENCY SITUATIONS)

Emergency: danger to self or others.

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4
Q

Assessment + pharm

A

H&P, EKG, waist circumference

Cultural considerations (Table 4-1, pg 63) like many Asians are more sensitive to certain meds

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5
Q

Med admin + evaluation

A

Continuous monitoring. Assess, we ask the patient how the med is working for them. Whether its helping at all.

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6
Q

Patient education considerations

A

Use everyday language

Remember it is imperative to assess education level, 1st language, dev. Stage, literacy

Always give reading info on meds

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7
Q

How do psychotropics work?

A

Affects neurotransmission

Antipsychotics may block receptors/ leave chem out there to do its job

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8
Q

How is dopamine different in Parkinson’s & schizophrenia?

A

Increased: Schizophrenia
Decreased: Parkinson’s

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9
Q

Anti-Anxiety agents: Indications

A

Anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epileptics, and pre operative sedation.

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10
Q

Anti-Anxiety agents: Action

A

Depression of the CNS (CNS exception: Buspirone)

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11
Q

Anti-Anxiety agents: contra & caution

A

Contraindicated: In known hypersensitivity, in combination with other CNS depressants, in pregnancy and lactation, narrow angle glaucoma, shock, and coma

Caution: with elderly & debilitated clients, clients with renal or addiction, and those who are depressed or suicidal

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12
Q

Anti-Anxiety agents: Lecture notes

A

Benzodiazepines used a lot. Can sometimes be in higher doses. We want a chill sedation not a coma (which it can cause)

Deadly combos possible

Don’t give to pt with history of addiction. Bentos are VERY ADDICTIVE.

INTERACTS > with Alcohol & Niquil

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13
Q

Anti-Anxiety agents: Interactions (Increased vs Decreased)

A

Increased effects when taken with alcohol, barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, neuromuscular blocking agents, cimetidien, disufiram, kava kava, or valerian root (& other herbal depressants)

Decreased effects with cigarette smoking & caffeine consumption

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14
Q

Anti-Anxiety agents common meds: Clorazepate (Transxene)

A

Long acting. Effective for anxiety disorders. Short term use only

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15
Q

Anti-Anxiety agents common meds: Chlorodiazepoxide (Tranxene)

A

Used for alcohol withdrawal

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16
Q

Anti-Anxiety agents list of common ones

A

Diazepam (Valium)

Clonezepam (Klonopin)

Lorazepam (Ativan)

Alprazolam (Xanax)

17
Q

The other Anti-anxiety agents slide: one you need to know

A

Buspirone (BuSpar)

Doesn’t addict or depress CNS

Takes weeks to starts working

18
Q

Anti-Anxiety agents: Monitor for

A

Safety!

Think about tolerance. Think about risk for falls related to lethargy & CNS depression

Sometimes paradoxical reactions occur. Where we get the opposite effect of what the med should do.

19
Q

Antidepressants: Indications

A

Dysthymia, major depressive disorder, depression associated with organic disease, alcoholism, Schiziophrenia, intellectual disability, depressive phase of bipolar disorder, and depression paired with anxiety

20
Q

Antidepressants: Action

A

Increase concentration do norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, heterocyclic, SSRIs, SNRIs) or by inhibiting the release of Monoamines oxidase (MAOIs)

21
Q

Antidepressants: Contraindications & Caution

A

Caution in elderly. Very sensitive. Have to monitor

Doesn’t mean don’t give

Contraindicated: In known hypersensitivity, acute recovery from MI & in angle closure glaucoma, and concomitant with MAOIs

Caution: pts with hepatic, cardiac, or hyper trophy.
Hist of seizures.

22
Q

Antidepressants: Classifications (5 of them)

A

MAOI’s (Monoamine oxidase inhibitor). Many S/E and dietary restrictions.

Tricyclics antidepressants (TCAs). Work really well. Can cause heart probs. Could be used for suicide if whole bottle is ingested

Serotonin Reuptake inhibitors (SSRIs)

Serotonin/Norepinephrine reuptake inhibitors (SSRIs). Sometimes called S-SNRIs

Heterocyclics

23
Q

Antidepressants: MAOIs extra precaution

A

Can’t have certain foods because the interaction can kill you if the food has thyramine in it.

If taking standardized test: EX: best thing for MAOI taking pt to eat? FRESH IS BEST. Baked chicken over aged salami meat.

24
Q

Antidepressants: MAOIs & ICAs (names of 4 MAOIs)

A

MAOIs: could be a Kaplan question related to them.

  1. Tranylcyclopromine (Parnate)
  2. Phenelzine (Nardil)
  3. Isocarboxazid (Marplan)

The MAOI Selegline (Emsam) is almost always a path. No dietary restriction cause of it.

TCA’s: Could be used for chronic pain + depression

25
Q

Antidepressants: List of older SSRIs that could be on Kaplan

A

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Vilazodone (Viibryrd)

26
Q

Antidepressants: Heterocyclines (3 names + detail)

A

Bupropion (Wellbutrin)

Mirtazapine (Remeron)

Trazadone

— Bupropion is a great antidepressant. Also used for smoking cessation. S/Es possible.
27
Q

Antidepressants: Common S/E with SSRIs & Tricyclic meds

A

SSRIs: sexual dysfunction can cause many people to stop use.
Tricyclic meds: urinary retention. But can be used for bed-wetting cessation.

28
Q

Antidepressants: Monitor for these S/E

A

With all classes: dry mouth, sedation, nausea

Discontinuation syndrome

Most common with tricyclines + heterocyclic:
Blurred vision, constipation, urinary retention, orthostatic hypotension, reduction of seizure threshold, tachycardia, arrhythmias, photosensitivity, weight gain

29
Q

Antidepressants: Common S/E for SSRIs & SNRIs

A

Insomnia, weight loss, agitation, headache, sexual dysfunction, serotonin syndrome

30
Q

Antidepressants: Common S/E for MAOIs & uncommon misc. S/E

A

Hypertensive crisis (can be fatal)
Site reactions (selegiline transdermal system)
Misc: Priapism, Hepatic failure

31
Q

Antidepressants: Serotonin syndrome. What is it?

A

When there is too much serotonin in the body. Related to antidepressants because they usually increase the freely available serotonin.

St. John’s. Wort + SSRI could cause it because the OTC med and antidepressant both have serotonin or block its reuptake

Immediately take person off serotonin elated meds + get them to clear + usually they recover

32
Q

Antidepressants: S&S of serotonin syndrome

A

Restlessness, agitation

Confusion

Tachycardia

High BP

Dilated pupils

Muscle rigidity

Loss of muscle coordination

Diarrhea

Sweating

NRSG 331 (28 decks)

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